10 - SURGERY

A 21-year-old man with a cut wound on the hand

presents to the Emergency Room. He cut himself
working in the garden. He presented a record
confirming he had received all mandatory vaccinations
– the last Td dose 3 years ago. Choose the
recommended tetanus prevention:
 A
Neither vaccine nor specific immunoglobulin is needed.
84%
 B
One dose of Td or T vaccine is recommended.
11%
 C
Give one dose of Td or T vaccine and fix the date for two consecutive doses (after 1
month and 6 months).
1%
 D
One dose of Td or T vaccine and one dose of a specific immunoglobulin are
recommended.
3%
 E
One dose of Td or T vaccine and one dose of a specific immunoglobulin are recommended; fix
the date for two consecutive doses of the vaccine (after 1 month and 6 months).
„Open surgical debridgement” – the operative method,
which consists of several scheduled repeated
laparotomies connected with necrectomy, debridement
and lavage is the golden standard in:
 A
Mechanical ileus.
4%
 B
Acute necrotic pancreatitis.
87%
 C
Chronic pancreatitis.
5%
 D
Pancreatic cancer.
2%
 E
Acute appendicitis.
An 8 month-old girl has been suffering from sharp
attacks of uneasiness and cry for 4 hours. During the
 attacks she raises her legs upwards. Between the
episodes the infant is apathetic, sleepy and pale. She
vomited several times and expelled one stool looking
like „raspberry jelly”. On physical exam flatulence and a
mass in right upper quadrant were found. On rectal
exam small amounts of blood and mucus were found.
Radiograms revealed asymmetric bowel gases and fluid
levels. In ultrasound a „sign of a shield” was seen.
What’s the most probable diagnosis?
 A
Acute appendicitis
2%
 B
Incarcerated umbilical hernia
3%
 C
Intestinal invagination
90%
 D
Acute Meckel’s diverticulum inflammation
4%
 E
Acute mesenterial lymphadenitis
In a patient with cholecystolithiasis and
choledocholithiasis the correct combination of treatment
is:
 A
Only endoscopic removal of the deposits.
5%
 B
Laparoscopic cholecystectomy and after a few days endoscopic removal of the
deposits.
14%
 C
Endoscopic removal of the deposits and after a few days laparoscopic
cholecystectomy.
75%
 D
Only laparoscopic cholecystectomy.
5%
 E
Only open cholecystectomy.
In a patient with paroxysmal atrial fibrillation there was a
sudden cooling, livedo and weakness of lower limb.
 There was no previous lower limb ischemia. Taking into
consideration the most probable reason the best
treatment is:
 A
Vasodilatation drugs.
2%
 B
Intra-arterial heparin administration (to femoral artery).
20%
 C
Intra-arterial streptokinase administration (to femoral artery).
10%
 D
Intra-arterial tissue plasminogen activator administration (to femoral artery).
8%
 E
Lower-limb arteries embolectomy.
In the case of surgeon’s intraoperative injury the proper
behavior is:
1) HIV and HCV examination in the surgeon;
2) HIV and HCV examination in the patient;
3) in every case surgeon’s anti-retrovirus treatment.
The correct answer is:
 A
Only 1.
3%
 B
Only 2.
9%
 C
1,2.
67%
 D
2,3.
5%
 E
1,2,3.
The drainage of the pleural cavity for fluid evacuation
should be made in:
 A
3rd – 4th intercostal space in posterior axillary line.
4%
 B
5th – 6th intercostal space in posterior axillary line.
46%
 C
 3rd – 4th intercostal space in anterior axillary line.
5%
 D
5th – 6th intercostal space in anterior axillary line.
21%
 E
7th – 8th intercostal space in posterior axillary line.
In an 80-years old woman prepared to elective surgery
for an abdominal aortic aneurysm of 85 mm in diameter
without iliac arteries dilatation, you discovered heart
insufficiency with ejection fraction 30%. In this case the
best method of aneurysm treatment is:
 A
Open surgery with straight tube implantation.
5%
 B
Open surgery with bifurcated tube implantation.
8%
 C
Endovascular surgery.
71%
 D
Aneurysm of 85 mm in diameter is not the indication for surgery.
2%
 E
30% ejection fraction is absolute contraindication for any type of surgery.
A 71-years old patient was admitted to hospital due to
severe hematemesis. For the last week he has used a
lot of non-steroid anti-inflammatory drugs. He is also on
long-term acetylsalicylic acid treatment. Taking into
consideration the most probable reason of bleeding the
routine procedure includes:
1) recombinant factor VII;
2) gastroscopy;
3) laparotomy and surgical closure of the bleeding site;
4) thrombocyte concentrate transfusion.
The correct answer is:
 A
Only 2.
71%
 B
1,2.
6%
 C
 2,3.
7%
 D
2,4.
14%
 E
Only 4.
In a patient with abdominal trauma, an examination
revealed splenic rupture. The proper treatment is:
1) leaving the rupture – hematoma surrounding the
ruptured spleen will stop the bleeding;
2) attempting to stop the bleeding (capsule suture, glue
of the spleen);
3) splenectomy if the attempt to stop the bleeding is
unsuccessful;
4) leaving small pieces of the removed spleen in the
greater omentum.
The correct answer is:
 A
Only 1.
2%
 B
1,2.
1%
 C
2,3.
31%
 D
3,4.
8%
 E
2,3,4.
The optimal time of creation (point 1-3) and the site of
the primary arteriovenous fistula for hemodialysis (point
4-5) is:
1) few months before dialysis;
2) few days before dialysis;
3) after the beginning of the dialysotherapy – first
dialysis should be made with central catheter;
4) on forearm;
 5) on arm.
The correct answer is:
 A
1 and 4.
77%
 B
1 and 5.
5%
 C
2 and 4.
10%
 D
2 and 5.
3%
 E
3 and 4.
In the case of neoplasmatic oesophagostenosis the
best method of persistent nutrition could be:
 A
Intravenous glucose solution.
1%
 B
Peripheral vein intravenous nutritional mixture.
2%
 C
Central vein intravenous nutritional mixture.
9%
 D
Nutritional mixture through gastrostomy.
87%
 E
Anal feeding with nutritional mixture.
A patient was admitted to hospital due to chest trauma.
In x-ray a rupture of 7- th and 8-th rib was found (on the
right side). The correct management is:
 A
Surgical anastomosis of broken ribs.
3%
 B
Relaxation and intubation of the patient.
2%
 C
Chest bandage.
10%
 D
Analgetic drugs.
83%
 E
Pleural cavity drainage.
 Portal hypertension may present with the following
conditions except for:
 A
Horner’s syndrome.
91%
 B
Esophageal varices.
1%
 C
Hepatorenal syndrome.
1%
 D
Jaundice.
6%
 E
Ascites.
Which of the statements related to paronychia are true?
1) it is inflammation of the tissues surrounding nail;
2) ingrown nail is the source of infection;
3) infection results in subcutaneous abscess formation
at the base of the nail;
4) generalized symptoms of infection are always
present;
5) incision of the abscess is the proper treatment.
The correct answer is:
 A
1,2,3,5.
84%
 B
1,2.
4%
 C
1,4,5.
2%
 D
1,2,5.
8%
 E
1,2,3,4.
Which of the following procedures can be performed
laparoscopically?
1) cholecystectomy;
2) appendectomy;
3) adrenalectomy;
 4) nephrectomy;
5) inguinal hernia repair.
The correct answer is:
 A
1,2.
5%
 B
1,2,3.
4%
 C
1,2,3,4.
11%
 D
1,2,4.
1%
 E
All of them.
The most characteristic clinical symptoms of cholangitis
inducted by E. coli are:
1) fever;
2) pruritius;
3) jaundice;
4) hypotension;
5) pain in the upper right quadrant of the abdomen.
The correct answer is:
 A
All of them.
31%
 B
1,2,3,4.
3%
 C
1,3,5.
63%
 D
1,3,4.
2%
 E
None.
The most typical symptoms of Crohn’s disease include:
1) disease localizes only in the terminal ileum and right
colon;
2) inflammatory process involves all layers of the
intestinal wall and mesentery;
 3) disease is frequently complicated with intraabdominal
abscesses;
4) surgical treatment includes resection of the terminal
ileum and colon.
The correct answer is:
 A
1,4.
1%
 B
1,2,3.
3%
 C
2,3.
90%
 D
1,3,4.
2%
 E
All of them.
Melaena is the symptom of:
1) gastric carcinoma;
2) duodenal ulcer;
3) tumor of the small intestine;
4) right colon carcinoma;
5) left colon carcinoma.
The correct answer is:
 A
Only 5.
1%
 B
1,2.
22%
 C
1,2,3.
65%
 D
4,5.
2%
 E
All of them.
Hospital treatment of cold injury includes:
1) rewarming of the frostbiten parts and the body;
2) tetanus prophylaxis;
3) pain management;
 4) broad-spectrum antibiotic therapy;
5) vasodilatants administration.
The correct answer is:
 A
1,2,3.
18%
 B
3,4,5.
2%
 C
1,3,5.
14%
 D
2,3,5.
2%
 E
All of them.
After the reduction of a dislocated elbow the
immobilization should last:
 A
1 week.
3%
 B
2-3 weeks.
44%
 C
6 weeks.
19%
 D
Depending of the type of dislocation.
29%
 E
Immobilization is not necessary.
For the third degree burns typical finding is not:
 A
Tissue necrosis.
10%
 B
A ring of the second and first degree burn around the site of the third degree burn.
7%
 C
Thromboembolic changes in the vessels of the burn site.
4%
 D
Absent or insignificant pain.
17%
 E
No damage to the tissues below third degree site.
 A medical emergency team should be called when you
find:
1) a sudden onset of bradycardia (below 40/min) or
tachycardia (above 130/min);
2) systolic pressure decrease below 90 mm Hg;
3) sudden fluctuations in respiratory rate, below 8/min
and above 30/min;
4) sudden decrease in oxygen saturation level below
90% despite normobaric oxygen therapy;
5) sudden consciousness disturbances – no motor
response to painfull stimuli, no verbal response.
The correct answer is:
 A
1,2,3.
3%
 B
2,3,4.
1%
 C
3,4,5.
7%
 D
All of them.
85%
 E
1,3,5.
The most common localization of the aneurysms of the
peripheral arteries is:
 A
The internal carotid artery.
5%
 B
The basilar artery.
15%
 C
The internal iliac artery.
14%
 D
The brachial artery.
1%
 E
The popliteal artery.
The posterior wall (floor) of the inguinal canal is formed
by:
 A
The lower border of the internal obliqe abdominis muscle.
11%
 B
The lower border of the transversus abdominis muscle.
6%
 C
Transversalis fascia.
65%
 D
The inguinal ligament.
6%
 E
The aponeurosis of the external oblique abdominis muscle.
Ranson's criterion is a clinical prediction rule for the
prediction of the severity of:
 A
Carcinoma of the cervix.
2%
 B
Crohn's disease.
4%
 C
Cirrhosis of the liver.
5%
 D
Acute pancreatitis.
84%
 E
Stomach carcinoma.
Which of the following lesions of the large intestine is
characterized by the highest risk of malignant
transformation?
 A
Tubulovillous adenoma.
3%
 B
Villous adenoma.
79%
 C
Tubular adenoma.
8%
 D
Hyperplastic tumor.
7%
 E
All of the above have similar risk of malignant transformation.
A 65-year-old man who suffers from chronic
constipation has had an aggravating pain in the left
 lower quadrant of the abdomen (iliac fossa) for the last
5 days. On admission he has diffuse pain of the
abdomen and presents with peritoneal signs. All of the
below examinations are favored except:
 A
Colonoscopy.
70%
 B
Ultrasound.
5%
 C
CT scan.
5%
 D
MRI.
13%
 E
Plain abdominal x-ray.
A patient was hospitalized for 6 weeks because of acute
pancreatitis. Three weeks after discharge from the
hospital he started to feel epigastric pain accompanied
by increasing fever. During examination a painful, fixed
mass can be palpated in the epigastrium. The most
likely diagnosis is:
 A
Pancreatic pseudocyst.
32%
 B
Abscess.
61%
 C
Cyst.
3%
 D
Neoplastic tumor.
2%
 E
Recurrent acute pancreatitis.
A 86-year-old woman with a history of a stroke which
occurred a few months ago is bedridden. She has had
an evacuation problems for some time but for three
days she has been completely unable to defecate and
pass the gasses. She also complains of severe
abdominal pain. The abdomen is distended and bowel
 movements typical of mechanical bowel obstruction.
What should be done first?
 A
Abdominal x-ray.
25%
 B
Administration of spasmolytics.
5%
 C
Digital rectal examination.
59%
 D
I.v. infusion of fluids.
3%
 E
Enema.
According to the rule of 9's, the surface area affected by
the burn of the front of the trunk and both upper
extremities stands for:
 A
10%.
0%
 B
18%.
2%
 C
27%.
11%
 D
36%.
83%
 E
45%.
Which of the following statements concerning acute
appendicitis is true?
 A
It is the most common inflammatory disease of the abdomen; occurs mostly in the
elderly.
1%
 B
Males are affected more frequently than females; urinary tract disorders most often
mimic the symptoms of appendicitis.
4%
 C
Starts as a pain in the right iliac fossa; leucocyte count is one of the crucial factors
of the diagnosis.
4%
 D
 Abdominal ultrasound determines the diagnosis; appendectomy is the only possible
treatment of diagnosed appendicitis.
