0% found this document useful (0 votes)

20 views83 pages

Emergency Surgery for Fecal Impaction

Uploaded by

Skull crusher

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

0% found this document useful (0 votes)

20 views83 pages

Emergency Surgery for Fecal Impaction

Uploaded by

Skull crusher

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

FSBEI HE «Mari State University» Approve

Medical Institute Director of the Medical Institute

Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 1

The patient, 32 years old, went to the doctor with complaints of "dull" pain in the
epigastric region and behind the sternum, usually occurring after eating, as well as when working
bent over. At the height of the pain attack, sometimes there is vomiting, a feeling of lack of air.
Symptoms of the disease appeared 1/2 year ago, tend to progress.
On examination: The skin is pale pink, with normal moisture. In the lungs, vesicular respiration
is significantly weakened in the lower parts of the left lung. In the same place, intestinal noises
are not clearly heard. Respiratory rate - 18 in 1 minute. Pulse - 76 in 1 minute, rhythmic. BP -
130/80 mm Hg. Heart tones are muted, rhythmic. On the anterior abdominal wall, there is a scar
from a median laparotomy, performed, according to the patient, a year ago for a knife wound
penetrating into the abdominal cavity. The abdomen is not swollen, soft, with palpation painless
in all parts. There are no symptoms of peritoneal irritation. Liver along the edge of the costal
arch. The spleen is not palpable. Bowels been normal and regular, formed. Urination is free,
painless.

1. What disease can you think about?

2. Classification of this disease?
3. Variability of the clinical picture depending on the differences in etiopathogenesis?
4. What research methods will confirm your diagnosis?
5. What complications can develop?
6. Methods of treatment of this disease?

Head of Department _______________________________

FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 2

A 37-year-old man was admitted 16 hours after the onset of the disease with complaints of
sudden severe cramping pains in the upper abdomen, repeated vomiting of food eaten, bloating.
From the anamnesis, it is known that two years ago he was operated on for a penetrating wound
of the abdominal cavity with damage to the liver and transverse colon. During the postoperative
period, similar attacks were observed several times, which were effectively stopped by the use of
antispasmodics. This time the attack is more severe, the usual conservative measures are not
effective.
Objectively: the condition is of moderate severity, the patient is restless, changes position. Pulse
90 per minute, blood pressure 110/70 mm Hg. The tongue is somewhat dry, overlaid. The
abdomen is evenly swollen, soft, painful more in the upper parts, peristalsis is listened to,
peritoneal symptoms are not determined. There is a hypertrophic scar on the anterior abdominal
wall after median laparotomy. A day ago, there was a normal chair. During rectal examination-
traces of feces of the usual color.

1. Your preliminary diagnosis?

2. Plan for additional examination of the patient?
3. The role and scope of X-ray examination, data interpretation.
4. Etiology and pathogenesis of disorders developing in this pathology.
5. What is the amount of conservative medical measures necessary for this patient?
6. Indications for surgery, options for surgical interventions?
7. Measures aimed at preventing the recurrence of the disease.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 3

The patient, 68 years old, was admitted to the surgical department in an emergency 3 days
after the onset of the disease with complaints: constant pain in all parts of the abdomen, repeated
vomiting, delayed stool and non-discharge of gases; the presence of painful, tumor-like
protrusion in the right groin area; the rise of the body temperature to 38° C.
The disease began with the appearance of a tumor-like, painful protrusion in the right groin area.
Subsequently, the described symptomcomplex developed, the clinic of the disease progressed.
Objectively, the patient's condition is severe. The skin is pale pink. In the lungs, vesicular
respiration is weakened in the lower parts. No wheezing. Pulse 100 in 1 minute, rhythmic, weak
filling. Blood pressure - 110/70. The heart tones are muted. The tongue is dry, overlaid at the
root with a brown coating. The abdomen is swollen, painful on palpation in all parts. Symptoms
of peritoneal irritation are slightly positive. Single intestinal noises with a "metallic" tinge are
listened to auscultatively. The "splash noise" is detected. There was no stool for 2 days, the gases
do not go away.
In the right inguinal region, a tumor-like formation up to 5 cm in diameter is determined. The
skin above it is hyperemic, edematous, and the skin temperature is elevated. On palpation, the
formation is sharply painful, of a dense-ellastic consistency, with a softening in the center.

1. What diagnosis should be made in this case?

2. Etiopathogenesis of this pathology?
3. Classification of the disease?
4. Scope of examination of the patient in this case?
5. Tactics of treatment of this disease?
6. Scope of medical care and features of the surgical aid in a particular case?
7. Postoperative management of the patient?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 4

A 60-year-old man was admitted on the 2nd day from the onset of the disease with
complaints of moderate-intensity cramping pains in the lower abdomen, radiating to the sacrum,
bloating, delayed stool and gas. The disease started gradually. The patient suffers from
constipation, notes that such conditions were several times and were resolved at home after a
cleansing enema.
The general condition of the patient is relatively satisfactory, the temperature is normal, the pulse
is 90 per minute, the tongue is covered, moist. The abdomen is "skewed" due to the swelling of
its right half, soft on palpation, moderately painful along the left lateral canal. On the right, a
large formation of dense-elastic consistency is palpated, the peristalsis above it is not heard. The
"splashing noise" is determined, with percussion-high tympanitis.
During rectal examination, the ampoule of the rectum is empty, when trying to make a siphon
enema, it is possible to inject no more than 400 ml of liquid.

1. What is the clinical syndrome of this patient?

2. The probable cause of the development of this syndrome in the patient?

3. Classification of this pathology?

4. What additional methods are justified to confirm and clarify the preliminary diagnosis?

5. The tactics of the surgeon when confirming your preliminary diagnosis?

6. Options for surgical assistance depending on the stage of the disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 5

A 50-year-old patient 6 months ago complained of pain behind the sternum in the
projection of its lower third, occurring during meals and an almost constant burning sensation in
the esophagus. Occasionally, dysphagia was observed.
Objectively: the neck is of the correct shape, painless on palpation. Sternum without
features. The epigastric region is of the usual shape, painless. Esophagoscopy revealed a
protrusion of the left wall of the esophagus at the level of 32 cm from the incisors measuring 3 x
4 cm with unchanged mucosa and an entrance to it up to 2 cm. The patient had not been treated
before, and for the first time she went to the doctor.

1. Classification of this pathology.

2. What mechanisms of occurrence of this pathology do you know?

3. What additional research methods should be performed?

4. What treatment tactics should be chosen?

5. What is the course of conservative measures for this pathology?

6. What are the possible complications of this disease?

7. What is the indication for surgery and what types of surgical treatment are used for this
pathology?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 6

A 25-year-old patient at complete picture of health developed dysphagia, pain behind the
sternum after swallowing food, regurgitation of undigested pieces of food. Food passes better
after drinking warm water, milk or tea. With a sharp tilt of the head and a tilt of the trunk back,
the patient sometimes felt like food "fell" into the stomach. Objectively: oral cavity, neck,
sternum, epigastric region without changes.

1. Your preliminary diagnosis?

2. What additional research methods should be performed?

3. What is the etiology and pathogenesis of this disease?

4. What diseases should be treated with differential diagnosis?

5. Describe the radiological semiotics of the disease.

6. What stages of the disease according to B. V. Petrovsky should be distinguished?

7. What types of treatment are used for this disease?

8. What are the indications for surgical treatment, options for operations?

Head of Department _______________________________

Task #1
A 25-year-old patient, among full health, developed dysphagia, pain behind the sternum after swallowing food, regurgitation of
undigested pieces of food. Nishcha is better after drinking it with warm water, milk or tea. With a sharp tilting of the head and
tilting the body back, the patient sometimes felt how the food “failed” into the stomach. Objectively: the oral cavity, neck,
sternum, epigastric region without features.
1)Whatour preliminary diagnosis?
2)additional research methods need to be performed?
3)What is the etiology and pathogenesis of this disease?
4) what diseases should differential diagnosis be carried out?
5)Describe the X-ray semiotics of the disease.
6)What stages of the disease according to BV Petrovsky should be distinguished?
7)What types of treatment are used for this disease?
8)What are the indications for surgical treatment, options for operations?
ANS1. Preliminary Diagnosis: Achalasia
2. Additional Research Methods: Esophagogastroduodenoscopy (EGD), Barium swallow study, Esophageal
manometry
3. Etiology and Pathogenesis: Achalasia is primarily caused by the degeneration of ganglion cells in the
myenteric plexus of the esophagus, leading to impaired peristalsis and failure of the lower esophageal sphincter
(LES) to relax properly during swallowing.
4. Differential Diagnosis: Gastroesophageal reflux disease (GERD), esophageal spasm, esophageal stricture,
esophageal cancer
5. X-ray Semiotics: X-ray findings typically include a dilated esophagus with a bird’s beak appearance at the
gastroesophageal junction, along with poor emptying of contrast from the esophagus into the stomach.
6. Stages of the disease according to BV Petrovsky: The stages include the initial stage (Stage I) characterized by
dilation of the esophagus, the second stage (Stage II) with retention of food in the esophagus, and the third stage
(Stage III) with massive dilatation of the esophagus.
7. Treatment Options: Treatment may include pharmacological interventions such as calcium channel blockers
or nitrates to relax the LES, botulinum toxin injections to temporarily paralyze the LES, pneumatic dilation to
stretch the LES, or surgical interventions such as laparoscopic Heller myotomy.
8. Indications for Surgical Treatment: Surgical intervention is indicated for patients who do not respond to
conservative management or have complications such as recurrent aspiration pneumonia or severe weight loss.
Options include laparoscopic Heller myotomy with or without fundoplication.

Task 2
Patient P., 58 years old, was operated on an emergency basis 36 hours after the onset of the disease for a
perforated gastric ulcer complicated by diffuse purulent-fibrinous peritonitis. The ulcer was sutured and the
abdominal cavity was drained. The course of the postoperative period is severe. Despite the ongoing intensive
therapy on the fourth day after the operation, the patient still had abdominal pain without a clear localization,
nausea, and a temperature of 37.9 °C.
Objectively: the tongue is dry, the abdomen is swollen, diffuse pain is determined by palpation. Peritoneal
symptoms are weakly positive . Paresis of the gastrointestinal tract persists, 600-1000 ml of stagnant contents are
evacuated from the stomach per day, gases and stools do not go away. Through drainage from the abdominal
cavity, a moderate amount of serous- purulent discharge. Pulse 1 10 per minute, leukocytosis 13.0 thousand,
Leukocyte index of intoxication 6.9.
1. What is your diagnosis?
2. What are the reasons for this condition?
3. What studies need to be performed to decide on further treatment tactics?
4. What should conservative treatment be aimed at?
5. What are the indications for surgery?
6. Volume of surgical care?
7. Principles of management of the postoperative period in this pathology?