6%
 E
The diagnosis of appendicitis is based on a thorough history and physical examination;
urological and gynecological diseases are the most frequent ones in differential diagnosis.
Which of the listed symptoms is not characteristic of the
mechanical bowel obstruction?
 A
Abdominal distention.
3%
 B
Vomiting.
20%
 C
Inability to pass gas or stool.
3%
 D
Lack of bowel movements.
71%
 E
Abdominal pain.
A patient with permanent atrial fibrillation had an onset
of an acute pain in the right lower extremity. On
examination the GP found the right limb cold and pale.
The right limb has no palpable pulses. Patient is unable
to move the foot. What is the most important emergency
treatment before the patient gets to hospital?
 A
Placement of the limb on a soft bedding.
1%
 B
Heparin bolus.
87%
 C
High doses of the vasodilatators.
4%
 D
Administration of analgetics.
7%
 E
Cooling the affected limb.
1
Which of the following examinations is least useful in
diagnosis of the mechanical bowel obstruction?
 A
Abdominal X-ray.
5%
 B
 Barium enema.
18%
 C
Auscultation of the abdomen (type of bowel movements).
15%
 D
Abdominal CT scan.
38%
 E
Upper GI and bowel series.
A method of choice in the diagnosis of the icterus
mechanicus (obstructive jaundice) is:
 A
Abdominal ultrasound.
16%
 B
Endoscopic retrograde cholangiopancreatography – ERCP.
77%
 C
Abdominal CT scan.
2%
 D
Percutaneous transhepatic cholangiography – PTHC.
3%
 E
Abdominal X-ray.
Advanced carcinoma of the coecum presents with:
1) tumor in the right iliac fossa;
2) diarrhoea;
3) anaemia;
4) hypoalbuminemia;
5) right hypogastric pain.
The correct answer is:
 A
1,2,3.
7%
 B
2,3,4.
2%
 C
3,4,5.
2%
 D
1,3,4.
5%
 E
1,3,5.
 The symptoms of the mechanical bowel obstruction are:
1) permanent abdominal pain;
2) recurrent abdominal pain;
3) inability to pass gas or stool;
4) hyperkalemia;
5) bradycardia.
The correct answer is:
 A
2,3.
93%
 B
2,4.
2%
 C
3,4.
4%
 D
1,4.
1%
 E
2,5.
The main symptoms of sigmoid cancer include:
1) narrowing of the stool (ribbon stools);
2) constipation and diarrhoea alternately;
3) elevated body temperature;
4) cachexia;
5) blood in the stool.
The correct answer is:
 A
1,2,4.
9%
 B
1,2,3.
1%
 C
2,3,5.
4%
 D
1,2,5.
85%
 E
2,3,4.
 A 28-year-old woman comes to the physician with
smooth, movable tumor in the upper external quadrant
of the mamma. The most likely diagnosis is:
 A
Fibrocystic breast disease.
24%
 B
Papilloma.
2%
 C
Fibroadenoma.
70%
 D
Phyllodes tumor.
1%
 E
Mammal carcinoma.
The presence of gallstones in the common bile duct can
be suspected when:
1) the common bile duct is distended;
2) the gallbladder contains numerous small gallstones;
3) a patient has a history of obstructive jaundice;
4) the cystic duct is obstructed;
5) the cystic duct is enlarged.
The correct answer is:
 A
All of the above.
37%
 B
1,2,3,5.
52%
 C
1,2,3,4.
9%
 D
4,5
1%
 E
3,4,5.
The most frequent clinical symptom after surgical
treatment of esophageal carcinoma is:
 A
Dysphagia
69%
 B
 Vomiting and eructation
7%
 C
Retrosternal pain during swallowing
10%
 D
Musculo-articular pain
1%
 E
Regurgitation
A 60-year-old obese woman comes to the emergency
department because of acute pain in the right upper
quadrant of the abdomen radiating to the right shoulder
and scapula. The pain occurred 5 hours earlier after
fatty meal. In the clinical examination there is a pain in
the right upper abdomen just below the margin of the
ribs, no peritoneal signs are present. Bowel movements
are normal. She had similar symptoms in the past. Most
likely diagnosis is:
 A
Perforated peptic ulcer.
2%
 B
Superior mesenteric artery embolism.
1%
 C
Left-sided renal colic.
1%
 D
Acute calculous cholecystitis.
94%
 E
Acute appendicitis.
Which vein is suitable and appropriate for the
performance of chronic TPN (total parenteral nutrition)?
 A
The median cubital vein.
4%
 B
The subclavian vein.
84%
 C
The cephalic vein.
5%
 D
The inferior vena cava.
 6%
 E
The saphenous vein.
Digital rectal examination evaluates:
1) the length of an anal canal;
2) the integrity and pressure of the sphincters;
3) the contents of the rectum;
4) the rectal wall;
5) the prostate gland.
The correct answer is:
 A
1,2,3,5.
4%
 B
1,2.
0%
 C
1,4,5
1%
 D
1,2,5
1%
 E
All of the above
„Acute abdomen” symptoms can be triggered by:
1) acute cholecystitis;
2) pancreatitis;
3) adbominal aortic aneurysm rupture;
4) acute mesenteric ischemia;
5) high levels of serum urea.
The correct answer is:
 A
1,2.
1%
 B
1,2,3.
1%
 C
3,4.
1%
 D
1,2,3,4.
21%
 E
All of the above.
 A 56-year-old woman is admitted to hospital with the
hemoptysis and acute epigastric pain. She has a history
of ischemic heart disease and substitution
hormonotherapy. During physical examination she
presents a central cyanosis. The most likely diagnosis
is:
 A
Acute pancreatitis.
1%
 B
Pulmonary embolism.
87%
 C
Myocardial infarction.
2%
 D
Pneumonia.
1%
 E
Perforated duodenal ulcer.
The criteria of the diagnosis of thrombangitis obliterans
(Burger's disease) are:
 A
It affects mainly males under 40.
2%
 B
Preceded by the migrating thrombophlebitis.
2%
 C
Strongly associated with the use of tobacco products.
7%
 D
Absent pulses on pedal and popliteal arteries.
2%
 E
All of the above.
A 42-year-old patient during his visit to the Emergency
Department presents with severe pain in the left buttock
and anus making him unable to sit; the symptoms are
aggravated during defecation. The pain has lasted for 4
days and is accompanied by temperature of 38
degrees. During clinical examination there is a swelling
and redness in the anal area extending to the left
 buttock. Rectal digital examination is painful and reveals
hot protrusion in this area. The treatment would be:
 A
Analgetics, antibiotics administration and referral to outpatient clinic in 3 days.
4%
 B
Anti-inflammatory ointments and analgetics.
1%
 C
Antibiotic ointments, sitz baths and analgetics.
4%
 D
Urgent surgical treatment (excision and drainage).
86%
 E
Observation in the surgical ward, sitz baths, iv antibiotic and analgetics.
The risk factors for the esophageal carcinoma are:
1) GERD (gastrointestinal reflux disease);
2) esophageal mucosa atrophy due to iron deficiency;
3) alcohol overuse;
4) smoking;
5) ingestion of hot foods.
The correct answer is:
 A
1,2,3,5.
4%
 B
1,2.
1%
 C
,4,5.
3%
 D
1,2,5.
1%
 E
Al of the above.
Coumarin-based anticoagulants administration has to
be monitored by the blood testing of:
 A
APTT.
6%
 B
INR.
89%
 C
 Platelet count.
2%
 D
Serum fibrinogen.
1%
 E
None of the above.
Renal artery stenosis can lead to:
 A
Hypertension.
63%
 B
Hematuria.
0%
 C
Proteinuria.
0%
 D
Carcinoma of the kidney.
0%
 E
All of the above are true.
The advancement of the chronic venous insufficiency
can be evaluated by means of:
1) clinical examination;
2) duplex ultrasonography imaging of the deep and
superficial veins;
3) plethysmography;
4) phlebography of the leg veins;
5) arteriography of the leg arteries.
The correct answer is:
 A
1,2,4,5.
16%
 B
1,2.
10%
 C
4,5.
1%
 D
1,2,5.
1%
 E
1,2,3,4.
 Wide excision of a breast cancer (breast-conserving
therapy):
 A
Is performed in cases of small tumors.
4%
 B
Means a local excision of a breast segment with the tumor.
5%
 C
Simultaneous axillar lymphadenectomy is absolutely necessary.
2%
 D
Postoperative irradiation is always performed.
2%
 E
All are true.
The best prognosis after surgical treament of liver
metastases is in the case of primary tumor:
 A
Gastric cancer.
6%
 B
Melanoma.
3%
 C
Breast cancer.
9%
 D
Colorectal cancer.
80%
 E
Carcinoma of pancreas.
The patent had an open fracture of the femur, as a
result of a traffic accident. The fracture was treated
surgically. On the next day the patient complains of
severe pain, not controlled by high doses of
analgaetics. He is pale, sweating and delirious,
although he has no high temperature. The wound is
swollen and very sore. No crepitations are palpable.
After removal of one stitch an ichorous, greyish fluid
appeared. The most probable diagnosis is:
 A
MRSA infection.
11%
 B
 Gas gangraene.
74%
 C
Early strepotococcal phlegmon.
12%
 D
Massive E. coli infection.
3%
 E
Meningococcal infection.
In the postoperative course after hemicolectomy, the
patent presents symptoms of deep venous thrombosis
of the leg. He has to be treated with low molecular
heparin. The dose depends on:
 A
PT and INR.
8%
 B
APTT.
10%
 C
Patient’s weight.
78%
 D
Platelet count.
2%
 E
Extent of the thrombosis as assessed in Doppler-sonography.
After a routine examination of the removed gallbladder,
the pathologist reported the presence of carcinomatous
infiltration. The optimal proceeding is:
 A
Observation and monitoring with ultrasound.
4%
 B
Reoperation: excision of liver tissue within the gallbladder bed and
lymphadenectomy of the hepatoduodenal ligament.
87%
 C
Irradiatin of the right epigastrium followed by “second look” laparotomy.
6%
 D
Only chemotherapy.
2%
 E
The patient does not require any therapy.
40-years-old male patent was two months ago
discharged from the hospital after severe pancreatitis.
 Now he complains of epigastric discomfort and he
noticed a swelling in this area. During physical
examination a large, immobile tumor with no tenderness
is palpable. Sonography reveals a large, thick-walled
space containing fluid. The optimal method of treatment
will be:
 A
Puncture and evacuation of fluid.
17%
 B
Incision and drainage.
27%
 C
Anastomosis with intestine or stomach.
51%
 D
Total removal of the tumor.
4%
 E
Resection of the pancreas with the tumor.
A 75-years old male patent suddenly fainted. He is pale
and sweating, complaining of epigastric pain as well as
back pain radiating to the left inguinal region. He has
tachycardia 130/min and low BP – 80/40 mm Hg. The
first steps in the diagnostic process would be:
 A
ECG and coronarography.
10%
 B
CT or MRI of the lumbar spine.
2%
 C
Gastroscopy.
6%
 D
Ultrasound or CT of the abdomen.
78%
 E
IVP and examination of urine.
Which of the following statements are true:
1) perforated stomach ulcer is an indication for the
emergency surgery;
2) the most frequent presentation of the perforated
stomach ulcer is sudden onset of a severe, sharp
 epigastric pain;
3) upright abdominal X-ray is a basic diagnostic method
of the perforated stomach ulcer;
4) typical presentation of the perforated stomach ulcer
on the abdominal X-ray is presence of the free air in the
peritoneal cavity (pneumoperitoneum).
The correct answer is:
 A
1,3.
1%
 B
1,2,3.
6%
 C
1,3,4.
2%
 D
2,3,4.
5%
 E
All above.
The most frequent stomach malignancy is:
 A
Adenocarcinoma.
91%
 B
Lymphoma.
2%
 C
Stromal tumor.
1%
 D
Squamous carcinoma.
5%
 E
All listed tumors are of similar frequency.
Endoscopic picture of the intensity of gastrointestinal
hemoohage is classified by:
 A
Ranson’s criteria.
3%
 B
APACHE II classification system.
5%
 C
Forrest’s classification.
89%
 D
Sengstaken.
2%
 E
Mallory.
False statement about diaphragmatic hernias is:
 A
Paraesophageal hiatal hernias are more frequent than sliding hiatal hernias.
78%
 B
Fundoplication is the surgical treatment of the hiatal hernias.
7%
 C
Sliding hiatal hernia produce symptoms of gastroesophageal reflux disease.
4%
 D
Complications of paraesophageal hernia include bleeding and incarceration.
4%
 E
The congenital diaphragmatic hernias derive from Bochdalek and Morgagni foramen.
Carcinoma of the cecum is characterized by:
1) tumor in the right iliac fossa;
2) pain in the right lower abdomen;
3) anemia;
4) vomiting;
5) diarrhea.
The correct answer is:
 A
1,2,3.
91%
 B
2,3,4.
1%
 C
3,4,5.
1%
 D
1,3,4.
1%
 E
1,2,5.
The symptoms of perforated duodenal ulcer include: 1)
melena; 2) vomiting with traces of blood; 3) periodic
abdominal pain; 4) stoppage of flatus; 5) abdominal
guarding. The correct answer is:
 A
 1,2.
20%
 B
3,4.
3%
 C
4,5.
45%
 D
2,5.
16%
 E
1,5.
Panaritium:
1) is an infection of the palmar surface of fingers and
hand;
2) is a fungal infection;
3) is a hematogenous bacterial infection;
4) treatment consists in incision, drainage and
immobilization;
5) is an affection of the nail fold.
The correct answer is:
 A
2,4.
2%
 B
3,4.
3%
 C
4,5.
15%
 D
1,4.
78%
 E
2,5.
Typical signs of sigmoid colon carcinoma include:
1) thin, pencil-like stools;
2) elevated body temperature;
3) anemia;
4) body weight loss;
5) blood in the stool.
The correct answer is:
 A
 1,4.
5%
 B
1,3.
6%
 C
2,5.
1%
 D
1,5.
88%
 E
2,3.
Three most common causes of upper GI bleeding
include:
1) stomach cancer;
2) gastric mucosal inflammation (haemorrhagic);
3) ulcer disease;
4) Mallory-Weiss syndrome;
5) esophageal varices.
The correct answer is:
 A
1,2,3.
11%
 B
2,3,4.
7%
 C
3,4,5.
17%
 D
1,3,4.
2%
 E
2,3,5.
Large bowel obstruction most frequently is caused by:
 A
Sigmoid colon carcinoma.
59%
 B
Carcinoma of the cecum.
8%
 C
Postoperative adhesions.
28%
 D
Crohn’s disease.
 2%
 E
Volvulus of the sigmoid colon.
Three most common causes of mechanical bowel
obstruction include:
1) postoperative adhesions;
2) colon cancer;
3) Meckel’s diverticulum;
4) intestinal intussuspection;
5) incarcerated hernia.
The correct answer is:
 A
1,2,5.
82%
 B
2,3,5.
3%
 C
1,3,4.
2%
 D
1,2,4.
11%
 E
1,3,5.
Symptoms of the cancer of the head of pancreas
include:
1) jaundice
2) elevated temperature
3) abdominal pains varying in intensity
4) increased diameter of the biliary ducts and enlarged
gallbladder on ultrasounds
5) anemia
The correct answer is:
 A
1, 2
3%
 B
3, 4
3%
 C
4, 5
1%
 D
3, 5
 1%
 E
1, 4
91%
The “preacher's hand” or “blessing hand” (“pope's
blessing”, “hand of benedection”) syndrome is typical
for:
 A
Ulnar nerve neuropraxia.
14%
 B
Medial nerve neuropraxia.
71%
 C
Radial nerve axonotmesis.
6%
 D
Ulnar nerve neurotmesis.
5%
 E
Radial nerve axonotmesis.
35 years old patient suffers from palpable tumor
localised in lower external right breast quadrant. The
structure is painful, and the skin above is redden and
warmened. The patient is feverish. In ultrasonographic
examination there is regular hipoechogenic structure,
7cm in diameter. Which management would be the
most appropriate?
 A
Incision and drainage of the breast abscess, additionaly antibiotics.
86%
 B
Complete excision of the tumor, and the histopathological examination.
7%
 C
Rivanol compress and empiric antibiotic therapy.
1%
 D
Fine needle biopsy with an antibiotic cover.
5%
 E
None of the answers are correct.
Necrosis of toes can be the consequence of:
 A
Raynaud disease.
1%
 B
 Buerger disease.
1%
 C
Diabetes.
2%
 D
Correct answers are B and C.
55%
 E
All of the answers are correct.
Pregnant woman (8 month) suffers from strong pain in
right subcostal area. 2 years earlier she had a classic
cholecystectomy because of cholelithiasis. In physical
examination she has tachycardia (up to 140/min),
abdominal rigidity in projection of postlaparotomy scar,
positive Blumberg sign, no auscultable peristalsis. The
patient is feverish up to 38.0ºC, vomiting. Faetus pulse
is 140/min. In laboratory tests: liver function tests
normal, WBC 15 tys./mm³, CRP 120 mg/l. Which of the
diagnosis is the most probable?
 A
Diverticulitis
1%
 B
Cholangitis calculosa.
23%
 C
Postoperative adhesions.
4%
 D
Appendicitis.
72%
 E
Premature delivery.
The most frequent causes of acute pancreatitis include:
1) cholelithiasis;
2) high sodium diet;
3) alcohol;
4) low protein diet;
5) obesity.
The correct answer is:
 A
1,2.
 2%
 B
2,3.
2%
 C
1,4.
1%
 D
4,5.
1%
 E
1,3.
Which statements about inguinal hernia are true?
1) inguinal hernia is equally frequent in males and
females
2) each case of inguinal hernia has to be operated
3) tension-free (mesh) inguinal hernia operations gives
fewest number of recurrences
4) incarceration is more frequent than in femoral hernias
5) majority of inguinal hernias are bilateral
The correct answer is:
 A
1, 3
6%
 B
3, 4
48%
 C
2, 4
5%
 D
1, 5
1%
 E
2, 3
Classic pleurocentesis for pleural fluid evacuation
should be performed in:
 A
II intercostal space in midclavicular line.
6%
 B
IV-V intercostal space in midaxillary line.
14%
 C
III intercostal space in midclavicular line.
1%
 D
V-VI intercostal space in anterior axillary line.
14%
 E
VII-VIII intercostal space in posterior axillary line.
A patient operated for the large retrosternal nodular
goitre developed right sided myosis, ptosis and
enophtalmos after the procedure. Where in your opinion
the injury could occur?
 A
Oculomotorius nucleus in the brain.
3%
 B
Trunk of the vagus nerve.
10%
 C
Orbit.
3%
 D
Cervicothoracic sympathetic nerves.
83%
 E
Eye-ball.
Which of the following excludes the deceased as a
cadaver organ donor?
 A
Objection expressed by the deceased before his death.
90%
 B
Objection of the family.
2%
 C
Positive testing for HCV.
7%
 D
Alcoholism.
1%
 E
ICU treatment for the 14 days before the death.
Twenty four hours after cerebral injury a patient
develops increasing headache, nausea and apathy.
Which of the following is the most likely diagnosis?
 A
Increasing intracranial hypertension.
64%
 B
Hypertensive crisis.
1%
 C
Intracerebral bleeding.
4%
 D
Epidural hematoma.
19%
 E
Subdural hematoma.
Gastroscopic exam performed for the symptoms of
dyspepsia in a 60-year-old patient revealed crateriform
ulceration 4 cm in diameter in the subcardiac part of the
stomach on its lesser curvature. Histopathological
diagnosis of the biopsy specimens revealed gastric
cancer with an intestinal metaplasia. What type of the
surgical procedure is indicated for this patient?
 A
Total gastrectomy.
6%
 B
Total gastrectomy with lymphadenectomy.
78%
 C
Proximal gastrectomy.
8%
 D
Distal gastrectomy.
1%
 E
Distal gastrectomy with lypmphadenectomy.
A 56-year-old obese female patient was admitted to the
hospital because of an epigastric abdominal pain lasting
for the last 12 hours. On the ultrasound examination
cholelithiasis was found and retroperitoneal space was
not visualized. Lab testing revealed significantly
increased WBC count, elevated CRP and amylase
levels. What in your opinion is the most appropriate
treatment?
 A
Urgent laparoscopic cholecystectomy
19%
 B
Open cholecystectomy with intraoperative cholangiography
4%
 C
 ERCP
63%
 D
Careful monitoring of the patient in ICU
2%
 E
Fasting, iv fluids, antibiotics and observation
Acute appendicitis:
1) should not be approached laparoscopically;
2) is the most frequent at young age;
3) starts as a pain in the epigastrium which migrates
into the right lower abdomen;
4) is not found in patients over 50;
5) frequently coexists with Crohn's diesase.
The correct answer is:
 A
1,2.
3%
 B
3,4.
2%
 C
4,5.
1%
 D
2,3
94%
 E
2,4.
Which statements about inguinal hernia are true?
1) it is several times more frequent in males than
females;
2) only large hernias which had passed into the scrotum
should be operated;
3) mesh (tension-free) hernia repair tend to give the
best results;
4) it poses a risk of incarceration;
5) most frequently it is treated laparoscopically.
The correct answer is:
 A
1,2,3.
4%
 B
 1,3,4.
90%
 C
2,4,5.
1%
 D
1,2,5.
2%
 E
2,3,4.
The most frequent symptoms of advanced cecum
cancer are: 1) pain in the right lower abdomen; 2) tumor
over right iliac ala; 3) anemia; 4) melena; 5) cachexia.
The correct answer is:
 A
1,2,3.
82%
 B
2,3,4.
4%
 C
3,4,5.
3%
 D
1,3,4.
3%
 E
1,2,5.
The symptoms of perforated stomach or duodenal ulcer
include:
1) retention of gases (inability to pass gas);
2) melena;
3) hematemesis;
4) severe, sudden abdominal pain;
5) abdominal guarding.
The correct answer is:
 A
1,2,3.
2%
 B
2,3,4.
4%
 C
3,4,5.
12%
 D
1,2,5.
 3%
 E
1,4,5.
78%
The main symptoms of the cancer of the head of the
pancreas include:
1) coffee-grounds like vomiting;
2) painless obstructive jaundice;
3) enlarged gallbladder;
4) dilated biliary ducts;
5) splenomegaly.
The correct answer is:
 A
1,2,3.
2%
 B
2,3,4.
90%
 C
3,4,5.
2%
 D
2,4,5.
6%
 E
1,3,5.
1%
Segmental necrosis of the small intestine can be
caused by:
1) incarcerated hernia;
2) diabetes;
3) strangulation of the bowel over peritoneal adhesions;
4) mesenteric embolism;
5) porphyria.
The correct answer is:
 A
1,2,3.
3%
 B
2,3,4.
3%
 C
1,3,5.
4%
 D
1,3,4.
 88%
 E
1,2,4.
Panaritium:
1) is an inflammation of tissues of a finger;
2) frequently occurs without pain; pus evacuation and
stabilization;
3) is a blood-related infection;
4) is treated by an incision,
5) is caused by a trauma.
The correct answer is:
 A
1,2,3.
1%
 B
2,3,4.
2%
 C
1,4,5.
89%
 D
1,2,4.
7%
 E
1,2,5.
The most frequent symptoms of the sigmoid cancer
include:
1) narrow (pencil like) stools;
2) alternate diarrhea and constipation;
3) anemia;
4) cachexia;
5) bloody stools.
The correct answer is:
 A
1,2,4.
2%
 B
1,2,3.
6%
 C
2,3,5.
4%
 D
1,2,5.
 87%
 E
2,3,4.
Despite the effectiveness of endoscopy in terminating of
the bleeding from gastric varices, the use of balloon
tamponade can still be useful in selected cases. When
inserting a Sengstaken-Blakemore tube some rules
have to be followed:
 A
The tube is inserted orally with the assistance of the laryngoscope
4%
 B
Both balloons are inflated with air
68%
 C
Both balloons are filled with fluid
8%
 D
Gastric balloon should be filled with fluid and esophageal inflated with air
15%
 E
A tension should be applied to the tube using 1 kg weight
Polyposis colon syndrom/s with genetic background
is/are:
 A
Turcot’s syndrome.
3%
 B
Turner’s syndrome.
1%
 C
Gardner’s syndrome.
9%
 D
The correct answers are A and C.
82%
 E
The correct answers are B and C.
A 29-year-old woman with abdominal pain on the left
site radiating to the groin was admitted to ER, the pain
started when she tried to pick up a heavy bag. RTG and
US examinations showed no pathology apart from a big
amount of gas in the bowels. WBC 9.6 G/L, there was
no pain relief after metamizol and tramadol iv injection,
there was no effect after spasmolytic drugs. The doctor
 on call decided to administer morphine sc, after which
the pain grew stronger very quickly. What pathology do
you suspect?
 A
Appendicitis.
5%
 B
Adnexitis.
4%
 C
Subcapsular spleen haematoma.
6%
 D
Radiolucent concrement in the ureter.
67%
 E
Ovarian cyst torsion.
The indications for the surgical treatment in Crohn’s
disease are:
1) abscesses and fistulas;
2) obstruction (due to constrictions and adhesions);
3) intestinal perforation;
4) carcinogenesis.
The correct answer is:
 A
All of the above.
91%
 B
1,2,3.
3%
 C
2,3,4.
4%
 D
1,3,4.
1%
 E
3,4.
The oesophagitis with intestinal metaplasia above
cardia is called:
 A
Mallory-Weiss syndrome.
3%
 B
Cardiospasm.
0%
 C
Reflux disease.
1%
 D
Barrett’s oesophagus.
96%
 E
Achalasia.
A face and upper trunk skin rash lasting for about 30
minutes and caused by meal, extensive training, alcohol
consumption together with diarrhea, asthmatic bronchus
spasm and high blood pressure is characteristic of:
 A
Zollinger-Ellison’s syndrome.
9%
 B
Mallory-Weiss syndrome.
2%
 C
Lynch syndrome.
3%
 D
Gardner’s syndrome.
3%
 E
Carcinoid syndrome.
The following symptoms:
- abdominal pain increasing during moving and
coughing
- tachycardia
- fever
- palpable pain, guarding
- leucocytosis
are characteristic of:
 A
Gastrointestinal bleeding.
2%
 B
Peritonitis.
87%
 C
Mechanical bowel obstruction.
3%
 D
Abdominal angina.
5%
 E
Renal colic.
 4%
The total parenteral nutrition at patient’s home should
be administered after the following surgical procedure:
 A
Subtotal excision of small intestine owing to mesenteric embolism.
59%
 B
Total excision of large intestine owing to ulcerous colitis.