ANS 1. Diagnosis: Postoperative complication of gastric ulcer perforation with diffuse purulent-fibrinous
peritonitis and ongoing peritonitis.
2. Reasons for this condition: Delayed presentation to surgery, inadequate drainage of purulent exudate,
persistent peritonitis, ongoing intra-abdominal sepsis
. 3. Studies for further treatment tactics: Abdominal imaging (such as CT scan) to assess the extent of peritonitis,
blood cultures to identify causative pathogens, serial abdominal examinations to monitor for resolution or
progression of peritonitis.
4. Conservative treatment aims to control infection, support organ function, and manage complications. It may
involve broad-spectrum antibiotics, fluid resuscitation, pain management, nutritional support, and close
monitoring of vital signs and laboratory parameters.
5. Indications for Surgery: Persistent or worsening peritonitis, failure of conservative management, evidence of
intra-abdominal abscess formation, or signs of ongoing sepsis despite medical therapy.
6. Volume of Surgical Care: Surgical intervention may include re-exploration of the abdomen for better
drainage, debridement of necrotic tissue, and lavage of the peritoneal cavity. Additional procedures may be
necessary based on intraoperative findings
. 7. Principles of Postoperative Management: Focus on intensive care, including close hemodynamic monitoring,
optimization of fluid and electrolyte balance, early enteral nutrition when feasible, pain control, prevention and
management of complications such as sepsis, organ failure, and deep vein thrombosis, and prompt escalation of
therapy if clinical deterioration occurs. Regular assessment of the abdomen, vital signs, and laboratory
parameters is essential for monitoring the response to treatment.

blob:[Link] 28/05/24, 10:34 PM

Page 1 of 6
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 7

Patient P., 58 years old, was operated on urgently 36 hours after the onset of the disease for
a perforated stomach ulcer, complicated by spilled purulent-fibrinous peritonitis. The ulcer was
sutured and the abdominal cavity was drained. The course of the postoperative period is severe.
Despite the intensive therapy, on the fourth day after the operation, the patient still has
abdominal pain without a clear localization, nausea, and a temperature of 37.9 " C.
Objectively: the tongue is dry, the abdomen is swollen, palpation is determined by spilled
soreness. Peritoneal symptoms are mildly positive. The paresis of the gastrointestinal tract is
preserved, 600-1000 ml of stagnant contents is evacuated from the stomach per day, gases and
stools do not leave. The drains from the abdominal cavity contain a moderate amount of serous-
purulent discharge. Pulse 110 per minute, leukocytosis 13.0 thousand, Leukocyte intoxication
index 6.9.

1. Your diagnosis?
2. The causes of this condition?
3. What research needs to be done to decide on further treatment tactics?
4. What should conservative treatment be aimed at?
5. What are the indications for surgery?
6. The amount of surgical care?
7. Principles of postoperative management in this pathology?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 8

A 41-year-old patient turned to a polyclinic surgeon with complaints of pain in the anus, an
increase in temperature to 38°C. Before that, she was on a sick list issued by a therapist for
several days because of subfebrility, general malaise. From the anamnesis, it turned out that 5
years ago there was a short-term inflammation in the anus with a slight discharge of pus.
Objectively: In the area of the anus at 5 - 8 hours there is a painful inflammatory infiltrate of 2x3
cm with deformation of the external anal opening and its gaping. It hardly retains gases, mucus is
released from the rectum.

1. What disease are we talking about?

2. Clinical classification of this disease?
3. Is this pathology characterized by a pro- prodormal period?
4. What methods of additional examination should be performed, what is the preparation for
them and why should this be performed during the day?
5. Prescribe treatment for this disease?
6. List the clinical and pathogenetic forms of chronic and acute variants of the course of this
pathology?
7. What is the prevention of this disease?

Head of Department _______________________________

Task #3

A 41-year-old patient applied to a polyclinic surgeon complaining of pain in the anus, fever up to 38°C. Prior to
that, she had been on a sick leave for several days, issued by a general practitioner due to subfebrile condition,
general malaise. From the anamnesis it turned out that 5 years ago there was a short-term inflammation in the
anus with a slight discharge of pus.

Objectively: at 5-8 o’clock there is a painful inflammatory infiltrate 2x3 cm in the anus area with deformation of
the external anus and its gaping. With difficulty retains gases, mucus is excreted from the rectum.

1. What disease are we talking about?

2. Clinical classification of this disease?
3. Is the prodormal period typical for this pathology?
4. What methods of additional examination should be performed, what is the preparation for them and why
should it be done in the daytime?

5. Prescribe treatment for this disease?

6. List the clinical and pathogenetic forms of chronic and acute variants of the course of this pathology?
7. What is the prevention of this disease?
ANS
1. Disease: Anal abscess.
2. Clinical Classification: Anal abscesses can be classified based on their location (perianal, ischiorectal,
intersphincteric, or supralevator) and whether they are acute or chronic.
3. Prodromal Period: Yes, prodromal symptoms such as fever, malaise, and subfebrile condition can be typical
for anal abscesses, indicating an underlying infection before the development of the abscess.
4. Additional Examination Methods: Anoscopy or proctoscopy to assess the extent of the abscess, rule out other
pathologies, and guide treatment. These examinations should be done in the daytime for optimal visualization of
the anal canal and surrounding tissues.
5. Treatment: Treatment typically involves surgical drainage of the abscess, either by incision and drainage or by
needle aspiration, under local or general anesthesia. Broad-spectrum antibiotics may be prescribed to control
infection and prevent systemic spread.
6. Clinical and Pathogenetic Forms: Acute variants include perianal, ischiorectal, intersphincteric, and
supralevator abscesses, while chronic variants may manifest as recurrent or fistulizing disease.
7. Prevention: Prevention measures include good anal hygiene, avoiding constipation, prompt treatment of anal
fissures or other anal conditions, and early recognition and management of anal abscesses to prevent
complications and recurrence.

Task #4

A 42-year-old patient, a loader, complained of pain in the anus, bleeding after defecation. Similar symptoms
began to disturb about a year ago, but in the last 3 days the bleeding has intensified, there was a noise in the
head, dizziness, which makes it difficult to perform hard physical work.

Objectively: The patient is pale. Pulse 96 per minute of satisfactory filling, BP 110/60 mm .r [Link]. In the area of
the anal sphincter at 3, 7, 11 hours there are hemorrhoids up to 1.5 cm in diameter with a lilac tint, one of them
shows a bloody crust that bleeds on contact.

1. What is your diagnosis?

2. Clinical classification of this disease?
3. Are these about the pathogenesis of this disease?
4. What methods of examination should be carried out in this disease?
5. Tactics of an outpatient surgeon in this situation?
6. Methods and scope of emergency care for this pathology?
7. Methods of treatment of this disease?
ANS

blob:[Link] 28/05/24, 10:34 PM

Page 2 of 6
1. Diagnosis: Hemorrhoids.
2. Clinical Classification: Hemorrhoids can be classified based on their location (internal or external) and severity (grades
I to IV).
3. Pathogenesis: Hemorrhoids result from the swelling and enlargement of the vascular cushions in the anal canal, which
can be caused by increased intra-abdominal pressure, chronic constipation, or prolonged sitting or standing.
4. Examination Methods: Anoscopy or proctoscopy to assess the extent and severity of hemorrhoids, ruling out other
causes of rectal bleeding such as anal fissures or colorectal cancer.
5. Outpatient Surgeon Tactics: Conservative management initially, including dietary and lifestyle modifications (increased
fiber intake, adequate hydration, avoidance of straining during defecation), topical treatments (such as over-the-counter
creams or suppositories), and sitz baths. If symptoms persist or worsen, referral to a specialist for further evaluation and
consideration of procedures such as rubber band ligation or infrared coagulation may be necessary.
6. Emergency Care: In cases of severe bleeding or thrombosis of external hemorrhoids causing significant pain,
emergency care may involve direct pressure to control bleeding, pain management, and referral to a hospital for further
evaluation and possible surgical intervention.
7. Treatment: Treatment options include conservative measures as mentioned above, minimally invasive procedures such
as rubber band ligation, sclerotherapy, or infrared coagulation for internal hemorrhoids, and surgical excision for
thrombosed external hemorrhoids or severe cases not responsive to conservative management.

Task number 5

A 15-year-old patient complains of non-excretion of stools and gases, pain in the abdomen of a constant nature. From the
anamnesis it was established that from early childhood the patient had to resort to daily cleansing enemas in order to
achieve stool. Due to the circumstances (he was on the train), it was not possible to achieve a chair within 3 days.

Objectively: The tongue is wet. The abdomen is somewhat swollen, soft, painful along the colon. There are no peritoneal
symptoms. The splash noise is not audible. On rectal examination: The tone of the sphincter is increased, the ampoule is
empty.

1. What is your diagnosis?

2. Etiology and pathogenesis of the disease?
3. With what pathology should differential diagnosis be carried out?
4. Additional research methods?
5. First aid, conservative treatment?
6. Indications for surgical treatment?
7. The nature and extent of the operational allowance?
8. Possible postoperative complications?
ANS
1. Diagnosis: Chronic constipation with fecal impaction.
2. Etiology and Pathogenesis: Chronic constipation can result from various factors including dietary habits, lack
of physical activity, dehydration, medications, and underlying medical conditions. In this case, chronic use of
daily cleansing enemas likely led to dependence on them for bowel movements, contributing to loss of normal
bowel function and fecal impaction.
3. Differential Diagnosis: Other causes of chronic constipation such as irritable bowel syndrome (IBS), intestinal
obstruction, Hirschsprung’s disease, or anorectal malformations should be considered.
4. Additional Research Methods: Abdominal imaging such as abdominal X-ray or abdominal ultrasound to
assess for fecal impaction, stool studies to rule out infectious causes, and possibly anorectal manometry or
defecography to evaluate anorectal function.
5. First Aid and Conservative Treatment: Initial management may include rectal disimpaction under sedation or
anesthesia, followed by bowel cleansing with oral laxatives or enemas. Subsequent treatment focuses on dietary
modifications (increased fiber intake, adequate hydration), lifestyle changes (regular physical activity), and stool
softeners or laxatives to maintain regular bowel movements.
6. Indications for Surgical Treatment: Surgical intervention may be indicated in cases of refractory constipation
not responsive to conservative measures, presence of complications such as bowel obstruction or perforation, or
in cases of anatomic abnormalities requiring correction (e.g., Hirschsprung’s disease).
7. Nature and Extent of Surgical Intervention: Surgical options may include colonic resection or bypass
procedures, ileostomy or colostomy formation, or anorectal surgery such as sphincterotomy or rectal prolapse
repair depending on the underlying pathology.
8. Possible Postoperative Complications: Postoperative complications may include infection, bleeding,
anastomotic leaks, recurrence of constipation, or complications related to stomas if created. Close monitoring
and appropriate postoperative care are essential to minimize these risks.

Task number 6

A 40-year-old patient was delivered by ambulance; he has been suffering from gastric ulcer for a long time.
Currently, against the background of an exacerbation that began about two weeks ago, he noted a decrease in
pain in the emigastric region over the past two days. At the same time, there was a growing weakness, dizziness,
thirst. This morning, when I got out of bed, I lost consciousness for a few seconds. Objectively: the skin is pale,
moist to the touch. The tongue is moist, the abdomen is not swollen, soft, participates in the act of breathing,
there is slight pain in the epigastrium on palpation, there are no symptoms of peritoneal irritation, the pulse is
110 per minute, rhythmic, blood pressure is 100/70 mm Hg.

blob:[Link] 28/05/24, 10:34 PM

Page 3 of 6
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 9

A 42-year-old patient, a porter, complained of pain in the anus, the release of blood after
the act of defecation. Similar symptoms began to bother about a year ago, but in the last 3 days,
the bleeding has increased, there is a noise in the head, dizziness, which makes it difficult to
perform heavy physical work.
Objectively: The patient is pale. Pulse 96 per minute of satisfactory filling, blood pressure
110/60 mmHg. In the area of the anal pulp at 3, 7, 11 o'clock there are hemorrhoids with a
diameter of up to 1.5 cm with a lilac hue, one of them shows a bloody crust that bleeds on
contact.

1. What is your diagnosis?

2. Clinical classification of this disease?
3. What is the pathogenesis of this disease?
4. What methods of examination should be carried out for this disease?
5. Tactics of an outpatient surgeon in this situation?
6. Methods and scope of emergency care for this pathology?
7. Methods of treatment of this disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 10

A 15-year-old patient complains of non-withdrawal of stool and gases, abdominal pain of a

constant character. From the anamnesis, it is established that from early childhood the patient is
forced to resort to daily cleansing enemas to achieve a stool. Due to the circumstances (he was
on the train), could not get a stool for 3 days.
Objectively: The tongue is wet. The abdomen is somewhat swollen, soft, painful along the
course of the colon. There are no peritoneal symptoms. The sound of splashing is not heard.
Rectal examination: The sphincter tone is elevated, the ampoule is empty.