4%
 C
Total gastrectomy owing to cancer.
4%
 D
Excision of the esophagus complicated by anastomotic fistula.
5%
 E
Any of the aforementioned.
In the age of pharmacological treatment of HCl
oversecretion, the indications for surgical treatment of
gastric ulcer exist in the case of:
 A
Perforation.
5%
 B
Non effective treatment for more than 3 months.
1%
 C
Recurrence of the ulcer despite correct treatment.
1%
 D
No possibility to rule out the diagnosis of cancer.
1%
 E
All the aforementioned.
In a young woman aged 20, a breast lump 1.5 cm in
diameter, well limited, mobile, is most probably:
 A
A cyst.
8%
 B
Fibroadenoma.
87%
 C
Phylloid tumor.
1%
 D
On early stage of glandular cancer.
0%
 E
 Fibrocystic dysplasia.
Primary hyperparathyreoidism, caused by an adenoma
excreting parathormone may result in:
 A
Renal stones.
2%
 B
Abdominal pains.
0%
 C
Formation of bone cysts and bone frangibility.
3%
 D
Psychical disorders.
1%
 E
All the aforementioned.
Therapeutic dose of small-molecule heparin depends
on:
 A
Patient’s weight.
88%
 B
APTT.
4%
 C
Prothrombin time.
1%
 D
INR.
6%
 E
Platelet count.
The most adequate symptoms of the spinal cord lesion
at the Th2 level could be:
 A
Urine and faeces retention.
2%
 B
Upper limb paresis.
8%
 C
Lower limb paresis.
8%
 D
The correct answers are A and C.
70%
 E
All of the above could be the consequence of the Th2 level spinal cord lesion.
 Which of the blood group is a risk-factor for gastric
cancer?
 A
A.
76%
 B
B.
2%
 C
AB.
4%
 D
0.
11%
 E
None of the above blood group could be a risk factor for gastric cancer.
The most common complications of the peptic ulcer
includes:
1) upper GI bleeding;
2) perforation;
3) stenosis of the pylorus;
4) gastric cancer;
5) Mallory-Weiss syndrome.
The correct answer is:
 A
All the above.
11%
 B
1,2,5.
3%
 C
1,2,4.
28%
 D
1,2
58%
 E
3,4,5.
The most dangerous complication associated with so
called Barret’s oesophageus includes:
 A
Reflux oesophagitis.
2%
 B
Ulceration of the oesophageus.
0%
 C
Stricture of the oesophageus.
1%
 D
Perforation of the oesophageus.
3%
 E
Carcinoma of the oesophageo-gastric junction.
Which of the following sentences best characterizes the
incarcerated (irreducible) hernia?
 A
The hernia which is not possible to reduce by manipulation.
25%
 B
The hernia with associated relevant symptoms and signs of the mechanical
obstruction.
9%
 C
The hernia in which abdominal intestines have migrated into the hernia’s canal.
4%
 D
The hernia in which spasm of the hernia’s ring resulted in its squeeze on the
contents of the hernia’s sack.
58%
 E
The hernia in which adhesions occurred between the hernia’s sack and its contents.
Which of the following techniques of operative treatment
of inguinal hernias are non-tensioned ones (with the use
of synthetic mesh)?
1) Lichtenstein method;
2) Halsted method;
3) Bassini method;
4) Rutkow method;
5) Schouldice method.
The correct answer is:
 A
1,2,3.
13%
 B
1,4.
74%
 C
2,3,4.
5%
 D
2,3,5.
 4%
 E
4,5.
A 70-year-old lady has been complaining of constant
pain in the left lower quadrant for 3 days. A history of
chronic constipation. On the day of presentation the
pain exacerbated suddenly. On examination tenderness
along the whole hypogastrium, guarding, tachycardia,
fever 38C. The most probable diagnosis is:
 A
Left sided acute salpingitis.
5%
 B
Perforation of the peptic ulcer.
2%
 C
Large bowel mechanical obstruction.
11%
 D
Urinary tract infection with left-sided pyelonephritis.
2%
 E
Perforated sigmoid diverticulum.
A 62-year-old lady presents with diffuse pain of the
whole abdomen of moderate intensity. A history of
constipation, temporary presence of blood in the stools
and weight loss of approx. 4 kg. Retention of stool and
flatus for 3 days. No vomiting. On examination the
patient in good shape, abdomen distended, tender at
palpation, peritoneal signs negative, per rectum no stool
in the rectal ampulla. The most probable diagnosis
includes:
 A
Acute sigmoid diverticulitis.
5%
 B
Stricture of the sigmoid due to diverticular disease.
4%
 C
Exacerbation of the chronic constipation.
1%
 D
Large bowel mechanical obstruction, probably caused by malignancy.
85%
  E
Large bowel mechanical obstruction, probably caused by a fecalith.
Which of the following factors are contraindications for
breast conserving therapy in breast cancer?
1) size of the tumor less than 3 cm;
2) palpable single axillary lymph nodes on the affected
side;
3) carcinoma localized in the medial quadrants;
4) multifocal cancer;
5) age under 40.
The correct answer is:
 A
1,2.
3%
 B
1,3,4.
6%
 C
Only 5.
2%
 D
1,3.
2%
 E
Only 4.
The hereditary adenomatosus polypositas of the large
bowel is characterized by:
1) occurrence of numerous hyperplasic polypi in the
large bowel;
2) occurrence of fewer than 100 adenomatosus polypi
in the large bowel;
3) occurrence of much more than 100 adenomatosus
polypi in the large bowel;
4) risk of developing large bowel cancer in 3rd or 4th
decade of life in nearly 100% patients;
5) presence of hyperpigmentation on the face, mouth
and buccal mucosa.
The correct answer is:
 A
1,4,5.
4%
 B
2,4,5.
1%
 C
3,4,5.
20%
 D
1,4.
7%
 E
3,4.
68%
A 40-year-old male hit repeatedly on the head with a
blunt instrument is admitted to the Emergency Room
beaten. He could not remember the circumstances of
the incident. He complains of double vision. On physical
examination: remarkable retraction of the eyeball on the
right side, sensual deficiency under the orbit on the
same side, and multiple bruises but without pathological
mobility. The most probable injury includes?
 A
Fourth ventricular haematoma.
1%
 B
Subdural haematoma of the occipital region.
7%
 C
Frontal lobes contusion.
2%
 D
LeFort III type fracture.
15%
 E
Orbital fracture.
A 58-year-old patient treated with liver cirrhosis in the
Department of hepatology presents the symptoms of the
upper GI tract bleeding. The blood pressure is 170/80,
heart rate 118/min. The most probable diagnosis and
therapy include:
 A
Esophageal varices – Panendoscopy.
83%
 B
Esophageal varices – Laparotomy.
7%
 C
Bleeding duodenal ulcer – Panendoscopy.
 2%
 D
Bleeding duodenal ulcer – Laparotomy.
1%
 E
None of the answers is correct.
Over the years the problem of gastroduodenal ulcers
become less critical. Which of the following is believed
to be the main reason for this situation?
 A
Introduction of truncal vagotomy.
1%
 B
Introduction of truncal vagotomy and antrectomy.
1%
 C
Introduction of selective vagotomy.
2%
 D
Introduction of highly selective vagotomy.
6%
 E
Improvement of pharmacotherapy.
A 48-year-old patient is admitted to the Emergency
Room. His general condition is serious, he is suffering
from circulatory insufficiency, with looming respiratory
insufficiency. There was an incident of acute
pancreatitis in his past. Currently he complains of very
strong diffuse abdominal pain radiating to the back. On
physical examination the abdomen is distended,
peristalsis not auscultable, muscular defence reflex on
examination. In lab tests the levels of amylase in serum
and urine, as well as lipase in serum are manifoldly
elevated. Which of the following is the most adequate
procedure?
 A
Urgent laparotomy.
12%
 B
Hospitalization in the Intensive Care unit.
54%
 C
Urgent endoscopic retrograde cholangiopancreatography.
13%
 D
Intensive empiric antibiotic therapy.
2%
 E
All of the answers are correct.
Local femoral compression was administered to the
patient. Then he had to flex and extend his limb in knee
vigorously. After this procedure, the limb became pale
and swollen, superficial veins became inflated with
stagnating blood. How would you explain this situation?
 A
The procedure is called Pratt’s test. It caused insufficient arterial blood flow, and the
limb ischaemia as the consequence – it should be considered as physiologic
phenomenon.
4%
 B
The procedure is called Trendelenburg’s test. The symptoms denote positive result,
and the insufficiency of perforator veins.
14%
 C
The procedure is called Trendelenburg’s test. The symptoms denote negative
result, and the sufficiency of perforator veins.
3%
 D
The procedure is called Perthes’ test. The symptoms denote positive result, and the
insufficiency of perforator veins and/or occlusion of deep veins.
76%
 E
The procedure is called Perthes’ test. The symptoms denote negative result, and the
sufficiency of perforator veins and correct blood flow in deep veins.
Pulse assessment can be performed in all these
arteries, except:
 A
Cubital artery.
7%
 B
Iliac artery.
75%
 C
Tibial posterior artery.
3%
 D
Dorsal artery of foot.
1%
 E
The pulse can be assessed in all of the above.
During the catastrophe, according to START algorithm
(Simple Triage and Rapid Treatment), an unconscious
 victim with the respiratory rate above 30/per minute
should be marked as:
 A
Green.
1%
 B
Yellow.
10%
 C
Red.
84%
 D
Black.
2%
 E
The victim cannot be qualified to any of the above-mentioned groups on the basis of the above
description.
Acute toxic megacolon is a complication of:
 A
Intestinal tuberculosis.
2%
 B
Ulcerative colitis.
94%
 C
Rectal cancer.
2%
 D
Proctostenosis.
1%
 E
Abscess in the rectouterine pouch.
Open pneumothorax causes rapidly increasing
cardiovascular insufficiency, due to significant
dislocation of mediastinal organs away from the side of
pneumothorax.
 A
Both statements are true. There is a cause-and-effect relationship between them.
31%
 B
Both statement are true. The cause-and-effect relationship between them is not
present.
10%
 C
The first statement is true. The second statement is false.
44%
 D
The first statement is false. The second statement is true.
 4%
 E
Both statements are false.
A 56-year-old patient was admitted to hospital due to
painless jaundice. Physical examination revealed
enlarged, painless gallbladder. Laboratory tests
revealed the elevation of a total bilirubin level
(conjugated bilirubin/non-conjugated bilirubin levels
ratio, 3:1) and the slight elevation of transaminases
levels. The diagnosis is:
 A
Cholecystolithiasis.
8%
 B
Choledocholithiasis.
8%
 C
Tumor of the head of the pancreas.
79%
 D
Viral hepatitis.
1%
 E
Answers A and D are correct.
4
Schwartz test is used for the assessment of:
 A
Competence of saphenous vein valves.
51%
 B
Competence of small saphenous vein valves.
7%
 C
Competence of perforating veins.
18%
 D
Competence of deep veins valves.
18%
 E
Patency of deep veins.
Volkmann contracture is:
1) permanent hyperextension of the hand and fingers
caused by ischemia/necrosis of the muscle fibres of the
extensors of the wrist;
2) permanent flexion of the hand and fingers caused by
cicatrisation of the muscle fibres of the extensors of the
 wrist;
3) permanent flexion of the hand and fingers caused by
cicatrisation of the ischemic muscle fibres of the flexor
group of muscles of the forearm;
4) complication of a fracture of the ulnar bone;
5) complication of a fracture of the humeral bone.
The correct answer is:
 A
1,4,5
6%
 B
2,4.
12%
 C
3,5.
56%
 D
3,4.
13%
 E
2,5.
A patient underwent surgical treatment of follicular
thyroid carcinoma. Three days after thyroidectomy the
patient suffered from numb sensations in the fingers
and tingling sensations around the mouth. The patient
was irritated and excited with a tendency to
hyperventilation. Indicate the optimal treatment:
 A
Calcium gluconate.
95%
 B
Sedative and anxiolytic drugs.
3%
 C
Intensive oxygen therapy.
1%
 D
Intravenous antibiotic therapy.
0%
 E
Psychiatric consultation.
A twenty-year-old patient was admitted to the
Emergency Department owing to a furuncle of right
parietal region. The treatment should consist of:
 A
Incision and drainage.
14%
 B
Removal of the purulent plug and pus.
11%
 C
Excision of the furuncle and a local plastic operation.
2%
 D
Oral antibiotic therapy and local antiseptics.
4%
 E
Removal of the purulent plug and pus, antibiotic therapy.
One of the causes of the increase of pressure inside the
bile ducts, leading to primary biliary cirrhosis, is primary
sclerosing cholangitis (PSC). The true sentences about
PSC are as follows:
1) in 60% to 70% of PSC cases ulcerative colitis or
Crohn disease is diagnosed;
2) coexistence of PSC and inflammatory bowel
diseases significantly increases the risk of
cholangiocarcinoma;
3) Peyronie’s disease and pseudotumors of eyeballs
may coexist with PSC;
4) main signs and symptoms include painless jaundice
and skin itching (45-55% of patients);
5) endoscopic retrograde dilatation of the bile ducts and
stent implantation are used to treat the patients with
PSC.
The correct answer is:
 A
1,2,3,5.
11%
 B
1,2,4.
14%
 C
2,3,4,5.
11%
 D
All the above.
53%
  E
1,4,5.
A 30-year-old patient, after a traffic accident, was
admitted to the Emergency Department with blunt
abdominal trauma. The patient’s blood pressure was
100/70 mmHg, heart rate was 90 beats per minute.
Physical examination revealed: pain on pressure on the
left side of the abdomen, a pain with fist percussion in
the left lumbar region. FAST (Focused Assessment with
Sonography in Trauma) exam revealed a presence of
perisplenic fluid and presence of fluid in the rectovesical
pouch. Urine was blood-stained. Computed tomography
of the abdomen revealed Grade IV injury of the spleen
(according to American Association for the Surgery of
Trauma classification) and Grade II injury of the left
kidney (acc. to AAST). One hour after the admission to
the Emergency Department blood pressure decreased
to <90 mmHg and heart rate increased to 100 bpm. The
treatment should consist of:
 A
Laparotomy, splenectomy, a check-up of remaining abdominal organs, drainage.
69%
 B
Laparotomy, splenectomy, left nephrectomy, a check-up of remaining abdominal
organs, drainage.
11%
 C
Conservative treatment.
1%
 D
Laparotomy, left nephrectomy, a check-up of remaining abdominal organs,
drainage.
2%
 E
Laparotomy, an attempt to preserve the spleen, a check-up of remaining abdominal organs,
drainage.
A 33-year-old patient, after a traffic accident, was
admitted to hospital with fracture of the shaft of the
femur. No abnormalities were found on computed
tomography of the head, chest X-ray, and abdominal
sonography. Blood pressure was 120/80 mmHg;
 haemoglobin level was 12.5 g%. The treatment plan for
the next day was to insert an intramedullary rod.
Temporarily, a proximal tibial skeletal traction was
applied. During the night, disturbances of
consciousness and psychomotor agitation appeared.
The most probable cause of such abnormalities is:
 A
Pulmonary thromboembolism.
11%
 B
Brain concussion.
6%
 C
Progressive encephalomalacia.
1%
 D
Effects of analgesics.
2%
 E
Cerebral fat embolism.
Which of the following is not a risk factor for
postoperative wound dehiscence?
 A
Age (more than 30).
61%
 B
Diabetes mellitus.
1%
 C
Jaundice.
9%
 D
Increased abdominal pressure.
1%
 E
All of the above are the risk factors.
Dyspnoea and decreased saturation occurred half an
hour after subclavian vein catheterization. What is the
meaning of these symptoms?
 A
It is a normal situation after the procedure associated with chemokin release;
standard conservative therapy is sufficient (oxygen).
1%
 B
Air embolism. Urgent diagnostics (echocardiogram) and intensive conservative
treatment are essential.
 9%
 C
Pneumoedema. Urgent diagnostics (chest x-ray), immediate pleurocentesis and/or
chest drainage are essential.
25%
 D
Answers B,C are correct.
63%
 E
None of the answers explains the described symptoms.
The surgeon performed an incision one finger above
suprasternal notch, and after the preparation of isthmus
of thyroid gland and incision of two cartilage rings of the
trachea, the tube was introduced and fixed with skin
sutures. The procedure was performed without
anesthesia. What is the name of the procedure?
 A
Planned coniotomy.
3%
 B
Urgent coniotomy.
13%
 C
Planned tracheostomy.
12%
 D
Urgent tracheostomy.
71%
 E
Bronchostomy.
During the operation when the resection of the rectum
was performed, the intestinal perforation and the fecal
leakage to peritoneum occurred. What would be the
qualification of the wound?
 A
Clean wound
1%
 B
Clean-contaminated wound
8%
 C
Contaminated wound
73%
 D
Dirty-infected wound
18%
 E
 Operational wound
Injuries in multiple body injuries are most common in
the region of:
 A
Head.
52%
 B
Chest.
7%
 C
Abdomen.
27%
 D
Pelvis.
6%
 E
Limbs.
Kocher reposition of luxation of the glenohumeral joint is
performed in 4 phases in the sequence:
 A
Abduction, internal rotation, adduction to the chest, external rotation.
11%
 B
Abduction, external rotation, abduction from the chest, internal rotation.
18%
 C
Abduction, external rotation, adduction to the chest, internal rotation.
61%
 D
Abduction, internal rotation, abduction from the chest, external rotation.
8%
 E
Abduction, external rotation, adduction to the chest, external rotation.
Which of the following symptoms is not a part of
hypercalcemic crisis?
 A
Oliguria.
58%
 B
Polydipsia.
10%
 C
Nausea and vomiting.
3%
 D
Somnolence and coma.
5%
 E
Hypotension.
 A Sengstaken-Blakemore tube should not be kept in
place more than:
 A
12 hours.
6%
 B
24 hours.
81%
 C
48 hours.
10%
 D
36 hours.
1%
 E
There is no time limit established to keep the tube in place.
Which of the arteries are part of pancreatic vasculature?
 A
Upper pancreatico-duodenal artery.
1%
 B
Lower pancreatico-duodenal artery.
0%
 C
Splenic artery.
3%
 D
Correct answers are A and B.
13%
 E
Correct answers are A, B and C.
Which of the statements concerning disorders of
potassium homeostasis is correct?
1) potassium is the predominant extracellular cation;
2) excessive excretion because of diarrhea is one of the
causes of hypokalemia;
3) 20% glucose solution and short-acting insulin are
used for the treatment of hypokalemia;
4) acute and chronic renal failure impair potassium
excretion and lead to hyperkalemia;
5) cardiac asystole results from hyperkalemia.
The correct answer is:
 A
1,2,3.
5%
 B
2,4,5.
73%
 C
1,4,5.
8%
 D
2,3,5.
11%
 E
1,3,4.
Which of the statements concerning fluid therapy is
correct?
1) colloids are used to fill in the vessels;
2) crystalloids are used to fill in the extracellular space;
3) average arterial blood pressure, heart rate and
central venous pressure are used for monitoring the
level of patient’s hydration;
4) Ringer’s solution is an example of colloids;
5) dextran and gelatine are crystalloids.
The correct answer is:
 A
1,2,3.
77%
 B
2,4,5.
4%
 C
1,4,5.
4%
 D
2,3,5.
6%
 E
1,3,4.
Which of the statements concerning the infection
treated with surgery is true?
1) whitlow is an acute inflammation of the dorsal surface
of the fingers
2) carbuncle is most often located in the nape of the
neck
3) paronychia is an inflammation of the tissues
surrounding the fingernail or toenail
 4) in the era of antibiotics all the infections are treated
conservatively, and the surgical intervention is used
only for the treatment of complications
5) abscess is the limited inflammation of soft tissues
with necrosis and the presence of pus
The correct answer is:
 A
1, 2, 3
9%
 B
2, 4, 5
4%
 C
1, 4, 5
2%
 D
2, 3, 5
83%
 E
1, 3, 4
Which of the statements concerning the basic surgical
procedures is correct?
1) venflon is an intravenous cannula
2) venesection is the procedure aimed to expose the
peripheral vein
3) unconscious patient should have been intubated
before the introduction of a gastric probe
4) nausea and vomits are contraindications to the
introduction of gastric probe
5) urethral injuries are contraindications to a suprapubic
bladder puncture
The correct answer is:
 A
1, 2, 3
80%
 B
2, 4, 5.
2%
 C
1, 4, 5
4%
 D
2, 3, 5
 3%
 E
1, 3, 4
Which of the statements concerning the disorders of
hemostasis is correct?
1) Virchow triad relates to the formation of venous blood
clots;
2) thrombogenesis is the process of blood clots
dissolving;
3) DIC coagulopathy is the result of disseminated
intravascular coagulation;
4) fibrinolysis, which is the process of braking down
intravascular fibrin clots, counterbalances the process
of coagulation;
5) decrease in blood flow inhibits the formation of blood
clots.
The correct answer is:
 A
1,2,3.
5%
 B
2,4,5.
2%
 C
1,4,5.
6%
 D
2,3,5.
1%
 E
1,3,4.
The most common malignancy in the world is:
 A
Breast cancer.
4%
 B
Gastric cancer.
1%
 C
Cervical cancer.
1%
 D
Lung cancer.
83%
  E
Colon cancer.
The Intensive Care Units (ICU) patients should undergo
preventive procedures against stress ulcers. The most
important procedure is:
 A
Administration of proton pump inhibitors.
91%
 B
Induction of pharmacological coma in these patients in order to decrease the stress.
2%
 C
Examination of gastric acidity.
1%
 D
Eradication of Helicobacter pylori infection.
1%
 E
Performing the test for HP infection and its eradication when positive.
The only trustworthy method to diagnose breast cancer
is:
 A
Ultrasonography.
1%
 B
Mammography.
7%
 C
Cytology.
2%
 D
Histopathology.
90%
 E
Genetic testing.
The cause of primary spontaneous pneumothorax is:
 A
Ruptured, subpleural bubble (bleb).
84%
 B
Tuberculosis.
1%
 C
Lung cancer.
2%
 D
Bullous emphysema.
12%
 E
 Bronchial asthma.
The most common cause of esophageal perforation is:
 A
Swallowed foreign body.
18%
 B
Endoscopy.
58%
 C
Spontaneous rupture (Boerhaave’s syndrome).
6%
 D
Cervical spine surgery.
1%
 E
Post traumatic rupture.
A 45-year-old patient was admitted to the emergency
unit (EU) with a calf injury. Around 7 hours earlier, while
cleaning up the garage, the lateral surface of his calf
was torn by a piece of sheet metal. The length of the
wound is approx. 6 cm, the depth approx. 1.5-2 cm. The
wound has torn edges and you can see the redness
around it. The patient had tetanus vaccination in the
army (26 years before). Which of the following is the
most appropriate procedure?
 A
Wound irrigation, dressing, antibiotics.
2%
 B
Surgical wound cleaning, human tetanus antitoxin, anatoxin.
73%
 C
Surgical cleaning, anatoxin, antibiotics.
14%
 D
Surgical cleaning, human tetanus antitoxin, antibiotics.
9%
 E
Antiseptic dressing, antibiotics, secondary wound suturing after cleaning.
The recommended procedure in a patient with
symptoms of distal gastrointestinal bleeding is:
 A
Computed tomography with a contrast.
5%
 B
Barium X-ray.
2%
 C
Colonoscopy.
91%
 D
Selective angiography.
1%
 E
Digital subtraction angiography (DSA).
1
A 65-year-old patient called the emergency service
because of the heavy pain of the right lower extremity.
The pain is located down the knee and the patient is
unable to move the foot. Physical examination reveals
cold skin in this area and paresthesias. The patient’s
medical history is positive for ischemic heart disease
and atrial fibrillation. What is the most probable
diagnosis in your opinion?
 A
Arterial embolus.
89%
 B
Acute venous insufficiency.
9%
 C
Sciatica.
0%
 D
Leg compartment syndrome.
1%
 E
Leg phlegmon.
Whipple’s triad is the symptom of:
 A
Acute pancreatitis.
17%
 B
Pancreas tumor – insulinoma.
80%
 C
Perforated duodenal ulcer.
1%
 D
Upper gastrointestinal bleeding.
1%
 E
Bowel obstruction.
 Which part of the colon is the most common localization
of colon cancer?
 A
Ascending colon.
3%
 B
Rectum.
78%
 C
Descending colon.
16%
 D
Transverse colon.
2%
 E
All of them equally.
Courvoisier’s sign is defined as:
 A
Palpable tumor and tenderness above the right lower abdominal quadrant.
3%
 B
Palpable and painless enlargement of the gall bladder.
94%
 C
Local excessive intestine movements that can be seen while watching the
abdomen.
2%
 D
Palpable enlargement of the liver (hepatomegaly).
1%
 E
Palpable enlargement of the liver and spleen (hepato- and splenomegaly).
Paraesophageal hiatal hernia is defined as the
displacement of:
 A
The whole stomach with the cardia into the mediastinum.
7%
 B
Fundus and greater curvature of the stomach without the cardia.
74%
 C
Small intestine.
0%
 D
Stomach with the cardia and liver.
1%
 E
Cardia and upper part of the stomach.
 Contraindication to the upper gastrointestinal
endoscopy is/are:
 A
Bleeding esophageal varices.
15%
 B
Pyloric stenosis.
14%
 C
Perforated gastric ulcer.
68%
 D
Jaundice.
1%
 E
Colon cancer.
Method of choice for the treatment of upper
gastrointestinal tract bleeding is:
 A
Laparoscopic surgery.
5%
 B
Blood or blood substitute transfusion.
0%
 C
Classical surgery.
1%
 D
Endoscopy.
94%
 E
None of the above.
Choose the true sentence:
 A
Surgery is the proper therapy for rectal cancer.
36%
 B
Caecum is the most frequent localization of colorectal cancer.
3%
 C
Enteritis is not related to the increased risk of colorectal cancer occurrence.
2%
 D
Squamous cell carcinoma is the most common histopathological type of colorectal
cancer.
4%
 E
Neo-adjuvant radiotherapy is the proper therapeutic management for rectal cancer T3N0
localized 5cm from the edge of the anus.
 Kwashiorkor is the deficiency of:
 A
Carbohydrates.
2%
 B
Water.
0%
 C
Carbohydrates and water.
1%
 D
Protein.
87%
 E
Protein and carbohydrates.
Prophylaxis of thromboembolic complications includes:
 A
Early mobilisation.
2%
 B
Low Molecular Weight Heparin administration.
4%
 C
Acetylsalicylic acid administration.
1%
 D
Compression stockings.
1%
 E
All of the answers are correct.