1. Your diagnosis?
2. Etiology and pathogenesis of the disease?
3. With what pathology should differential diagnosis be performed?
4. Additional research methods?
5. First aid, conservative treatment?
6. Indications for surgical treatment?
7. The nature and scope of the operational benefit?
8. Possible postoperative complications?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 11

A 57-year-old man is concerned about pain in the left calf muscle, cold feet, rapid fatigue.
The pain appears after passing 60-70 meters. The duration of the disease is about 6 months. On
examination, the distal parts of the left leg are paler than on the right, cold to the touch, and the
muscles are painful on palpation. The pulse can only be detected on the femoral artery in the
groin area, it is weakened. A systolic murmur is heard above it. The pulsation of the main
arteries of the right leg is preserved at all levels, but somewhat weakened.

1. Your diagnosis?
2. The clinical classification of this disease?
3. The pathogenesis of the development of this disease?
4. The patient's examination plan?
5. With which diseases should this pathology be differentiated?
6. The principles of treatment of the disease depending on the stage of the process?
7. Possible complications in the treatment of this disease and their prevention measures?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 12

A 27-year-old woman suffering from mitral heart disease with atrial fibrillation suddenly
experienced severe pain in her right foot and lower leg an hour ago. By the time of the
examination, the intensity of the pain increased. The skin of the distal parts of the right leg is
pale, cold to the touch. Palpation of the foot and lower leg is painful. Active foot movements are
limited, passive-in full volume. Tactile and iroprioceptive sensitivity are reduced. Pulsation of
the right femoral artery under the Pupart ligament is increased, at other levels - absent.

1. What is your diagnosis?

2. The etiology and pathogenesis of this pathology?
3. What classification should be used to formulate a diagnosis in this case?
4. What diseases should this pathology be differentiated from?
5. What should be the treatment tactics for acute ischemia?
6. The amount of medical care?
7. Measures to prevent the recurrence of this pathology?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 13

A 34-year-old woman came to an outpatient appointment with a surgeon. Complains of

pain on the medial surface of the left shin in the lower and middle thirds of the thigh. The pain
appeared 3 days ago in the lower leg area and subsequently spread to the hip. The temperature
rose to 37.5 °C, and walking became difficult. When examined along the course of the varicose
left large saphenous vein on the lower leg and thigh, there is a hyperemia of the skin, with
palpation in this area, a painful weight is determined. Palpation in the groin area is painless.
There is no swelling of the foot and lower leg.

1. Your diagnosis?
2. Etiology and pathogenesis of the disease?
3. Classification of the disease?
4. With what disease should this pathology be differentiated?
5. What complications in this disease can be?
6. Treatment tactics depending on the variants of the course of the disease and the amount of the
benefit?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 14

A 43-year-old man soon after hypothermia, his temperature rose to 38.7 °C, there were
pains in the left half of the chest, increasing when breathing, and he began to worry about
coughing without sputum. The local therapist called to the house prescribed anti-inflammatory
treatment, but there was no improvement in the man's condition. On the 8th day of the disease,
purulent, fetid sputum began to separate in large quantities. After that, the temperature returned
to normal, and my health improved. The general condition is satisfactory. Under the left scapula
on the back, a shortening of the percussion tone, weakened breathing is determined. No other
pathology was detected.
1. Your diagnosis?
2. Classification of the disease?
3. Etiology and stages of development of the disease?

4. Additional research methods to clarify the diagnosis and treatment tactics?

5. Treatment of the disease?
6. Possible complications of the disease?
7. Rehabilitation measures of the outpatient period. Spa treatment?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 15

A 49-year-old patient was admitted with complaints of weakness, weight loss, and
sometimes blood during the act of defecation. Single, addicted to alcohol.
Objectively: Low nutrition, stellate pigmentation on the skin, erythema on the palms and
soles, lack of hair on the chest and in the armpits. The abdomen is of the usual shape, not
enlarged, with palpation, the liver protrudes 5 cm from under the right costal arch. In the left
hypochondrium, a moderately enlarged spleen protruding from under the edge of the costal arch.
Percussion: there is no blunting in the sloping areas. There are no dysuretic disorders. When
examining the distal rectum, there are hemorrhoids.

1. Your diagnosis?
2. What classification should be used to formulate a diagnosis?
3. Etiology and pathogenesis of this disease?
4. With what diseases should a differential diagnosis be made and for what syndrome?
5. What additional research methods should be used to confirm the diagnosis and choose
treatment tactics?
6. The main directions of conservative therapy, indications and types of surgical treatment?
7. Complications of the disease and their prevention?
8. Examination of working capacity in this pathology?
9. Prognosis?

Head of Department _______________________________

FSBEI HE «Mari State University» Approve
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 16

A 50-year-old patient was admitted with complaints of dull, almost constant pain in the
epigastrium, which takes on a shingling character. The pain increases after eating, especially
fatty foods. Notes weakness, in the last 2 months lost 4 kg. The stool is unstable: often diarrhea,
plentiful, fetid, greasy. The disease is associated with an attack of acute pancreatitis suffered 5
years ago. Abusing alcohol. The last 2 months, jaundice has appeared, which is gradually
increasing.
Objectively: Low nutrition, yellow sclera. The skin is pale with a yellowish tinge. There is no
wheezing in the lungs, no shortness of breath. The abdomen is not swollen, soft, with palpation
there is a slight soreness in the epigastric region along the course of the pancreas, where the
transfer pulsation of the aorta is clearly determined. Auscultative: no noise. The liver is not
enlarged, the gallbladder is not palpable. Leukocytosis - 9.6. Moderate anemia on the part of the
red blood.

1. Your diagnosis?
2. With what disease should a differential diagnosis be made and what methods of laboratory and
instrumental diagnostics should be used for this?
3. The etiology and pathogenesis of this disease?
4. What classification should be used to formulate a diagnosis?
5. What are the tactics of treating the patient?
6. Indications for surgical treatment and types of surgery?
7. Principles of assessment of working capacity and rehabilitation in this pathology?
8. Prognosis of the disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 17

A 28-year-old patient was taken to the emergency room on day 2nd from the onset of the
disease with complaints of sharp pain in the epigastrium, obstructing breathing and radiating to
the left hypochondrium and the heart area against the background of repeated vomiting, stool
retention and gases.
On admission, the condition is serious. Excited. Cyanotic spots on the sides of the
abdomen, buttocks and thighs. Body temperature 36.5 C, shortness of breath up to 32, shallow
breathing, weak pulse 140 in 1 minute, blood pressure 90/60 mmHg. Heart tones are weakened.
The abdomen is slightly swollen, soft, sharply painful in the epigastrium and left
hypochondrium. The peristalsis is weakened, the aortic pulsation above the navel is not
determined. In the sloping areas of the abdominal cavity with percussion, bluntness, weakly
expressed peritoneal symptoms. Leukocytosis - 18 thousand. Urine diastasis-4096 units. ECG
shows signs of focal myocardial hypoxia.

1. What diagnosis should I make?

2. What diseases should make a differential diagnosis?
3. What additional methods of laboratory and instrumental studies may apply to the patient?
4. The etiology and pathogenesis of this disease?
5. What clinical classification should be used for the formulation of the diagnosis?
6. What are the complications develop in this pathology?
7. The main directions in the treatment of this disease?
8. Indications for surgical treatment in this pathology?
9. Prognosis?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 18

A 25-year-old patient went to the reception with complaints of irritability, tearfulness,

rapid fatigue, headache, a feeling of spasm in the larynx. Works and studies, has little rest, sleeps
up to 6 hours a day.
Objectively: Low nutrition, bright eyes, slight trembling of the fingers of the hands. The neck is
normal, the thyroid gland is visible only when swallowing. On palpation, only the lateral lobes
are clearly defined, the latter are uniformly soft, and nothing is heard auscultatively above them.
Pulse 100 beats per minute, with single extrasystoles. Blood pressure is 150/60. At auscultation
of the heart, systolic murmur. With palpation of the abdomen without features.

1. Your diagnosis?
2. The etiology and pathogenesis of this disease?
3. What additional laboratory and instrumental research methods should be performed?
4. What clinical classification should be used to make a diagnosis?
5. What complications can develop in the patient?
6. What should be the treatment tactics?
7. Indications for surgical treatment in this pathology?
8. Principles of assessing the ability to work in this disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 19

The patient was taken to the emergency department in an unconscious state with periodic
attacks of clonic convulsions. According to relatives, he suffered from pain in the epigastrium
for many years. Over the past month, the patient had daily heavy vomiting, he lost a lot of weight
(by 12 kg).
Objectively: The patient is emaciated, dehydrated, there is hyperpigmentation of the skin in the
epigastric region. The abdomen is soft, palpatory in the epigastrium "splashing noise". Heart rate
is 105 per minute. Blood pressure I 10/90 mmHg

1. What diagnosis should be made in this case?

2. What is the condition with which the patient was admitted to hospital?
3. What kind of emergency care does this patient need?
4. What kind of research does this patient need?
5. What treatment does the patient need in the future?
6. What operations are performed in this pathology?
7. What determines the choice of the method of operation?
8. The prognosis of the disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 20

Three months after resection of 2/3 of the stomach according to Billroth II in the
Hofmeister - Finsterer modification for stomach ulcers, the patient complained of weakness that
occurs 15 minutes after eating, accompanied by a feeling of heat in the upper half of the trunk,
sharp sweating. After a while, he begins to feel dizzy, tinnitus, rapid heartbeat, trembling of the
limbs, then a feeling of fatigue, drowsiness, loose stools, polyuria. No abdominal pain. Seizures
are more pronounced when eating foods rich in carbohydrates. After the operation, the patient
does not gain weight. The body weight deficit is 8 kg.

1. Your diagnosis?
2. Classification of this pathology?
3. Pathogenesis of this disease?
4. What examination does this patient need?
5. What are the treatment tactics for the development of this pathology?
6. Indications for surgical treatment and the main types of operations?
7. How to prevent the development of this disease?

Head of Department _______________________________

Task number 36
3 months after resection of 2/3 of the stomach according to Billroth II in the Hofmeister-Finsterer modification, the
patient complained of weakness that occurs 15 minutes after eating, accompanied by a feeling of heat in the upper
half of the body, and sudden sweating. After some time, he begins to feel dizzy, tinnitus, heart palpitations, trembling
of the limbs, then a feeling of fatigue, drowsiness, loose stools, polyuria joins. There are no pains in the abdomen.
Attacks are more pronounced when eating food rich in carbohydrates. After the operation, the patient does not gain
weight. The body weight deficit is 8 kg.
1. What is your diagnosis?
2. Classification of this pathology?
3. The pathogenesis of this disease?
4. What examination does this patient need?
5. What is the treatment tactics in the development of this pathology?
6. Indications for surgical treatment and main types of operations?
7. How to prevent the development of this disease?

blob:[Link] 28/05/24, 10:35 PM

Page 13 of 14
blob:[Link] 28/05/24, 10:35 PM
Page 14 of 14
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 21

A 40-year-old patient was delivered by ambulance, suffering from stomach ulcers for a
long time. Currently, against the background of an exacerbation that began about two weeks ago,
he noted a decrease in pain in the emigastria over the past two days. At the same time, there was
a growing weakness, dizziness, thirst. This morning, when got out of bed, he lost consciousness
for a few seconds. Objectively: the skin is pale, moist to the touch. The tongue is moist, the
abdomen is not swollen, soft, participates in the act of breathing, with palpation there is slight
pain in the epigastrium, there are no symptoms of irritation of the peritoneum, the pulse is 110
per minute, rhythmic, blood pressure is 100/70 mm Hg.

1. What complication of peptic ulcer disease occurred in the patient?

2. What research methods are indicated to confirm your assumption?
3. What is the algorithm of your actions?
4. What questions should you answer when conducting additional studies?
5. What are the treatment tactics?
6. Indications for surgical treatment?
7. Types of operations for this pathology?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 22

The patient, 50 years old, was operated on urgently 10 hours after the infringement of the
umbilical hernia. During the operation: when opening the hernia sac, two loops of the small
intestine were found. After dissection of the infringing ring, the intestinal loops were found to be
viable (there was a distinct pulsation of mesenteric vessels, peristalsis, pink color of the
intestine), immersed in the abdominal cavity. Plastic surgery of the hernial gate was performed.
A day later, the patient's condition worsened. The pain in the stomach increased. Shortness of
breath up to 24 per minute. Pulse 112, rhythmic. The tongue is dry, overlaid with a brown
coating. The abdomen is moderately swollen, painful on palpation in all parts. Positive peritoneal
symptoms. Intestinal noises are isolated. The gases do not escape.