Which of the conditions mentioned below may be a
cause of hyperkalemia?
 A
Posttraumatic injury of the muscles.
46%
 B
Chronic diarrhoea.
4%
 C
Hyperthyroidism.
1%
 D
Correct answers are A and C.
47%
 E
None of the answers is correct.
Referred by GP, a 32-year-old male came to the
outpatient surgery clinic. He presented suppurative
wound caused by a rod sticking out from the ground,
 with fetid substance. The patient is feverish up to
38.0°C, apathetic, erythema is seen around the wound,
the skin is tensioned, glittering, on compression
palpable tissue crepitus. In the lab tests performed by
GP, apart from elevated inflammatory parameters, the
creatinin level is also higher than the reference. Which
of the proceeding would be the most likely in this case?
 A
Wound culture examination, empiric antibiotic therapy, nephrology consultation,
continuous treatment in the outpatient clinic.
3%
 B
Surgery department admission, wound culture examination, intravenous antibiotic
therapy, extensive necrotic tissue excision, possible limb amputation.
78%
 C
Surgery department admission, wound culture examination, empiric antibiotic
therapy, incision and phlegmon drainage.
16%
 D
Incision of phlegmon in the outpatient surgical clinic, wound culture examination,
empiric antibiotic therapy.
2%
 E
None of the answers is correct.
Choose the right set of features characteristic of
Leśniowski-Crohn disease:
1) pathologic changes may occur in each part of the
digestive tract;
2) pathologic changes are limited to the mucosa and the
submucosa;
3) changes are often accompanied by perirectal fistulas;
4) in this disease limited resections are the most
appropriate;
5) in this disease extensive resections are the most
appropriate.
The correct answer is:
 A
1,2,4.
3%
 B
2,3,4.
 1%
 C
2,3,5.
1%
 D
1,3,4.
90%
 E
1,2,3,4.
The proper placement of a tube in tube thoracostomy is
of primary importance in chest trauma patients’ care.
The standard position is in the midaxillary line in the fifth
or sixth intercostal space. Which of the following
statements are true:
1) this location is usually safely above the diaphragm;
2) this is the area with the thinnest chest wall
musculature;
3) this positioning depends on gravitation and assures
possibility of removing both: air and blood.
The correct answer is:
 A
Only 1.
6%
 B
Only 2.
2%
 C
1,2.
8%
 D
1,3.
17%
 E
1,2,3.
The patient treated with oral anticoagulants because of
atrial fibrillation comes to hospital with an upper
abdominal pain and yellowish discoloration of the
sclera. Sonography reveals small gallstones in the gall
bladder. The proper management is:
1) endoscopic papillotomy and evacuation of the
gallstone from the bile ducts as soon as possible;
2) therapy with spasmolytic drugs and fluids till the
 gallstone is eliminated from the bile ducts;
3) determination of INR level and – if it is not above 5 –
endoscopic papillotomy with the evacuation of the
gallstone from the bile ducts;
4) urgent transfusion of 3-4 units of fresh frozen plasma,
endoscopic papillotomy with the evacuation of the
gallstones from the bile ducts;
5) endoscopic papillotomy and the evacuation of the
gallstones from the bile ducts if INR level is below or
equals 1.5.
The correct answer is:
 A
Only 1.
7%
 B
Only 2.
7%
 C
2,3.
16%
 D
4,5.
8%
 E
Only 5.
Indicate sentences which properly characterize brain
concussion:
1) this is a transient loss of consciousness as a result of
head trauma, lasting a few seconds or hours;
2) lumbar puncture, which decreases troublesome
headaches, is the method of treatment;
3) ischemic stroke can be the complication of
concussion;
4) retrograde and anterograde amnesia are
characteristic features of brain concussion;
5) headache and vertigo, nausea and vomits frequently
last a few days after the trauma.
The correct answer is:
 A
2,3.
 1%
 B
1,4,5.
94%
 C
2,4,5.
3%
 D
2,3,4.
1%
 E
1,2,3.

The typical symptoms of upper gastrointestinal bleeding

do not include:
 A
Sudden fainting or syncope.
1%
 B
Hemodynamic shock (blood pressure drop, paleness, sweating).
1%
 C
Vomiting blood clots.
2%
 D
Tarry stool.
9%
 E
Presence of fresh blood in the stool.

Choose the true sentences concerning the treatment of

upper gastrointestinal tract bleeding:
1) in about 80% the bleeding stops spontaneously or
with the conservative treatment;
2) the best method of treatment is to achieve
hemostasis with endoscopy;
3) the most effective method of hemostasis is the
surgery;
4) the safest method of treatment is endovascular
procedure (embolisation of the bleeding vessel);
5) in some cases an effective method of therapy is to
control bleeding with the balloon (Sengstaken-
 Blakemore tube).
The correct answer is:
 A
1,2,4.
10%
 B
1,2,5.
75%
 C
1,4,5.
7%
 D
3,5.
5%
 E
None of the above.
Which of the following sentences concerning the
treatment of incarcerated hernia are true?
1) incarcerated hernia can be reduced within the first
few hours;
2) hernia may be always undertaken, irrespective of an
elapsed time from incarceration;
3) incarcerated hernia should always be treated
surgically;
4) reduction of hernia may be associated with the risk of
damage to the contents of the hernia sac.
The correct answer is:
 A
1,4.
65%
 B
2,4.
6%
 C
3,4.
23%
 D
Only 3.
5%
 E
Only 4.
Which of the following statements concerning
mechanical ileus (colorectal) are true:
1) it is most frequently caused by colon cancer;
 2) surgery should include the excision of part of the
intestine with the tumor;
3) formation of artificial anus is always necessary;
4) it is caused by sigmoid diverticulosis;
5) artificial anus is not always necessary.
The correct answer is:
 A
1,4,5.
8%
 B
1,2,5.
83%
 C
1,3,4.
1%
 D
1,2,4.
5%
 E
2,3,4.
Which of the following statements concerning hernias in
postoperative scar are true:
1) they may become incarcerated;
2) they are frequently caused by wound suppuration;
3) truss is the proper method of treatment;
4) the results of the surgery with or without
polypropylene mesh are similar;
5) they are the result of anaemia.
The correct answer is:
 A
1,2.
69%
 B
1,3.
25%
 C
4,5.
1%
 D
1,5.
4%
 E
2,4.
 Colorectal cancer develops on the basis of:
1) colorectal polyp;
2) hypochromic anemia;
3) familial adenomatous polyposis;
4) ulcerative colitis;
5) colon diverticulosis.
The correct answer is:
 A
1,2,4.
4%
 B
1,2,3.
1%
 C
1,3,5.
5%
 D
1,3,4.
90%
 E
2,3,5.
Which of the following statements concerning hernias of
inguinal region are true:
1) their formation is connected with the disorders of
collagen metabolism;
2) their formation is connected with the defect of
abdomen musculature;
3) laparoscopic surgery is the best method to treat
them;
4) femoral hernias are more frequent in men;
5) surgery with the use of plastic mesh gives the lowest
rate of recurrence.
The correct answer is:
 A
1,3.
4%
 B
3,4.
2%
 C
2,5.
28%
 D
1,5.
63%
 E
2,4.
The symptoms of sigmoid cancer are:
1) narrow stools and constipation;
2) anaemia;
3) increased body temperature;
4) cachexia;
5) presence of blood in the stool.
The correct answer is:
 A
1,2.
4%
 B
1,3.
0%
 C
2,5.
2%
 D
1,5.
93%
 E
1,4.
Which of the following statements is true with regard to
the risk of colorectal adenocarcinoma occurrence in
patients with Lesniowski-Crohn disease and ulcerative
colitis?
 A
The risk is similar to the risk in healthy population.
1%
 B
The risk is respectively: 5% (Lesniowski-Crohn disease) and 10% (ulcerative colitis)
after 10 years of the illness.
13%
 C
The risk increases with the duration of the illness.
80%
 D
The risk is not related to the duration of the illness and is 30% in the population of
patients with Lesniowski-Crohn disease and ulcerative colitis.
3%
 E
The highest risk is related to the presence of proctitis.
 A 25-year-old patient came to the ER because of the
wound in his right foot. Three hours before, while
cleaning up his garage, the plantar surface of his foot
had been pierced with a nail. This is a puncture wound
but according to the patient the nail stuck in the foot at
the depth of about 2 cm. The patient received tetanus
vaccine during his military service at the age of 19.
Which of the following methods of management is the
most correct?
 A
Rinsing the wound, dressing, antibiotic.
6%
 B
Surgical debridement, anatoxin.
55%
 C
Surgical debridement, anatoxin, antibiotic.
21%
 D
Debridement, human anti-tetanus immunoglobulin, antibiotic.
16%
 E
Antiseptic wet dressing, antibiotic, secondary wound suture after debridement.
Which of the following can be used in the treatment of
the pancreatic pseudocysts:
 A
US-guided percutaneous drainage.
4%
 B
Surgical anastomosis.
5%
 C
Endoscopic drainage.
2%
 D
The answers A and B are true.
9%
 E
All the answers are true.
The antibiotic prophylaxis in the treatment of patients
with colorectal cancer:
 A
Can be used only in patients with disseminated disease.
1%
 B
 Should be introduced one day before the surgery.
15%
 C
Can be used only in patients with obstruction.
2%
 D
Should be introduced before the operation on the same day.
74%
 E
The answers A and C are true.
The treatment of the first stage of acute pancreatitis
includes:
1) treatment of shock, and water and electrolytes
disturbances;
2) prevention of secondary infection;
3) surgery – laparotomy;
4) parenteral or enteral feeding;
5) constant suction through the gastric tube.
The correct answer is:
 A
1,2,3,5.
9%
 B
1,2,3,4.
10%
 C
1,2,4,5.
76%
 D
1,3,4,5.
4%
 E
2,3,4,5.
Superficial thrombophlebitis:
1) brings a risk of pulmonary embolism;
2) always requires administration of low molecular
weight heparins;
3) requires treatment with heparin pump;
4) requires the administration of anti-inflammatory
drugs;
5) may be treated with surgical removal of the clot.
The correct answer is:
 A
 1,3.
7%
 B
1,5.
24%
 C
2,4.
16%
 D
3,5.
5%
 E
4,5.
The following are contraindications to laparoscopic
cholecystectomy:
1) acute cholecystitis;
2) adhesion in the abdominal cavity;
3) heart failure;
4) 1 and 2 trimester of pregnancy;
5) mechanical jaundice in anamnesis.
The correct answer is:
 A
1,2,3.
9%
 B
2,3,4.
76%
 C
1,4,5.
2%
 D
1,3,4.
6%
 E
2,4,5.
A 85-year-old female patient fell over in her house and
suffered a fracture of the femoral neck. The most
probable cause of the fracture is:
 A
Local osteoporosis.
2%
 B
Postmenopausal osteoporosis.
13%
 C
Senile osteoporosis.
 84%
 D
Bone metastases.
0%
 E
Multiple myeloma.
The following are the causes of pathological fractures:
1) long lasting bone strain;
2) abuse of anabolic steroids;
3) bone metastases;
4) congenital bone fragility;
5) osteoporosis.
The correct answer is:
 A
1,3,4.
3%
 B
1,3,5.
8%
 C
2,3,4.
9%
 D
2,3,5.
24%
 E
3,4,5.
Which of the following medications are administered in
the case of bleeding caused by oral anticoagulants
overdose?
 A
Fresh frozen plasma preparations.
14%
 B
Platelets preparations.
2%
 C
Human recombinant factor VII.
3%
 D
A and C.
62%
 E
A, B and C.
The plain abdominal film should be ordered to confirm:
 A
Gastrointestinal obstruction.
 1%
 B
Gastrointestinal perforation.
2%
 C
Cholecystolithiasis.
1%
 D
A and B.
80%
 E
A, B and C.
Acute cholangitis occurs as a result of bile infection
induced by impaired bile duct patency which in turn is
caused by:
 A
Choledocholithiasis.
4%
 B
Bile duct neoplasms.
0%
 C
Iatrogenic biliary damage.
1%
 D
Parasites.
0%
 E
All the above.
Which of the following are true?
1) alcohol ingestion is one of the most frequent causes
of acute pancreatitis;
2) chronic pancreatitis is related to the increased risk of
pancreatic cancer;
3) about 50% of cases of acute pancreatitis is severe;
4) Whipple surgery procedure is the basic surgical
treatment of acute necrotizing pancreatitis.
The correct answer is:
 A
1,2.
62%
 B
1,2,3.
14%
 C
All the above.
 20%
 D
1,3.
2%
 E
1,4.
Is cholecystectomy indicated in the treatment of
asymptomatic patients with a sonographic picture of
normal thickness of the gallbladder wall and multiple
gallbladder stones?
1) yes, on the patient’s explicit request;
2) never;
3) yes, in patients awaiting cardiac surgery;
4) yes, in patients requiring immunosuppressive
treatment.
The correct answer is:
 A
Only 2.
5%
 B
1,3.
6%
 C
1,3,4.
64%
 D
3,4.
15%
 E
Only 1.
In which of the following situations percutaneus
endoscopic gastrostomy (PEG) would be inappropriate?
 A
In the case of obstructing esophageal tumor.
3%
 B
In the case of obstructing gastric cardia tumor.
3%
 C
In the case of obstructing gastric pylorus tumor.
31%
 D
A and B.
51%
 E
A, B and C.