1. What complication occurred in the patient and why?

2. Therapeutic tactics in this situation?
3. How to determine the viability of the intestine?
4. Definition of the concepts of "false infringement" and "imaginary reduction".
5. What are the main symptoms of a strangulated hernia?
6. Types and kinds of infringement?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 23

Patient N., 67 years old, was admitted with complaints of increasing abdominal pain during
the day, mainly in the left half of it, bloating, non-passage of stool and gases, nausea. From
anamnesis-more than a year notes constipation, deterioration of appetite, increasing weakness,
lost weight during this time by more than 10 kg. Recently, he has been worried about constant
pain in the left half of the abdomen.
Objectively: the condition of moderate severity, reduced nutrition, skin elasticity and tissue
turgor are reduced. The skin is pale. Heart rate 90 per minute, A / D 110/70 mm Hg.. The tongue
is moist, the abdomen is evenly swollen, percutorily "tympanitis", with palpation painful along
the left lateral canal, there are no symptoms of peritoneal irritation, peristaltic noises are heard.
Per rectum examination - rectal ampoule empty, blood test: er. -3.1 10/2 / l; NI-102 g / l ; L -6.5
1012/l

1. What is the clinical syndrome of this patient? Classification of the disease.

2. What is the probable cause of the development of this syndrome in this case?
3. Plan for additional examination of the patient.
4. The importance of X-ray and endoscopic methods in the diagnosis of the underlying disease
and its complications.
5. The scope of conservative measures and the purpose of their implementation in this patient?
6. The tactics of the surgeon depending on the effectiveness of conservative treatment?
7. Indications for surgery, options for surgical interventions, depending on the effectiveness of
conservative measures, the patient's condition, and the data of the surgical finding.
8. Features of postoperative management?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 24

Patient K., 18 years old, was operated on for acute gangrenous-perforated appendicitis,
complicated by diffuse serous-purulent peritonitis. Appendectomy and abdominal drainage were
performed. The early postoperative period was characterized by moderate intestinal paresis,
which was effectively stopped by the use of drug stimulation. However, by the end of 4 days
after the operation, the patient's condition worsened, there was increasing bloating, cramping
pains throughout the abdomen, gas stopped leaving, nausea and vomiting joined, common signs
of endogenous intoxication.
Objectively: the condition is of moderate severity, pulse 92 per minute, B/P 130/80 mm
Hg, the tongue is moist, overlaid, the abdomen is evenly swollen, spilled soreness in all parts,
peristalsis is increased, peritoneal symptoms are not determined, when examined per rectum-the
rectal ampoule is empty.
1. What complication of the early postoperative period occurred in this patient?
2. What methods of additional examination will help determine the diagnosis?
3. The role and scope of the X-ray examination, the interpretation of the data.
4. What are the possible causes of this complication in the early postoperative period?
5. Etiology and pathogenesis of disorders developing in this pathology.
6. The scope of conservative measures and the purpose of their implementation in the
development of this complication?
7. Indications for the operation, the amount of the operating allowance?
8. Intra-and postoperative measures aimed at preventing the development of this complication?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 25

A feeding mother of 28 years old, for two weeks, is worried about pain in the left breast.
Objectively: in the upper - outer quadrant of the left breast, a dense formation measuring 6 x 8
cm is clearly palpated, sharply painful, the skin above it is purplish-bluish, however, there is no
softening or fluctuation. The general condition of the patient is satisfactory, notes weakness,
increased sweating, the temperature in the evenings reaches 38 " C. During the last 6 days, she
has been treated on an outpatient basis by a surgeon. A course of antibiotic therapy (ampicillin)
was performed. There is no improvement. Due to the lack of effect, she was sent to the hospital.
1. Your diagnosis?
2. What are the causes of this disease?
3. Laboratory and special methods of diagnosis in this case?
4. What disease should be a differential diagnosis?
5. What treatment tactics?
6. Is it possible to continue breastfeeding the baby?
7. What tools can be used to stop lactation?
8. Prescribe antibacterial therapy.
9. Prevention of this disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 26

A 36-year-old patient went to the polyclinic to see a surgeon with complaints of abdominal
pain, more in the right mesogastrium, in the evenings he notes a rise in temperature to 37.5 C'.
From the anamnesis, it was established that the disease began 6 days ago with the appearance of
pain in the right half of the abdomen, mainly near the navel. There was nausea, vomiting. On the
third day, the pain decreased. He did not seek medical help because he was on a business trip.
During the period of the disease, there were four stools, twice liquid.
Objectively; the tongue is moist, the skin is of the usual color, the pulse is 80 per minute, there is
vesicular breathing in the lungs, there is no wheezing. The abdomen is involved in the act of
breathing, soft. Palpation in the right iliac region determines the formation of up to 10 cm in
diameter, moderately painful on palpation, sedentary. There are no peritoneal symptoms.
Leukocytosis 9,0 thousand, HH-140 g/l.
1. Your diagnosis?
2. Additional methods of examination to clarify the diagnosis?
3. What are the further treatment tactics?
4. What is the arsenal of conservative therapy?
5. Indications for surgery?
6. The essence and scope of the operation?
7. What is the optimal time frame for performing the operation in the long-term period?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 27

A 45-year-old patient was admitted to the surgical department with a clinic of mechanical
jaundice. Jaundice appeared 3 days ago on the background of pain after an error in the diet. In
the anamnesis of gallstone disease for 8 years, when small stones in the gallbladder were found
during ultrasound. Previously, she was not treated in the hospital, there was no history of
jaundice.
Objectively: the patient's condition is satisfactory, good nutrition, subicteric sclera and skin.
From the side of the chest organs without features.
The tongue is wet. The abdomen is symmetrical, with palpation painful in the epigastrium and
more in the right hypochondrium, especially at the point of the gallbladder. Positive Ortner's
symptom. The pulsation of the aorta above the navel is not determined. The peristalsis is distinct.
There are no peritoneal symptoms. Dysuric and dyspeptic disorders are not noted, the feces are
lighter than usual. Leukocytosis -10 thousand. Urine diastasis - 256 units. On ultrasound, the
expansion of the choledochus to 1.4 cm was noted, but no concretions were found in the latter,
the head of the pancreas was slightly enlarged. Gallbladder 10 x 4 cm, in the lumen of many of
the stones from 0.3 to 0.7 cm, a wall - 04.
1. Your presumptive diagnosis?
2. What diseases should make a differential diagnosis?
3. What additional laboratory and instrumental studies should be conducted to refine the
diagnosis and select the tactics to surgical intervention?
4. What surgical interventions can be taken in the patient and their advantages, disadvantages,
indications?
5. Recommendations at discharge?
6. Examination of working capacity?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 28

A 38-year-old patient was admitted to the surgical department with complaints of severe
pain in the epigastrium of a shingling nature, nausea, vomiting. The disease is associated with
the use of alcohol. A history of hyperacid gastritis.
Objectively: The condition is of moderate severity, anxious, micro-circulatory disorders are
noted. No jaundice. The number of respiratory rate is 18 - 20. There is no wheezing in the lungs.
Pulse 100 in 1 minute, rhythmic, blood pressure 120/80 mm Hg. Tongue overlaid, moist. The
abdomen is evenly swollen, participates in the act of breathing. On palpation, pain in the
epigastrium, where the resistance of the abdominal wall is determined, extending to the right
hypochondrium.
Percutaneous: swollen transverse colon. The free fluid in the abdominal cavity is not determined.
The gallbladder is not palpable. The liver protrudes from under the edge of the costal arch.
Peristalsis is listened to, but sluggish. There are no peritoneal symptoms. Leukocytosis - 13
thousand. Urine diastasis - 1024 units. There is no free gas on the review radiograph of the
abdominal cavity. Ultrasound -there is no biliary hypertension. The gallbladder is 8x2 cm, the
wall is 0.3 cm, does not contain concretions. There is an increase in the pancreas, especially in
the area of the head and body with blurred contours. Liquid in the stuffing box in the form of a
slit 2.5 x 8 cm. The free fluid in the abdominal cavity is not determined.
The patient underwent conservative therapy with positive clinical and laboratory dynamics, but
at the control ultrasound after 7 days, the preservation of fluid formation in the area of the body
of the pancreas 3x6 cm was noted.
1. What is the main diagnosis of the disease?
2. What complication of the underlying disease can be considered?
3. What additional laboratory and instrumental methods of research should the patient perform?
4. What are the main directions of treatment of the underlying disease?
5. Your tactics regarding the formation of the omentum sac?
6. What surgical treatment is indicated for the patient?
7. The timing of its implementation?
8. The outcome of this complication?
9. Prognosis?
10. Your recommendations at discharge?
Head of Department _______________________________
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 29

A 62-year-old patient was admitted to the hospital with complaints of constant moderate
pain in the lower abdomen with radiation to the sacrum. He got sick about a day ago, when he
took a large amount of food after a long period of malnutrition. The pain was accompanied by
double vomiting, which did not bring relief. There was no stool, no gas escaping. During the
year, the patient suffers from constipation. At home, he used laxatives.
Objectively: The patient is contactable, adequate. Heart rate is 86 per minute. Blood pressure
140/90 [Link] overlaid, moist. The abdomen is "skewed" - the right half of it is sharply
swollen, the abdominal wall is soft on palpation, an elastic formation is determined on the right,
the peristalsis above it is not heard, the "splashing noise" is also determined here. When
percussion - high tympanitis. During rectal examination, the ampoule of the rectum is empty, the
sphincter is gaping. When trying to put a siphon enema, it was possible to inject only 300 ml of
liquid, after which there were pains in the left lower abdomen, the liquid began to flow out.
1. Your diagnosis?
2. Clinical classification of this pathology?
3. Etiopathogenesis of this disease?
4. What examination should be carried out in patients with this disease?
5. Treatment tactics for such a disease?
6. The amount of benefits for this pathology?
7. Prevention of relapse of the disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 30

A 40-year-old patient was operated on two weeks ago for a gunshot wound to the
abdominal cavity with damage to the small intestine. Suturing of numerous wounds of the small
intestine, sanitation and drainage of the abdominal cavity were performed.
On the 8th day of the postoperative period, intestinal contents began to be released from the right
iliac region through drainage. The amount of discharge over the past 3 days began to increase
(up to 600-800 ml per day). An independent stool.
Objectively: the tongue is dry, the abdomen is not swollen, soft, painful in the area of wounds.
The bandage on the right side was soaked with intestinal contents. Maceration of the skin
appeared. There are no peritoneal symptoms. In recent days, the patient's condition has
deteriorated. Increased weakness, thirst increases, loses weight, dry skin appeared. Pulse-94 per
minute, rhythmic, of satisfactory quality. Blood pressure 140/80 mm Hg - 130 g/l. Daily diuresis
up to 1 liter.
1. Your diagnosis?
2. What was the complication?
3. The cause of the complication?
4. Treatment tactics in this case?
5. Methods of local treatment?
6. Methods of corrective therapy?
7. Options for surgical interventions?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 31

A 50-year-old patient was admitted to the department with complaints of pain in the right
half of the abdomen with radiation to the lumbar region, frequent urination, sharp weakness. He
got sick 3 days ago, when he suddenly had severe pain in the right lumbar region. A day ago,
there was frequent painful urination in small portions of urine, an increase in body temperature
to 39-40°, today there were chills twice.
On examination, the patient is adynamic, pale, temperature 39.5°, pulse up to 100 beats,
per minute, rhythmic, blood pressure 90/50 mm Hg. The abdomen is tense in the right half,
painful in the depth of the iliac region and up the lateral canal. The Shchetkin-Blumberg
symptom is negative. The painful pole of the right kidney is palpated. Pasternatsky's symptom is
positive on the right.
In the general analysis of urine-proteinuria 0.065 g / l, white blood cells up to 10 in n / a.,
red blood cells up to 20-30 in n/a.
In the general analysis of blood-white blood cells up to 15,000 with a shift to the left, ESR 45 m.
m/h.
According to ultrasound data, ureteropyelectasia on the right, thickening of the renal
parenchyma, irregularity of its contour, and hypoechoic formation in the lower pole of the
kidney are determined. Against the background of a full bladder, a concretion of 10 mm in the
lower third of the ureter cannot be excluded.

1. The clinical and echographic picture of which urological diseases is described in the problem?
2. What complication occurred in this patient?
3. What is the form of the process in the kidney?
4. What research methods should be performed to clarify the diagnosis?
5. What treatment method should be used in this case?
6. What is the scope and nature of treatment measures in a particular case?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 32

A 54-year-old patient complains of total hematuria with blood clots that have a worm-like
shape. Hematuria appeared suddenly, in full health, three days ago. Yesterday, severe
paroxysmal pain began in the right lumbar region, right hypochondrium. Several times there was
vomiting, bloating of the intestine. The patient called an ambulance, was given an injection of
antispasmodics, the pain was gone. The patient has a history of chronic cholecystitis, peptic ulcer
of the 12th duodenum. With an objective examination of the patient, the correct physique,
satisfactory nutrition. Attention is drawn to the high figures of BP -180/110 mm Hg. When
palpation in the right mesogastrium, a sedentary, dense, lumpy tumor-like formation is
determined, the size of 10x6 cm, almost painless. When examining the organs of the scrotum, a
varicocele was found on the right.

1. In what urological diseases can total hematuria be observed?

2. What disease can be thought of in this case?
3. What research methods should be used to clarify the diagnosis?
[Link] diagnostic value of the varicocele symptom in this case.
5. Offer options for the classification of this disease.
6. What are the approaches to the treatment of this disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 33

Patient V., 34 years old, went to the polyclinic to the surgeon with complaints of a
non-healing ulcer of the right shin. As a child, there was a lower leg injury-a scalped wound.
Subsequently, a deforming scar was formed, easily traumatized. Periodically, a superficial ulcer
formed in the area of the scar, which was closed after treatment with ointment dressings. The last
exacerbation a month ago-there was an ulcer in the scar area, up to 1 cm in diameter, there is no
effect from the treatment with ointment dressings, the ulcer has increased to 3 cm in diameter,
the edges have become dense, covered, palpation is painless. In the right inguinal region, two
dense, sedentary, non-painful nodes are palpated, 1 cm and 1.5 cm in diameter.

1. Your preliminary diagnosis?

2. What are the methods of clarifying diagnosis?
3. What method of morphological verification of the diagnosis should be used?
4. Possible preblastomous state and risk factors for the disease?
5. Treatment plan?
6. What are the methods of preventing relapse of the disease?
7. Determine the ability to work?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 34

The patient is 49 years old ambulance paramedic in the village, married, has 2 children. A
year ago, she found a dense formation in the left mammary gland, has not gone to specialists
until now. Notes a slight increase in the size of the tumor, there are no unpleasant sensations in
the mammary gland. The general condition is good, the mammary glands are of the correct
shape, there is no visible deformation. In the right gland, there is a picture of diffuse mastopathy.
In the left-on the border of the outer quadrants, a rounded tumor is palpated, about 4 cm in
diameter, without clear borders, painless, its mobility is limited, the skin above the tumor is not
changed. In the left axillary region, a single lymph node is palpated, mobile, of elastic
consistency, measuring 1.5 x 1 cm. On radiographs of the mammary glands: bilateral, involutive
changes, against this background, a 2 x 2 cm seal with indistinct radiant contours is determined
in the upper outer quadrant of the left breast. Cytological examination of the punctate of the left
breast revealed single destroyed cells with some signs of atypia.

1. Your preliminary diagnosis?

2. Choose a plan for further examination?
3. What method should be used to obtain morphological verification of the diagnosis?
4. What are the risk factors for the disease?
5. What are the local and general criteria for the disease to be determined?
6. Possible options for therapeutic tactics, give reasons?
7. Tasks of rehabilitation treatment?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 35

A 17-year-old girl developed a painful bright red acne 0,5 cm in diameter on her upper lip,
with a black dot in the center. In order to speed up the cure, she tried to squeeze it out. On the
second day, the infiltration increased, the temperature rose to 38 C. She did not seek medical
help for another 6 days. she took aspirin, ampicillin. She was taken to the hospital in a serious
condition with complaints of severe headache in the occipital region, weakness, vomiting, and
high fever. Objectively: the patient's condition is serious. The skin is pale, the temperature is 39
C. Pulse is rhythmic 102 per minute, blood pressure 105/70 mm Hg. On palpation, the liver
protrudes from under the edge of the costal arch.
Local status: the face is swollen, the eye slits are 4 mm. In the area of the left nasolabial fold, an
infiltrate of 1x4 cm, hyperemia, a necrosis site of 0,2 cm is located to the left of the wing of the
nose in the direction of the left eye. When the head is tilted anteriorly, there is pain in the
occipital region, rigidity of the occipital muscles.

1. Your final diagnosis?

2. What was the cause of facial swelling and headache?
3. Is hospitalization in the surgical department necessary?
4. What regime should be created for the patient?
5. Tactics of treatment of the patient?
6. Is it necessary to prevent tetanus?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 36

A 9-year-old boy was taken to the surgical department of the district hospital with
complaints of sharp pain in his right hip, a stunning chill with an increase in temperature to 39.6
C, headache, vomiting. Five days before that, he was treated for an acute respiratory illness. On
examination, the condition is severe, the face is pale, the skin is dry. Pulse 120 v min., blood
pressure 90 and 55 mm Hg. The right leg is half-bent at the knee joint, the thigh is increased in
volume by 2 cm, the skin is slightly hyperemic, hot. The place of greatest soreness is on the
anterior surface of the lower third of the thigh.

1. Your diagnosis and the scope of the examination.

2. With what disease should a differential diagnosis be made.
3. Whether there is a need for an X-ray examination of the hip.
4. What treatment is indicated.
5. How to stop pain.
6. What may be the complications.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 37

A 40-year-old patient addressed the surgeon with complaints of bursting pain in the area of
the little finger of the right hand. Three days ago, he pricked the finger with a nail, then treated
the wound with a solution of iodine. Gradually, the intensity of the pain increased, there was a
pronounced swelling of the tissues of the entire finger.
Objectively, there is swelling and soreness of the 5th finger of the right hand, on its palmar
surface in the area of the main phalanx there is a 2x2 mm wound covered with a crust.
Movement in the finger is limited due to the increasing pain.

1. Diagnosis options?
2. What conditions must be observed in the treatment of this pathology?
3. What type of surgical intervention is appropriate in this situation?
4. What complications are possible in this disease?
5. Determine the ability to work.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 38

A 30-year-old man was hit on the head with a blunt object. Lost consciousness for a few
minutes. He got home on his own and went to bed. In the morning, his wife couldn't wake him
up. "Ambulance" delivered to the emergency room of the CRH. During hospitalization, he is
inhibited, resists examination, and speech contact is impossible. With defensive movements, a
decrease in muscle strength in the right extremities is determined. In the left temporal region, the
skin is darkened. The left pupil is wider than the right. Pulse 48 per minute.

1. Preliminary diagnosis.
2. Additional research methods.
3. Clinical diagnosis.
4. Therapeutic tactics in the CRH.
5. Principles of surgical intervention.
6. Forecast.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 39

A 30-year-old man was hit on the neck and back of the head by the top of a fallen tree. He
didn't lose consciousness. He felt the passage of an "electric current", then numbness and
weakness in my limbs. After 20 minutes, movement in the limbs was restored. Delivered to the
CRH in the cab of a logging truck in a sitting position. Complains of pain and restricted
movement in the cervical spine. has to hold my head in the hands. There is a decrease in muscle
strength in the arm and legs, a decrease in pain sensitivity in the hands of both hands, legs and
trunk from the level of the costal arches. The bladder is full. He can't urinate on his own.

1. Preliminary diagnosis.
2. Additional research methods.
3. Therapeutic tactics.
4. Transport immobilization and the position of the victim during transportation.
6. Principles of surgical treatment.
7. Prognosis and examination of working capacity.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 40

A 36-year-old man was taken to the emergency department of the CRH 30 minutes after
receiving the injury with complaints of pain in the face, right arm, anterior chest, anterolateral
abdomen on the right, right leg, chills, thirst, nausea, hoarseness of voice.
Circumstances of the injury: during welding work in the garage, the oiled clothing ignited. With
the help of neighbors in the garages, the flames were extinguished, the smoldering clothes were
removed and an ambulance was called. First aid was not provided. In the ambulance, 1 ml of 2%
omnopone solution was injected intravenously, contour dressings were applied. You are the
CRH doctor on duty.
On examination: the patient is conscious, excited, euphoric. The intact integument is pale gray.
Pronounced chills. Pulse 96 per minute, blood pressure 110/70 mm Hg, body temperature 36.2
C, respiratory rate 30 per minute. There is no urine, including through the catheter. Face-soot on
the cheeks, focal blisters with transparent contents, areas of deflated epithelium, wrinkles-white,
hair in the nose singed, voice hoarse, pharynx hyperemic, in the mouth and in the nasal passages
- traces of soot. In the area of the anterior surface of the chest and abdomen on the right,
hyperemia is determined with large epidermal blisters with transparent and hemorrhagic
contents, partially opened and occupying 1/4 of these zones. On the right forearm, the scab along
the entire circumference is a dense brown-brown string with translucent skin vessels, the hand is
pronounced edema, the tissues are bluish-pale, on the back of the hand is a single large bubble
with hemorrhagic contents. Right shoulder-brown scab and several large blisters with bloody
contents - in the lower third, in the middle and upper-desquamated epidermis, erosively bleeding
surface-the anterior and outer surface is affected. On the right thigh, along the anterior surface,
there is a dense brown scab from the upper to lower third of the surface with translucent vessels,
the rest of the surface is an alternation of the broken epidermis and large blisters with
hemorrhagic and gelatinous contents. The entire right shin is covered with a dense circular scab
with coagulated vessels. The foot is sharply swollen, cyanotic, pulsation on the arteries of the
foot is not determined. On the back of the foot - a small epidermal bubble with transparent
contents. Burn surface on the lower leg, forearms of the anterior surface of the thigh on the right
is painless.
General blood test: er. - 6.2 x 10; Iv-220 g/l; cp. - 1.2; l. - 12.2 x 10: ESR-25 mm / h.
1. Diagnosis on admission.
2. First and first aid.
3. What samples can be used to determine the depth of the burn.
4. Tactics and treatment plan. The three-catheter rule. Criteria for getting out of burn shock.
5. What emergency medical procedures should be performed

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 41

A 42-year-old man was beaten by unknown people half an hour ago. They kicked him in
the chest and stomach. On his own, he reached the bus stop, from where he was taken by
ambulance to the emergency room of the CRH on a stretcher. In the ambulance, the blood
pressure is 100 and 60 mm Hg, the pulse is 110 per minute. During transportation, 400 ml of
polyglucine was poured, morphine 2% - 1 ml, diphenhydramine 1% - 1 ml, cordiamine 2 ml
were administered.
In the emergency department of the hospital, the patient is pale, covered with cold sweat,
conscious, restless - he tries to sit up, then lies down on his right side. There are numerous
hemorrhages on the body, including on the side surfaces of the chest and abdomen. Sharp pain
during palpation of the cartilaginous portions of 7-9 ribs on the left. Blood pressure 80 and 45
mm Hg, pulse 120 per minute, weak filling and tension. The abdomen is not involved in
breathing, painful on palpation, more in the left hypochondrium, tense. Peristalsis is sluggish.
Hepatic dullness is absent, in the sloping places of the abdomen there is a dulling of the
percussion sound, more distinct along the left channel. Symptoms of peritoneal irritation are
mild. The urine was removed by a rubber catheter, transparent, straw-yellow, 300 ml. In a rectal
examination, there is no blood on the glove, the anterior wall of the rectum is overhanging,
painless on palpation.