 70-year-old female comes to the ER because of
abdominal pain and distension lasting 3 days, and
constipation (last stool 4 days ago). In anamnesis there
are no abdominal surgeries. For the last 2 months she
has lost approx. 5 kg. What is the proper management?
1) laparotomy as soon as possible due to mechanical
obstruction;
2) radiological diagnostics (plain abdominal film) for
mechanical small bowel obstruction caused by
adhesions, as the most probable cause of the
complaints;
3) radiological diagnostics (plain abdominal film) for
mechanical large bowel obstruction caused by cancer,
as the most probable cause of the complaints;
4) after confirming mechanical obstruction on the plain
abdominal film – urgent laparotomy;
5) after confirming mechanical large bowel obstruction
on the plain abdominal film – contrast enema in order to
determine the level of obstruction and whether it is
partial or complete. Decision concerning a mode of the
operation depends on the result of the contrast enema.
The correct answer is:
 A
Only 1.
3%
 B
3,5.
85%
 C
2,4.
5%
 D
2,5.
4%
 E
None of the above.
Which of the following properly characterize the most
probable causes of the condition following head trauma:
1) if a patient was temporarily unconscious, suffered
 head trauma and at the same time urinated, then the
most probable cause of his/her condition would be brain
stroke;
2) if a patient was temporarily unconscious, suffered
head trauma and at the same time passed tarry stool,
then the most probable cause of his/her condition is
gastrointestinal bleeding;
3) if a patient suffered head trauma, was unconscious
for a moment and does not remember circumstances of
the event, then it is a typical picture of brain concussion;
4) if a patient was temporarily unconscious, suffered
head trauma and presents with anisocoria, it is most
probably the result of epileptic seizure;
5) if a patient suffered head trauma, is unconscious,
presents with anisocoria and bradycardia, then it is
most probably caused by intracranial hematoma.
The correct answer is:
 A
1,2,3.
6%
 B
1,4,5.
4%
 C
2,4,5.
5%
 D
2,3,4.
5%
 E
2,3,5.
Which of the following sentences concerning gastric
cancer is true?
1) early cancer, when the infiltration does not exceed
the mucosa, with tumor diameter up to 2 cm can be
treated with endoscopy (mucosectomy);
2) advanced cancer is treated surgically with total
gastrectomy, regardless of the location of the tumor;
3) early cancer typically is treated surgically with partial
 gastrectomy and regional lymph nodes resection;
4) adjuvant chemotherapy is as important part of the
treatment as surgery;
5) preoperative radiotherapy is a standard procedure
before surgical treatment of advanced gastric cancer.
The correct answer is:
 A
1,2,4.
29%
 B
1,2,5.
17%
 C
1,3.
39%
 D
3,5.
8%
 E
1,4.
The best way to differentially diagnose GI bleeding from
esophageal varices and GI bleeding from gastric or
duodenal ulcer is:
 A
Nature of vomit: the presence of bright red blood or clots (varices) or vomit that
looks like coffee grounds (ulcer).
20%
 B
Characteristics of stool: bloody stool (varices) or tarry stools (ulcer).
1%
 C
Patient’s general condition: severe with hemodynamic instability (varices) or good,
with no hemodynamic changes (ulcers).
8%
 D
Anamnesis and physical examination: liver cirrhosis in anamnesis and clinical
symptoms of cirrhosis on physical examination (varices).
66%
 E
Intensity of bleeding: massive bleeding (varices) or small bleeding (ulcer).
Which of the following concerning abdominal hernia
incarceration are true?:
1) inguinal hernia is most often incarcerated;
2) in some cases only the intestine wall is incarcerated;
3) incarcerated hernia always leads to mechanical
 bowel obstruction;
4) incarceration occurs mostly at night during sleep.
The correct answer is:
 A
All the above.
7%
 B
1,2,4.
8%
 C
2,4.
7%
 D
1,2.
62%
 E
1,2,3.
A pathologic fracture is when a bone fails in an area
weakened by pre-existing disease. The causes do not
include:
 A
Injury to an old fracture site.
67%
 B
Primary bone tumors or metastatic lesions.
7%
 C
Bone infection.
12%
 D
Metabolic and systemic diseases.
6%
 E
Inborn diseases.
A patient comes to the surgery ER because of severe
pain in the anal region lasting for the last 24 hours. On
physical exam, to the left of the anus there is a fluctuant
mass covered with red and palpable tender skin. In
anamnesis: there are no concomitant diseases. Which
of the following abscesses according to Corman’s
classification is the most probable in this patient?
 A
Intersphincteric abscess.
13%
 B
 Ischioanal abscess.
71%
 C
Supralevator abscess.
6%
 D
Abscess in rectal marginal clot.
5%
 E
Abscesses mentioned in A, B and C are equally frequent.
Which of the following are the correct approaches to an
asymptomatic, incidentally found adrenal tumor of 5 cm
in diameter:
1) only laparoscopic surgery;
2) surgery should be dependent on hormonal
evaluation;
3) laparoscopic or traditional surgery;
4) approach should not be dependent on tumor size
changes in subsequent imaging studies;
5) start pharmacological treatment before the surgery.
The correct answer is:
 A
1,2.
11%
 B
3,4.
36%
 C
1,5.
5%
 D
2,4.
13%
 E
3,5.
The intestine wall undergoes necrosis as a result of:
1) hernia incarceration;
2) portal hypertension;
3) bowel strangulation around peritoneal adhesions;
4) mesentery artery embolism;
5) diverticula of small intestine.
The correct answer is:
 A
 1,2,3.
1%
 B
2,3,4.
3%
 C
1,3,5.
3%
 D
1,3,4.
92%
 E
1,2,4.
Which of the following concerning acute appendicitis
are true?
1) should be operated only laparoscopically;
2) does not occur over the age of 50;
3) ultrasound imaging is helpful in diagnosis;
4) is a result of Clostridium difficile infection;
5) begins with an epigastric pain migrating to the right
iliac fossa.
The correct answer is:
 A
3,5.
91%
 B
2,4.
1%
 C
3,4.
2%
 D
1,5.
4%
 E
2,5.
Which of the following are the symptoms of mechanical
bowel obstruction:
1) elevated white blood count
2) wave-like abdominal pain
3) retention of gases and constipation
4) hyperkalemia
 5) bradycardia
The correct answer is:
 A
2, 3
93%
 B
2, 4
1%
 C
3, 4
2%
 D
1, 3
2%
 E
2, 5
Mechanical jaundice and the enlarged gallbladder are
typical symptoms of:
1) cancer of the pancreatic corpus;
2) pancreas head cancer;
3) hepatocellular carcinoma;
4) cholecystolithiasis;
5) carcinoma of the ampulla of Vater.
The correct answer is:
 A
1,2.
2%
 B
2,3.
3%
 C
4,5.
6%
 D
2,5.
83%
 E
1,5.
In the treatment of perianal fistulas in Lesniowski-
Crohn’s disease all of the following are used except:
 A
Fistulotomy and drainage.
4%
 B
Steroids.
51%
 C
Infliximab and adalimumab.
18%
 D
EUA (examination under anaesthesia) and placing of non-cutting loose setons.
15%
 E
Fistulectomy.
The intestinal obstruction most commonly results from:
 A
Gallstone disease.
8%
 B
Inguinal hernia incarceration.
11%
 C
Big polyp of small intestine.
2%
 D
Colon cancer.
75%
 E
Small intestine torsion.
Which of the following methods is not used in the
surgical treatment of the hemorrhoidal disease?
 A
DGHAL.
7%
 B
Stretta.
60%
 C
Milligan-Morgan.
12%
 D
Longo.
10%
 E
Ferguson.
The knowledge of the Calot’s triangle topography is
necessary in the surgical treatment of:
 A
Adrenal tumor.
6%
 B
Pancreatic tumor.
12%
 C
Gastric ulcer.
2%
 D
Hashimoto disease.
3%
 E
Gallstone disease.
TEM (Transanal Endoscopic Microsurgery) is the
surgical technique useful in:
 A
Miniinvasive treatment of advanced anal tumors.
12%
 B
Treatment of the low grade (poorly differentiated) sigmoid cancer.
3%
 C
Miniinvasive treatment of rectal tumors.
40%
 D
Laparoscopic treatment of rectal cancer.
2%
 E
C and D are correct.
Which of the following concerning post-thrombotic
syndrome are true?
1) develops as a result of superficial vein thrombosis;
2) develops as a result of deep vein thrombosis;
3) causes trophic skin changes near the medial ankle;
4) causes trophic skin changes near the lateral ankle;
5) venous hypertension is the cause of trophic skin
changes;
6) perforating vein ligations do not prevent recurrent
ulcerations.
The correct answer is:
 A
1,3,5.
13%
 B
1,4,6.
6%
 C
2,3,5.
59%
 D
2,4,5.
14%
 E
2,4,6.
 Which of the following concerning erysipelas are true?
1) it is an acute skin inflammation caused by
Streptococci;
2) it is an acute skin inflammation caused by
Staphylococci;
3) it is characterized by high fever (up to 40 °C);
4) it is characterized by fever that does not exceed 38
°C;
5) systemic symptoms are characteristic;
6) only local symptoms are characteristic.
The correct answer is:
 A
1,3,5.
68%
 B
1,3,6.
14%
 C
1,4,6.
8%
 D
2,3,5.
8%
 E
2,4,6.
The most common complication of the treatment of the
humerus shaft fractures is:
 A
Ulnar nerve palsy.
8%
 B
Median nerve palsy.
25%
 C
Radial nerve palsy.
46%
 D
Brachial artery damage.
19%
 E
Post-traumatic algodystrophy.
Which of the following are the complications of fractured
bone union?
1) mal-union of fractured bone;
 2) osteitis;
3) contractures in neighbouring joints;
4) delayed union of the fractured bone;
5) pseudoarthrosis.
The correct answer is:
 A
1,2,5.
11%
 B
1,4,5.
76%
 C
2,3,5.
5%
 D
2,4,5.
2%
 E
3,4,5.
Abdominal pain, retention of gases, constipation,
nausea and vomiting are the symptoms of:
1) paralytic ileus;
2) mechanical ileus;
3) biliary colic;
4) hyperkalemia;
5) hypernatremia.
The correct answer is:
 A
1,2,3.
70%
 B
2,3,4.
7%
 C
2,4,5.
3%
 D
1,3,4.
4%
 E
1,2,5.
Indicate the correct statements regarding hernias:
1) laparoscopic surgery is most commonly used;
2) surgeries with the use of plastic mesh give the best
 results;
3) there is always a risk of incarceration;
4) inguinal hernias are a few times more often in men
than in women;
5) only big hernias should be treated with surgery.
The correct answer is:
 A
1,2,3.
11%
 B
1,3,4.
4%
 C
2,4,5.
5%
 D
1,2,5.
1%
 E
2,3,4.
The common symptoms of diverticulitis are:
1) left lower abdomen pain;
2) admixture of blood in the stool;
3) painful resistance above the left hip;
4) retention of gases and vomiting;
5) narrow stools.
The correct answer is:
 A
1,2.
25%
 B
2,3.
5%
 C
3,4.
5%
 D
1,3.
64%
 E
1,5.
Which of the following statements regarding urgent
blood transfusion is true? (PRBC-Packed Red Blood
Cells, FFP – Fresh Frozen Plasma).
 A
In the cases of emergency there is a possibility of blood group AB PRBC
transfusion, without compatibility testing, and without the recognition of the blood
group type of the recipient.
5%
 B
In the case of pregnants only the group 0 Rh(+) PRBC may be transfused, without
compatibility testing, and without the recognition of the blood group type of the
recipient.
6%
 C
In the cases of emergency there is a possibility of the AB group FFP transfusion,
without compatibility testing, and without the recognition of the blood group type of
the recipient.
63%
 D
A and C are correct.
11%
 E
Blood transfusion cannot be performed without the recognition of the blood group of the
recipient.
Soft tissue infection limited to subcutaneous tissue,
often infiltrating one phalanx bone, and in the case of
spreading to proximal one it shows the tendency of
expansion to the hand. Initially it forms an inflammatory
infiltration, later purulent vesicle. Which of the
diagnoses seems to be correct?
 A
Paronychia.
15%
 B
Empyema.
8%
 C
Felon (whitlow).
76%
 D
Seroma.
1%
 E
Fibroma.
Which of the following disorders are the most
characteristic of hypogastric and left iliac fosssa pain?
1) sigmoid diverticulitis;
2) small bowel obstruction;
3) urine retention;
 4) pancreatitis;
5) renal colic;
6) splenic infarction.
The correct answer is:
 A
3,4,6.
1%
 B
2,3,5.
5%
 C
1,3,5.
90%
 D
3,4,5.
2%
 E
4,5,6.
The patient was admitted to the surgery ward with
suspected appendicitis. Additional tests (ultrasound
imaging) confirmed periappendicular inflammatory
infiltration. Conservative therapy was administered, and
after the pain withdrawal and the reduction of white
blood cells count in peripheral blood, the patient was
discharged. On the second day the patient was
readmitted to the emergency room, complaining of
fever, dizziness, and mild pain in the right iliac fossa.
Indicate the correct conclusions and action:
 A
The ultrasonography of the abdomen should be done in this patient.
5%
 B
The CT scan may be done in this patient.
3%
 C
The patient probably will require urgent invasive treatment.
13%
 D
The peritoneal abscess would be possible to diagnose.
7%
 E
All of the answers are correct.