1. Your diagnosis after an examination in the emergency room.

2. What additional research methods are needed.
3. Providing assistance in the district hospital.
4. Principles of the operational manual.
5. Terms of rehabilitation.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 42

A 28-year-old man was taken to the emergency department of the CRH two hours after the
injury. He was stabbed with the knife in the left side of his chest.
The condition is severe, the consciousness is clear. Covered in cold sweat, pale skin, pulse 120
per minute, blood pressure 80 and 40 mm Hg. In the fourth intercostal space along the mid-
clavicular line on the left, the wound is 1.5 by 0.5 cm with smooth edges, sharp corners, air and
scarlet blood are released from the wound. With percussion, the percussion sound is shortened
from the level of the middle axillary line (the patient is lying down), with auscultation, the
breathing on the left is sharply weakened. The left and right borders of the heart are percutorily
expanded, the apical push is not determined. The ECG shows the area of ischemia in the
anterolateral parts of the left ventricle. In the X-ray image, the waist of the heart is smoothed in a
straight projection, the shadow of the heart in the shape of a trapezoid. In the pleural cavity, there
is a uniform darkening over the entire pulmonary field.

1. Diagnosis.
2. Tactics in the district hospital.
3. The choice of anesthesia.
4. Principles of operation.
5. Possible complications after surgery, their prevention.
6. What is a scrap blood transfusion, the technique of execution.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 43

A 38-year-old man has his right leg and the right half of his pelvis pinned down by the
rubble of a collapsed building. Released in 4 hours. The condition is satisfactory. Moderate pain
in the entire right leg. At the stage of the first medical aid (after 2 hours), the pain in the leg
sharply increased, there was a feeling of numbness in it. There was a general weakness, there
was a single vomiting. The patient is drowsy. On examination, the condition is severe. Slowed
down. Pale. Pulse 110 per minute, blood pressure 90 and 60. The right leg is noticeably enlarged
in volume, the skin is bluish in color with areas of subcutaneous hemorrhages.
The pulsation of the arteries of the foot is sharply weakened. The tissues of the limb are tense.
The skin is cold. Sensitivity is preserved. Active movements in the knee, ankle, and foot joints
are limited. He doesn't urinate. The catheter released 50 ml of dark brown urine.

1. Preliminary diagnosis.
2. Pre-medical care.
3. First aid.
4. Qualified surgical care.
5. Specialized surgical care.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 44

A 30-year-old man is pinned down by the side of an overturned truck. The main blow fell
on the pubic area and the right half of the pelvis. After 4 hours, was delivered by a passing car to
the CRH. The condition is severe, pale, adynamic, the number of breaths is 24 per minute, blood
pressure is 85 and 60 mm Hg. Heart rate is 108 per minute. Lying on his back. The left leg is
bent at the knee. Hematoma on the perineum and scrotum. He can't urinate. There is blood on the
head of the penis, it flows out of the urethra. The abdomen is tense during palpation. Positive
symptoms of peritoneal irritation, peristalsis is not listened to.

1. Preliminary diagnosis.
2. Additional research methods.
3. Clinical diagnosis.
4. Principles of treatment. Surgical tactics at the stage of qualified surgical care.
5. Forecast.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 45

A 25-year-old man was taken to a local hospital 3 hours after being shot through the right
side of his chest with a gun. The condition is severe, the number of breaths is 28 per minute.
Cyanosis. The cervical veins are swollen. Pulse 115, weak filling, rhythmic, blood pressure 105
and 55 mm Hg. Moderate subcutaneous emphysema on the right. The entrance wound is located
in the 3rd intercostal space along the midclavicular line, the exit wound is at the lower angle of
the right scapula. The breath on the right is not heard, on the left is the usual vesicular,
percussive above the right half of the chest is a box sound. The boundaries of the heart are
preserved.

1. Preliminary diagnosis.
2. Additional research methods.
3. Assistance at the stage of first aid.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 46

The patient, 43 years old (weight 75 kg, height 180 cm), was admitted to the emergency
department of the hospital with complaints of weakness, a single loss of consciousness, vomiting
of the "coffee grounds" type, dark liquid stools over the past two days.
From the anamnesis, it is known that he was on outpatient treatment for acute respiratory
infections for the last week. He took antibiotics, aspirin, and expectorant medicine. Three days
ago, there was weakness, flashing "flies" before the eyes, dark liquid stool, cold sticky sweat.
Relatives noted the pallor of the skin. For the last five years, he has been suffering from
duodenal ulcer.
On examination: The skin is pale, the pulse is weakly filled 120 per minute, the blood pressure is
80/20 mm Hg. Heart tones are muted, rhythmic. In the lungs, wet, wired wheezes. The abdomen
is moderately painful in the epigastric region. Per rectum-melena.

1. Set up a preliminary diagnosis.

2. Therapeutic and diagnostic tactics?
3. What additional methods of examination does the patient need?
4. Determine the severity of volemic disorders.
5. The algorithm of further actions for the treatment of the patient?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 47

A 42-year-old patient with a diagnosis of acute intestinal obstruction is preparing for the
surgery. Complains of severe cramping pains in the abdomen, accompanied by repeated
vomiting with a fetid smell. Aroused, skin moist, blood pressure 90/60 mm Hg, pulse 120 in 1
min. The probe could not be inserted into the stomach due to psychomotor agitation. For
premedication, I/v administered: morphine, relanium atropine. After 3 minutes, there was a
respiratory arrest, which required forced ventilation of the lungs with a tight mask. During
laryngoscopy, massive regurgitation of the gastric contents was observed. The anesthesiologist
performed oral sanitation and tracheal intubation. After intubation, the patient developed a
critical condition: sharp cyanosis of the lips, acrocyanosis, diffuse cyanosis of the face. During
auscultation of the lungs, multiple dry wheezing wheezes are heard with an elongation of the
exhalation. Blood pressure 70/40 mm Hg,, pulse 130 in 1 min. with single extrasystoles.

1. Your diagnosis?
2. Measures to prevent this syndrome?
3. Necessary medical measures?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 48

A 33-year-old man was admitted to the surgical hospital with damage to a large vessel and
massive blood loss. BP - 60/0. Pulse 120 in 1 min. of weak filling. Against the background of
infusion therapy with plasma-substituting solutions and crystalloids, surgical intervention was
performed (a vascular suture was applied). A transfusion of 1 liter of the same group blood was
also performed.
After 3 hours, the patient developed back pain, chills, headache, and decreased blood
pressure. The urine removed by the catheter is brown in color.

1. How do you interpret this condition?

2. What additional research is needed?
3. What is the doctor's treatment strategy?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 49

Patient C, 39 years old, was taken to the hospital two days after the onset of the disease
with complaints of pain in the lower abdomen. Condition of moderate severity, conscious, skin
with an earthy shade, facial features are sharpened, T 38.5, respiratory rate 24, pulse 118 per
minute, blood pressure 100/60 mm Hg, tongue dry, abdomen evenly swollen, tense and painful
more in the lower parts, there are also defined peritoneal symptoms. Peristalsis is sluggish,
percutaneous-bluntness in the lateral parts of the abdomen. In the blood test: Er. -3.9 x 10/l,
hemoglobin-120 g/l, white blood cells-17.5 x 10/l, pronounced shift of the white blood cell
formula to the left, toxic neutrophil granularity. The leukocyte intoxication index is 4.
It was found out that the disease began with the occurrence of pain in the epigastric region,
followed by their movement within a few hours to the right iliac region. The patient was treating
himself independently, using in self-medication, did not seek medical help.

1. Your diagnosis.
2. The scope of the additional survey.
3. What is the possible cause of the development of this pathology in a particular case?
4. Tactics of the surgeon. Justification of the choice of operative access and the scope of the
operation.
5. The need and scope of preoperative preparation.
6. Features of the postoperative period management.

Head of Department _______________________________

- Consulting with a nephrologist for further evaluation and management of
acute kidney injury.
- Monitoring the patient closely for any signs of worsening condition and
adjusting treatment accordingly.

Problem #45

Patient C , 39 years old, was delivered two days

after the onset of the disease with complaints of
pain in the lower abdomen. The state of moderate
severity, conscious, skin with an earthy tint, facial
features are pointed, T 38.5, NPV 24, pulse J J8
per minute, blood pressure J00/60 mm .[Link] .,
tongue dry, abdomen evenly swollen, tense and
more painful in the lower sections, peritoneal
symptoms are also determined there. Peristalsis is
sluggish, percussion - dullness in the lateral parts
of the abdomen. In the blood test: Er.-3.9 x JO/I,
hemoglobin - J20 g/l, leukocytes - 17.5 x JO/I, a
shift of the leukocyte formula to the left, toxic
granularity of neutrophils. The leukocyte index of
intoxication is 4.

It was possible to find out that the disease began

with the onset of pain in the epigastric region,
followed by their movement for several hours to
the right iliac region. The patient self-medicated,
did not seek medical help.

1. Your diagnosis.

2. Scope of additional examination.

3. What is the possible reason for the

blob:[Link] 28/05/24, 10:36 PM

Page 11 of 13
development of this pathology in a particular
case?

4. Tactics of the surgeon. Rationale for the choice

of operative access and scope of the operation.

5. Necessity and volume of preoperative

preparation.

6. Features of the postoperative period

Ans:
1. Acute preforated appendicitis
With peritoniti 2.
• In adults purely clinical - Test for psoas sign

-Rovsing ’s sign
-Dunphy's sign
• Supplemental lab inv

• Usg

• Cect(conformatory test ).

• Use Mantrels score to confirm dx

3. Cause of appendicitis Luminal obstruction due

to fecolith
or worm eggs or fruit seeds
Cause of peritonits is due to perforated
appendicitis .M/c
organisim:Bacteroides fragilis › Ecoli

4. Emergency appendectomy and drainage of

abscess and irrigation of the abdomen with
saline and insertion of peritoneal drain
Appendectomy using Lanz incision

blob:[Link] 28/05/24, 10:36 PM

Page 12 of 13
5. The patient is shown an emergency operation;
preoperative preparation should not take much
time. Access - laparotomy.

6. Possible complications are Bleeding, wound

infection,ileus,intestinal obstruction ,fecal fistula.

The wound should be kept clean and dry.

blob:[Link] 28/05/24, 10:36 PM

Page 13 of 13
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 50

Patient K., 58 years old, was admitted to the surgical department 12 hours after the onset of
the disease with complaints of sharp pain in the epigastric region and right hypochondrium, a
single vomiting of bile. Vomit was 2 hours ago. From the anamnesis, it was established that
during the year the patient is disturbed by aching pains in the right hypochondrium, which
increase after eating fatty foods. She was not examined, did not seek medical help, and was
treated at home.
Objectively: the general condition is serious. Obese. The skin and sclera are slightly icteric.
Heart rate 102 per minute, rhythmic. Blood pressure 100/60 mmHg. Shortness of breath up to
22-23 per minute.
The tongue is moist, covered with a white coating. The abdomen is not swollen, when
palpated, it is tense and sharply painful in the right hypochondrium and epigastrium. Positive
symptoms of Ortner and Murphy. Peristalsis is listened to, but weakened. There are no peritoneal
symptoms. The gallbladder is not palpable.
Body weight 37.2, blood leukocytosis (11.8 x 10 /l) with a moderate shift of the leukocyte
formula to the left.
1. What disease can the patient think about?
2. What additional laboratory and instrumental methods of research will you prescribe when
confirming the diagnosis?
3. Your tactics: A) Conservative therapy. .B) Surgical treatment (nature, deadlines).
4. Complications of the disease.
5. Examination of working capacity.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 51

A 53-year-old man was admitted to the surgical department in a planned manner with complaints
of a feeling of heaviness in the epigastric region, nausea, belching, vomiting of the digestive
system eaten the day before. In history for 20 years, duodenal ulcer has been observed, for which
he was repeatedly treated in a hospital. Four years ago, ulcers began to be tolerated (suturing of a
perforated ulcer), after which relapses increased over the past 2 years. I lost 7 kg, my appetite is
good, but lately I have been afraid of food because of vomiting.
Objectively: the condition is satisfactory. Reduced nutrition. The skin is dry, turgor is reduced.
Pulse 82 per minute, rhythmic, BP 130/80 mm Hg. There are no rales in the lungs. The tongue is
wet. The abdomen is not swollen, soft on palpation, moderately painful in the epigastrium.
"Splashing noise" is determined, auscultatory enlargement of the stomach. Peristalsis reported,
tendency to constipation.
1. Your diagnosis.
2. What complication of the disease do you think about?
3. What instrumental and laboratory tests are needed to confirm the diagnosis and choose the
next tactics?
4. Treatment and diagnostic tactics.
5. Features of preoperative preparation?
6. Principles of surgical interventions.
7. Early and late complications after operations.
8. Features of postoperative management of the patient.
9. Recommendations for discharge, ability to work.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 52

A 48-year-old patient was admitted to the emergency department of a surgical hospital.

Complains of intense pain in the upper abdomen with radiation to the right upper arm. Got sick
suddenly 5 hours ago, when there were sharp pains in the epigastrium, there was a single
vomiting. The pain spread through the right lateral canal.
From the anamnesis, it was established that 10 years ago he was operated on for
destructive appendicitis. He suffered from pneumonia twice. A year ago, he began to worry
about pain in the epigastrium, he addressed a therapist. With FGDS, an ulcer of the duodenum
bulb was found on the background of bulbitis. After conservative treatment, the ulcer was
healed.
Objectively, on examination, the skin is pale. He takes a forced position, lies motionless on his
right side, with his legs tucked up to his stomach. Pulse 96 per minute, rhythmic, blood pressure
110/60 mm Hg. The tongue is dry, covered with a gray coating. The abdomen is drawn in
symmetrical, does not participate in the act of breathing. Muscle defiance and soreness in all
departments are determined. With percussion, hepatic dullness is smoothed out. The Shchetkin -
Blumberg symptom is positive. Peristalsis is not listened to. During rectal examination, sharp
soreness and overhanging in the area of the anterior wall of the rectum. Blood test: Red blood
cells 4.6 x 10 / l, White blood cells 15.2 x 10/l, ESR 18 mm/h. Urine diastasis 64 units.

1. Your presumed diagnosis.

2. What additional diagnostic measures should be performed, the order of their application?
3. Methods of surgical treatment.
4. Features of the postoperative period management.
5. Recommendations for discharge. Examination of working capacity.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 53

Patient M., 64 years old, was admitted to the emergency room of the surgical department
with complaints of pain in the right hypochondrium, jaundice of the skin and sclera, darkening of
urine, discolored stool, increased body temperature to 39 degrees, accompanied by chills.
She is sick for three weeks. The disease began with an attack of pain in the right hypochondrium.
The next day, she noticed a darkening of the color of my urine, "like beer." Soon there was
jaundice of the sclera and skin. She did not seek medical help. Over the past 4 days, the
condition worsened, there was a body temperature of up to 39, accompanied by chills.
Objectively: general condition of moderate severity. Pulse rate of 98 per minute,
satisfactory quality. The tongue is dry, overlaid. The abdomen participates in the act of
breathing, with palpation there is pain in the right hypochondrium, the Shchetkin - Blumberg
symptom is weakly positive.

1. What pathology can the patient think about?

2. Therapeutic and diagnostic tactics.
3. What research methods should be performed additionally?
4. Are there indications for surgical treatment? If "yes", which ones?
5. Features of postoperative treatment management.
6. Your recommendations to the patient after the end of treatment.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 54

A 52-year-old man suffering from coronary heart disease with atrial fibrillation suddenly
developed severe abdominal pain of a diffuse nature. Soon there was vomiting (twice), not
bringing relief. After 2 hours from the beginning of the disease, the patient was taken to a
medical institution. On examination: the patient's behavior is restless due to severe abdominal
pain. The abdomen on palpation is soft, painful in the epigastric and mesogastric regions.
Peristalsis is sluggish. The Shchetkin - Blumberg symptom is negative. When rectal examination
- on the glove feces of the usual color. General blood test: leukocytosis up to 17.0 x 10/l. ECG -
no special features.

1. Your diagnosis.
2. Clinical classification of this disease.
3. Etiology and pathogenesis of this pathology.
4. The patient's examination plan.
5. Treatment tactics?
6. Principles of treatment?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 55

In a 35-year-old patient suffering from gallstone disease, 2 hours after the error in the diet,
shingles appeared in the upper abdomen, repeated vomiting of food eaten with an admixture of
bile. On examination, the patient's condition is severe. The skin is somewhat pale. The sclera are
subicteric. Heart rate is 120 per minute. Blood pressure 100/60 mm Hg. The tongue is dry,
overlaid with a whitish coating. The abdomen is swollen, sharply painful in the epigastrium and
hypochondrium, where the rigidity of the muscles of the anterior abdominal wall is determined.
The Schetkin-Blumberg symptom in the iliac regions is negative. Intestinal peristalsis is
weakened. There was no stool.

1. Your diagnosis.
2. Classification of the disease.
3. Differential diagnostic measures.
4. Your tactics: - the main directions of conservative therapy.
- indications for surgical treatment, methods of surgical interventions.
5. Forecast.

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 56

The patient, 38 years old, went to the doctor with complaints of an increase in the volume
of the right half of the scrotum. After 3 minutes, there was a respiratory arrest, which required
forced ventilation of the lungs with a tight mask. Pain began to occur during physical exertion.
The general condition of the patient is without features.
The right half of the scrotum is enlarged to 2 x 8 x 6 cm. The formation is determined both
standing and lying down, it is not set in the abdominal cavity. The consistency is dense-elastic.
Percussion-tympanite. The outer ring of the inguinal canal on the left is not expanded, on the
right it is not clearly defined. The spermatic cord is not palpable.

1. What disease can you think about?

2. Classification of the disease?
3. Anatomical features that determine the occurrence of this disease?
4. Predisposing and producing factors for the occurrence of this disease?
5. What diseases should be treated with differential diagnosis?
6. What should be done to clarify the diagnosis?
7. Treatment tactics?
8. What complications can be encountered during the operation and in the postoperative period?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 57

On the evening round, your attention was drawn to a patient who had a subtotal resection
of the thyroid gland in the morning for a thyrotoxic goiter. The patient complains of pain in the
head, palpitations, general weakness. On examination: the skin is pale, the eyes are covered with
a towel, due to intolerance to bright color. Pulse 105-110 in 1 minute, satisfactory filling. Blood
pressure 160/100 mmHg. Temperature-38°C. The bandage was slightly soaked with hemorrhagic
contents. Hemoglobin -135 g / l. White blood cells-10.5 x 10^.

1. Your diagnosis?
2. The causes of this complication?
3. Possible mechanisms of development?
4. The main directions of therapeutic measures?
5. What are the methods of prevention?
6. Assessment of working capacity?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 58

The patient, 42 years old, was admitted to the hospital in an emergency. 3 hours ago, there
was bloody vomiting. During the last 2 years, bloody vomiting occurs for the 3rd time. A history
of Botkin's disease. On examination: the skin is pale. Pulse 110-115 in 1 minute, weak filling.
Blood pressure is 100/70 mmHg. The abdomen is slightly swollen, the venous network on the
anterior abdominal wall is determined. The spleen and the dense edge of the liver near the costal
arch are palpated. Indicators of red blood: Hemoglobin-80 g / l, Red blood cells-3 x 10.

1. Your diagnosis?
2. Etiopathogenesis of this disease?
3. Classification of the disease?
4. The scope of the patient's examination in this pathology?
5. The degree of blood loss in this case?
6. The main directions of conservative therapy?
7. Indications for surgery and options for surgical aids?
8. The prognosis of this disease?

Head of Department _______________________________

STATE EXAMINATION
SITUATIONAL TASK № 59

The patient, 72 years old, obese woman, for 15 years suffering from periodic pain in the
right hypochondrium, 8 hours ago there were again sharp pains in the right hypochondrium with
radiation to the right shoulder, vomiting, t to 38° C. The tongue is dry, overlaid with a white
coating, a small icteric sclera. The abdomen is slightly swollen. Sharp soreness and moderate
muscle tension in the right hypochondrium. Symptoms of peritoneal irritation are slightly
positive. Pulse - 96 in 1 minute. Leukocytosis - 12 x 109.
1. Your diagnosis?
2. Etiology and pathogenesis of this disease?
3. Classification of the disease?
4. What pathology should be used for differential diagnosis?
5. Possible complications of this disease?
6. The scope of the patient's examination?
7. Options for treatment tactics in this pathology?
8. Directions of conservative therapy?
9. The nature and scope of surgical intervention in this pathology?
10. Postoperative complications.

Head of Department _______________________________

presence of complications such as recurrent bleeding. Without successful management, the prognosis can
be poor, with a high risk of further bleeding episodes and mortality.

blob:[Link] 28/05/24, 10:37 PM

Page 5 of 5
FSBEI HE «Mari State University» Approve
Medical Institute Director of the Medical Institute
Study program: 31.05.01 General medicine _________________ [Link]. Struchko
«_____» _________________ 2024

STATE EXAMINATION
SITUATIONAL TASK № 60

A 28-year-old woman complains about the presence of a formation in the left armpit area,
which during the menstrual cycle becomes denser, slightly painful. The formation of a rounded
shape, 4 cm in diameter, soft-elastic consistency, has a lobular structure.
1. Your diagnosis?
2. What additional methods of examination allow you to verify the diagnosis?
3. What is the danger of this disease?
4. Tactics for this pathology?
5. With which disease should this pathology be differentiated?

Head of Department _______________________________

Common questions

Management of hemorrhoids initially involves conservative measures such as dietary modifications, topical treatments, and possibly minimally invasive procedures like rubber band ligation if symptoms persist . In contrast, managing fecal impaction begins with rectal disimpaction, followed by dietary and lifestyle changes, along with the use of laxatives to maintain bowel movements . Both conditions require careful monitoring, but the treatment strategies and initial interventions differ based on their distinct pathophysiologies.

A differential diagnosis for acute abdominal pain suggestive of appendicitis involves distinguishing it from other conditions like gastroenteritis, urinary tract infections, gynecological disorders (such as ectopic pregnancy or ovarian cysts), and other causes of acute abdomen such as perforated peptic ulcer or pancreatitis. Diagnostic methods include thorough history taking, physical examination, laboratory tests like complete blood counts, and imaging studies such as an abdominal ultrasound or CT scan .

Gastric ulcers often result from compromised mucosal defenses against gastric acids, influenced by factors such as Helicobacter pylori infection, NSAID use, and stress. In contrast, duodenal ulcers are typically associated with increased gastric acid secretion and a faster gastric emptying process. Protective factors in the duodenum may also be compromised, leading to ulceration. Both conditions require different management strategies based on their distinct pathophysiologies .

Diagnosing chronic constipation with fecal impaction in a 15-year-old involves understanding the patient's history of bowel habits, which in this case includes reliance on daily cleansing enemas leading to fecal impaction. Factors such as diet, physical activity, hydration, use of medications, and any underlying medical conditions must be considered. Abdominal imaging and stool studies are recommended to further confirm the diagnosis and rule out other causes .

The primary considerations in managing the postoperative period for a perforated stomach ulcer complicated by peritonitis include close hemodynamic monitoring, optimization of fluid and electrolyte balance, early enteral nutrition when feasible, effective pain control, and prevention of complications such as sepsis, organ failure, and deep vein thrombosis. Regular assessment of the abdomen and vital signs is crucial to monitor the treatment response, and prompt escalation of therapy is necessary if clinical deterioration is observed .

Early enteral nutrition is emphasized in the management of patients post-abdominal surgery to promote gut integrity, reduce the risk of infections, and enhance recovery. It helps maintain mucosal function, supports the immune system, and reduces the incidence of complications like infections or ileus by stimulating gastrointestinal motility. This approach contrasts with prolonged fasting, which can result in nutritional deficiencies and delayed recovery .

Management of suspected acute cholecystitis with fever and jaundice involves initial supportive care including fluid resuscitation, pain management, and broad-spectrum antibiotics. Diagnostic confirmation via imaging such as ultrasound or CT is essential. If the diagnosis is confirmed, early cholecystectomy is often recommended to prevent complications. In high-risk patients or those not stable for surgery, percutaneous cholecystostomy may be considered as an interim solution .

Postoperative complications in patients treated for peritonitis can include infection or abscess formation, deep vein thrombosis, organ failure, and adhesion formation leading to bowel obstruction. Prevention strategies involve maintaining strict aseptic techniques during surgery, administering prophylactic antibiotics, early mobilization, optimization of fluid and electrolyte balance, and close monitoring for signs of sepsis or organ dysfunction. Regular evaluations using vital signs and laboratory parameters are essential for early detection and intervention .

Conservative treatment options for hemorrhoids include lifestyle and dietary modifications, topical treatments, and sitz baths. Surgery is indicated in cases of symptomatic hemorrhoids that do not respond to conservative management, especially in cases of severe bleeding or prolapse. Surgical options include hemorrhoidectomy, stapled hemorrhoidopexy, or minimally invasive procedures like rubber band ligation or sclerotherapy depending on severity and classification of the hemorrhoids .

Indications for surgical intervention in complicated chronic pancreatitis include persistent abdominal pain not responsive to medical management, obstructive symptoms such as jaundice due to bile duct compression, and complications like pseudocysts or pancreatic necrosis. Types of procedures could include drainage techniques, resection surgeries like Whipple's procedure, or decompressive surgery depending on the underlying anatomical and pathological findings .

Abdominal Pain Diagnosis and Treatment Guide
No ratings yet
Abdominal Pain Diagnosis and Treatment Guide
25 pages
Clinical Tasks for Surgical Diagnosis
No ratings yet
Clinical Tasks for Surgical Diagnosis
9 pages
Apenectomy Surgical Case Analysis
No ratings yet
Apenectomy Surgical Case Analysis
66 pages
FS
No ratings yet
FS
29 pages
Clinical Diagnoses and Treatments in Surgery
No ratings yet
Clinical Diagnoses and Treatments in Surgery
24 pages
Of Clinical Surgical Situations4
No ratings yet
Of Clinical Surgical Situations4
9 pages
Anal Canal Conditions and Treatments
No ratings yet
Anal Canal Conditions and Treatments
50 pages
Usmle 2019 - 102537
No ratings yet
Usmle 2019 - 102537
6 pages
Gastroenterology Case Studies and Diagnoses
No ratings yet
Gastroenterology Case Studies and Diagnoses
23 pages
ГИА-2025: Вопросы по хирургии
No ratings yet
ГИА-2025: Вопросы по хирургии
6 pages
Surgery Revision
No ratings yet
Surgery Revision
10 pages
Surgical Internship Curriculum Questions
No ratings yet
Surgical Internship Curriculum Questions
38 pages
Surgery Problem
No ratings yet
Surgery Problem
17 pages
Task Surgery Exam
No ratings yet
Task Surgery Exam
59 pages
Task Surgery Exam
No ratings yet
Task Surgery Exam
59 pages
Osce
No ratings yet
Osce
55 pages
Control Tasks Surgery 4 TH Yr
No ratings yet
Control Tasks Surgery 4 TH Yr
11 pages
Surgical Case Studies and Diagnoses
No ratings yet
Surgical Case Studies and Diagnoses
17 pages
CLINICAL CASe Fomative Assesment
No ratings yet
CLINICAL CASe Fomative Assesment
9 pages
Acute Cholecystitis Case Study
No ratings yet
Acute Cholecystitis Case Study
9 pages
Surgical Pathology Case Studies Summary
No ratings yet
Surgical Pathology Case Studies Summary
31 pages
Coprostasis and Choledocholitis Cases
No ratings yet
Coprostasis and Choledocholitis Cases
15 pages
Usmle 2019 - 102537
No ratings yet
Usmle 2019 - 102537
6 pages
5 Курс Англ Тест (Numbered)
No ratings yet
5 Курс Англ Тест (Numbered)
127 pages
Neoplasiacharts
No ratings yet
Neoplasiacharts
14 pages
Colorectal Cancer and Hemorrhoid Diagnosis Guide
No ratings yet
Colorectal Cancer and Hemorrhoid Diagnosis Guide
38 pages
Hirsutism and Its Diagnostic Challenges
No ratings yet
Hirsutism and Its Diagnostic Challenges
137 pages
Abdominal Pain Case Studies and Diagnoses
No ratings yet
Abdominal Pain Case Studies and Diagnoses
16 pages
Surgical Exam3
No ratings yet
Surgical Exam3
51 pages
Abdominal Pain Diagnosis and Management
No ratings yet
Abdominal Pain Diagnosis and Management
20 pages
Left Hypochondrial Mass Case Study
No ratings yet
Left Hypochondrial Mass Case Study
21 pages
Surgery BMC Ospes 2024
No ratings yet
Surgery BMC Ospes 2024
13 pages
Emergency Room Patient Case Studies
No ratings yet
Emergency Room Patient Case Studies
12 pages
Surgical Exam6
No ratings yet
Surgical Exam6
53 pages
Surgery OSCE Scenarios for Final Year MBBS
100% (1)
Surgery OSCE Scenarios for Final Year MBBS
31 pages
Surgery OSCE Revision Guide
No ratings yet
Surgery OSCE Revision Guide
188 pages
Surgery Problem Cards for Hernia and Abdominal Masses
No ratings yet
Surgery Problem Cards for Hernia and Abdominal Masses
17 pages
Medical Diagnosis and Complications Quiz
No ratings yet
Medical Diagnosis and Complications Quiz
18 pages
Case Scenario (Prof - Nat)
No ratings yet
Case Scenario (Prof - Nat)
58 pages
Acute Abdominal Conditions and Symptoms
No ratings yet
Acute Abdominal Conditions and Symptoms
15 pages
Cholecystitis and Appendicitis Cases
No ratings yet
Cholecystitis and Appendicitis Cases
32 pages
Malignant Colon Neoplasm Case Study
No ratings yet
Malignant Colon Neoplasm Case Study
32 pages
Surgical Management MCQs for Emergencies
No ratings yet
Surgical Management MCQs for Emergencies
33 pages
Hemorrhoids Causing Bloody Stool
No ratings yet
Hemorrhoids Causing Bloody Stool
8 pages
Surgical Case Studies on Hernias and GI Issues
No ratings yet
Surgical Case Studies on Hernias and GI Issues
9 pages
تجميعات جراحة
No ratings yet
تجميعات جراحة
23 pages
Rectal Carcinoma Case Study Analysis
No ratings yet
Rectal Carcinoma Case Study Analysis
9 pages
General Surgery Case Studies and Assessments
No ratings yet
General Surgery Case Studies and Assessments
49 pages
Understanding OSCE: Clinical Examination Guide
No ratings yet
Understanding OSCE: Clinical Examination Guide
158 pages
Surgical Case Studies and Management Plans
No ratings yet
Surgical Case Studies and Management Plans
10 pages
Gastric Cancer Case Study and Diagnosis
No ratings yet
Gastric Cancer Case Study and Diagnosis
47 pages
Spot PPT Final
No ratings yet
Spot PPT Final
46 pages
Stomach Carcinoma Patient Case Study
No ratings yet
Stomach Carcinoma Patient Case Study
4 pages
Emergency Medical Case Studies and Management
No ratings yet
Emergency Medical Case Studies and Management
16 pages
Sigmoid Colon Malignancy Evaluation
No ratings yet
Sigmoid Colon Malignancy Evaluation
5 pages
Systemic Surgery (Solved Ajk 2025)
No ratings yet
Systemic Surgery (Solved Ajk 2025)
13 pages
Abdominal Mass Case: Possible Stomach Cancer
No ratings yet
Abdominal Mass Case: Possible Stomach Cancer
23 pages
Case Study: 50-Year-Old with Rectal Bleeding
No ratings yet
Case Study: 50-Year-Old with Rectal Bleeding
52 pages
Abdomen
No ratings yet
Abdomen
30 pages
Typhoid Ileal Perforation Management
No ratings yet
Typhoid Ileal Perforation Management
5 pages
Appendicitis Pathophysiology Explained
No ratings yet
Appendicitis Pathophysiology Explained
3 pages
Understanding Acute Appendicitis
No ratings yet
Understanding Acute Appendicitis
5 pages
Postoperative Care for Appendicitis
No ratings yet
Postoperative Care for Appendicitis
22 pages
Understanding Gastroesophageal Reflux Disease
No ratings yet
Understanding Gastroesophageal Reflux Disease
13 pages
Abdominal Tuberculosis: Diagnosis & Management
No ratings yet
Abdominal Tuberculosis: Diagnosis & Management
9 pages
Evaluating Adult Abdominal Pain
No ratings yet
Evaluating Adult Abdominal Pain
13 pages
Burns Management and Complications Guide
No ratings yet
Burns Management and Complications Guide
54 pages
Overview of Peritonitis Types and Management
100% (1)
Overview of Peritonitis Types and Management
28 pages
Indicación Relaparotomia
No ratings yet
Indicación Relaparotomia
6 pages
The Management of Intra Abdominal Infections From A Global Perspective 2017 WSES Guidelines For Management of Intra Abdominal Infections
No ratings yet
The Management of Intra Abdominal Infections From A Global Perspective 2017 WSES Guidelines For Management of Intra Abdominal Infections
34 pages
Peritonitis Nursing Care Overview
No ratings yet
Peritonitis Nursing Care Overview
10 pages
Management of Anastomotic Leaks
No ratings yet
Management of Anastomotic Leaks
28 pages
Surgical Diseases Course Notes for Students
No ratings yet
Surgical Diseases Course Notes for Students
298 pages
Veterinary Emergencies Guide
No ratings yet
Veterinary Emergencies Guide
114 pages
Acute Abdomen: Diagnosis & Management
No ratings yet
Acute Abdomen: Diagnosis & Management
40 pages
Peritoneal Dialysis-Associated Peritonitis: Cheuk-Chun Szeto and Philip Kam-Tao Li
No ratings yet
Peritoneal Dialysis-Associated Peritonitis: Cheuk-Chun Szeto and Philip Kam-Tao Li
6 pages
Understanding Acute Appendicitis
No ratings yet
Understanding Acute Appendicitis
29 pages
Medical Knowledge Assessment Questions
No ratings yet
Medical Knowledge Assessment Questions
46 pages
Radiological Findings in Pediatric TB Peritonitis
No ratings yet
Radiological Findings in Pediatric TB Peritonitis
7 pages
Intra-Abdominal Sepsis & Abscess Guide
No ratings yet
Intra-Abdominal Sepsis & Abscess Guide
9 pages
Documenting Abdominal Auscultation Sounds
No ratings yet
Documenting Abdominal Auscultation Sounds
18 pages
Pediatric Acute Abdomen Diagnosis Guide
No ratings yet
Pediatric Acute Abdomen Diagnosis Guide
32 pages
Tuberculous Peritonitis: Diagnosis & Treatment
No ratings yet
Tuberculous Peritonitis: Diagnosis & Treatment
16 pages
Online Registration for Dr. Soetomo Hospital
No ratings yet
Online Registration for Dr. Soetomo Hospital
2 pages
Emergency Surgery for Fecal Impaction
No ratings yet
Emergency Surgery for Fecal Impaction
83 pages
Abdominal Emergencies Overview
No ratings yet
Abdominal Emergencies Overview
3 pages
2020 Guidelines for Perforated Peptic Ulcer
No ratings yet
2020 Guidelines for Perforated Peptic Ulcer
27 pages
Intraabdominal Infections Overview
No ratings yet
Intraabdominal Infections Overview
42 pages