Which of the operations would be most suitable in the
case of 3 synchronic colon tumors localized in
 ascendent, transverse and descendent colon
respectively if these are adenocarcinomas, and the
stage is not later than T3NXM0?
 A
Endoscopic polypectomy.
9%
 B
Transanal Endoscopic Microsurgery (TEM).
7%
 C
Colectomy.
81%
 D
Endoscopic prosthesis implantation.
1%
 E
Paliative treatment.
A 40-year-old woman, weight 104 kg, height 172 cm, a
history of two births – this is a woman with tendency to:
 A
Gastric and duodenal ulcer.
3%
 B
Choledocholithiasis and urolithiasis.
11%
 C
Cholelithiasis.
84%
 D
Duodenal ulcer.
1%
 E
Nephrolithiasis.
A 27-year-old patient reported to his GP because of low
abdominal aching while coughing and after strenuous
exercise. Body temperature normal, rather regular
urination, without constipation. Physical exam: a soft
abdomen with no pathological resistance. Peristalsis
normal. There is a small lump (size of tangerine) in the
region of the left groin appearing during slight cough.
This description suggests:
 A
Lipoma of the inguinal canal.
1%
 B
 Enlarged lymph node.
0%
 C
Lymphadenitis.
0%
 D
Left scrotal hydrocele.
2%
 E
Inguinal hernia.
A female patient vomiting for the last few months. The
vomiting occurs almost immediately after a meal and
brings relief. The vomiting is preceded by pain within
the central epigastric region. She has been previously
treated for chronic peptic ulcer disease. Physical exam:
gastric splash present. This clinical condition will be
characterized in biochemical findings by:
 A
Compensated metabolic acidosis and hypokalemia
5%
 B
Metabolic alkalosis and hypochloremia
18%
 C
Metabolic alkalosis and hypokalemia with hypochloremia
71%
 D
Uncompensated metabolic acidosis with hypochloremia
5%
 E
Compensated metabolic acidosis and the beginning of alkalosis
A 50-year-old man with left low abdominal pain lasting
for 2 days. Physical exam: body temperature 37.8°C,
tenderness and Blumberg sign present in the left iliac
region. Laboratory findings: leucocytes 17,000 per
mm3, CRP 45 U/l. Abdominal CT scan: sigmoid wall
thickening and the presence of inflammatory infiltrations
in the fat tissue surrounding the sigmoid colon. The
most appropriate procedure would be:
 A
Empirical antibiotics with following CT scan after 48-72 hours if the symptoms of
localized peritonitis persist.
69%
 B
 Emergency laparotomy with bowel resection and primary intestinalanastomosis.
4%
 C
Emergency colonoscopy or double-contrast enema due to suspected sigmoid
tumor.
5%
 D
Emergency surgery – sigmoid resection m/o Hartman – due to suspected
diverticulitis.
20%
 E
Laparoscopic sigmoid resection with anastomosis without waiting for disease progression.
A 28-year-old man has been admitted to the ER in a
severe condition after the fall from scaffolds (height 3
m). The patient, primarily unconscious, regained
consciousness in the ambulance. ER Glasgow Coma
Scale (GCS) – 6. Blood pressure 175/80 mmHg. Pulse
50/minute. Irregular breathing. Upon examination:
anisocoria and bruises within the left temporal region.
The most probable diagnosis is:
 A
Fracture of the skull base and optical nerve injury.
10%
 B
Subdural hematoma.
14%
 C
Epidural hematoma.
54%
 D
Extensive intracranial hematoma.
15%
 E
Posterior cranial fossa fracture.
A 45-year-old patient was admitted to the ER because
of severe peri-rectal pain and fever. Upon examination:
significant tenderness during per rectum exam and
tender, reddish tumor located on the right buttock 3 cm
from anus. The most appropriate procedure in this case
would be:
 A
Tumor incision and drainage.
84%
 B
Drainage under ultrasound control.
 7%
 C
Antibiotic therapy and drainage after the resolution of inflammation.
6%
 D
Drainage directed from the lumen of the rectum.
1%
 E
Puncture, antibiogram and targeted antibiotic therapy.
Pleomorphic microcalcifications in the upper outer
quadrant of the right breast have been found in a 52-
year-old woman on screening mammography. They
have been classified as BIRADS IV. Please choose
subsequent procedure:
 A
Observation.
1%
 B
Mammography after 3 months.
4%
 C
Surgical biopsy.
77%
 D
Modified radical mastectomy.
14%
 E
Neoadjuvant chemotherapy.
There has been an upper gastrointestinal (GI) bleeding
in a patient treated because of advanced liver hepatitis
C cirrhosis. Successful first aid treatment has been
applied and hemostasis obtained. The patient is now
discharged from hospital with treatment
recommendations. Which of the therapeutic options
listed below is the least successful in the prophylaxis of
recurrent GI bleeding?
 A
Beta-adrenolytics.
18%
 B
Endoscopic use of rubber garters.
4%
 C
Transdermal portocaval anastomosis.
4%
 D
Interferon.
69%
 E
Liver transplantation.
A 40-year-old man has been admitted to hospital with
symptoms of gastrointestinal (GI) bleeding. In the past
medical history there have been a few episodes of
upper GI bleeding for the last year. The patient has
been suffering from frequent, massive diarrhea for a few
months. What is the most common localization of the
pathology which causes this disorder?
 A
Lung.
5%
 B
Right half of colon.
16%
 C
Lymph nodes.
1%
 D
Pancreaticoduodenal region.
76%
 E
Brain stem.
Obstructive jaundice, dilation of the biliary ducts and of
gallbladder are the symptoms of:
1) pancreatic body cancer;
2).carcinoma of the ampulla of Vater;
3) pancreatic head cancer;
4) common bile duct cancer;
5) hepatocellular carcinoma.
The correct answer is:
 A
1,2,3.
4%
 B
2,3,4.
92%
 C
3,4,5.
2%
 D
 2,4,5.
1%
 E
1,3,5.
A 75-year-old woman suffered from severe, constant
abdominal pain on the 5th day after right
hemicolectomy. Upon examination: abdomen
tenderness, peritoneal signs present, peristalsis absent,
body temperature 39°C, pulse 120/minute. The most
probable diagnosis is:
 A
Paralytic ileus.
16%
 B
Intestinal anastomosis leakage.
75%
 C
Peptic ulcer perforation.
2%
 D
Pancreatitis.
1%
 E
Abscesses between the intestinal loops.
What is the appropriate treatment of intestinal necrosis
caused by superior mesenteric artery embolism?
1) embolectomy;
2) intraoperative thrombolytic therapy;
3) necrotic intestine resection;
4) revision 24-48 hours after the primary laparotomy;
5) fractionated heparin application.
The correct answer is:
 A
1,2,3.
8%
 B
1,3,4.
15%
 C
1,3,5.
16%
 D
2,3,5.
7%
 E
 3,4,5.
Vomiting, pain within the right half of the abdomen and
body temperature 39°C occurred in a 47-year-old
patient on the 2nd day after a blunt abdominal injury.
Laboratory findings: elevated plasma amylase level,
leucocytosis. Abdominal X-ray: air bubbles along the
right iliopsoas muscle. The most probable diagnosis is:
 A
Duodenal ulcer perforation – “stress ulcer”.
10%
 B
Post-traumatic pancreatitis.
24%
 C
Extraperitoneal duodenal rupture.
49%
 D
Post-traumatic ascending colon rupture.
13%
 E
Pancreatic contusion.
A 46-year-old woman suffered from severe abdominal
pain and vomiting. In the past medical history:
laparotomy 2 years ago due to similar symptoms, but
without finding the cause of the symptoms. Recently
she has been taking sedative and antiinflammatory
drugs. The cause of her symptoms may be:
 A
Acute porphyria.
66%
 B
Ogilvie syndrome.
27%
 C
Lead poisoning.
2%
 D
Type IV hyperlipidemia.
2%
 E
Hemolytic crisis in sickle-cell anemia.
Which of the following statements regarding abdominal
angina are true?
1) it is caused by stenosis or occlusion of visceral
 vessels;
2) the most often cause is atherosclerotic stenosis or
occlusion of the superior mesenteric artery;
3) the most frequent cause is fibro-muscular
hypertrophy of the arterial walls and Burger’s disease;
4) patient waste with epigastric colic pain after the
meals and diarrhea dominates in clinical picture;
5) it is rarely symptomatic disease owing to multiple
junctions of visceral vessels with the internal iliac artery.
The correct answer is:
 A
1,2,3.
8%
 B
1,2,4,5.
60%
 C
1,2,5.
20%
 D
3,4,5.
2%
 E
All the above.
The indication for performing thoracic sympathectomy
is:
 A
Acute upper extremity ischemia.
4%
 B
Paget-Schrotter syndrome.
6%
 C
Thoracic outlet syndrome.
11%
 D
Raynaud disease with fingers’ ischemia.
53%
 E
Severe pain syndrome in advanced pancreatic cancer.
Which of the following symptoms differentiate acute
appendicitis from acute pyelonephritis?
1) chills in the beginning of the disease;
2) body temperature above 39°C;
 3) marked peritoneal signs;
4) regular rhythm of urinating;
5) positive Rovsing sign;
The correct answer is:
 A
All the above.
12%
 B
1,2,3.
3%
 C
3,4,5.
65%
 D
3,5.
18%
 E
1,2.
To assess the prognosis of acute pancreatitis one can
use:
1) APACHE scale;
2) Milan criteria;
3) CEAP classification;
4) Ranson’s scale;
5) GCS classification.
The correct answer is:
 A
1,3,5.
5%
 B
2,3,5.
1%
 C
2,4.
7%
 D
1,4.
85%
 E
2,5
In Poland organ harvesting after the death of a human
may be performed:
 A
In every case apart from neoplastic diseases
12%
 B
Only if the patient has given a written consent in life
11%
 C
Only if the prior permission has been stated in the presence of two witnesses.
3%
 D
In all cases if only the immediate family consent is stated.
5%
 E
None of the above.
Which of the following concerning acute appendicitis
are true?
1) laparoscopic surgery is not recommended;
2) can occur at any age;
3) pain moving from epigastric to the right inguinal
region is typical;
4) no gender preponderance;
5) often accompanies caecum carcinoma.
The correct answer is:
 A
1,2,3.
5%
 B
2,3,4.
83%
 C
3,4,5.
2%
 D
1,2,4.
1%
 E
1,4,5.
Periodic check-ups after the resection of the colon
because of cancer should include:
1) abdominal ultrasound and chest X-ray;    4)
barium enema;
2) colonoscopy;          5)
alkaline phosphatase test.
3) CEA test;
The correct answer is:
 A
 1,2,3.
80%
 B
1,3,4.
12%
 C
1,2,5.
3%
 D
1,4,5.
1%
 E
2,3,5.
Which of the following are the most frequent causes of
acute pancreatitis:
1) alcoholic liver cirrhosis;      4) low-
protein diet;
2) excessive fat-food intake;       
5) cholelithiasis.
3) alcohol;
The correct answer is:
 A
1,2.
1%
 B
2,3.
10%
 C
1,3.
3%
 D
4,5.
1%
 E
3,5.
Which of the following concerning femoral neck
fractures are true?
1) frequently occur in elderly people;
2) they are more frequent in women;
3) surgical treatment consists of hip debris being pinned
together;
4) surgical treatment consists of hip replacement;
 5) surgical treatment is indicated only in young patients.
The correct answer is:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
1,3,4.
21%
 B
1,2,3.
65%
 C
2,3,4.
6%
 D
1,2,5.
7%
 E
2,4,5.
Discussion:
Ad. 5 - Surgical treatment can be used both in young and old patients.
Femoral neck fracture :
 frequent in elderly people
 more often in women
 life-threatening due to distant complications: deep veins thrombosis of the
lower limbs, pulmonary embolism
 subcapital fractures are the worst
 symptoms:
o hip and groin pain
o limb in external rotation
 treatment :
o conservative :
 orthopedic extraction
 if there is no consent to surgical treatment
o surgical:
 subcapital fracture:
 removal of the femoral head
 arthroplasty
 intracervical and intertrochanteric fracture:
 fusion of the head with the neck
Source:
Chirurgia - Repetytorium, Wojcech Noszczyk; PZWL; Wydanie I - 7 dodruk; 2016; ISBN: 978-
83-200-4555-0; strona 261-262

Hoarseness occurred in a patient after the surgery of

the huge goiter. Right vocal fold paralysis is seen during
laryngoscopy. Damage to which of the following
structures has caused those symptoms?
 A
Vocal fold.
1%
 B
Vocal cord.
1%
 C
Inferior laryngeal nerve.
3%
 D
Superior laryngeal nerve.
3%
 E
Recurrent laryngeal nerve.
On UGI endoscopy performed for dyspepsia in a 78-
year-old man, a 4-cm crater-like ulcer located in the
cardiac region is diagnosed. Biopsy specimens showed
gastric carcinoma of intestinal type. The patient is
classified to group II according to the American Society
of Anaesthesiology. Which of the following procedures
is most recommended?
 A
Cardiac (stomach) prosthetics.
1%
 B
Neo-adjuvant radio-chemotherapy.
6%
 C
Total gastrectomy and distal esophagectomy.
91%
 D
Feeding gastrostomy.
1%
 E
Argon plasma coagulation of the lesion.
A 25-year-old man presented to the ER with a perianal
pain. The pain is severe when he is seated and during
defecation. Pain started 3 days ago and has been
increasing. Physical exam: a painful tumor on the right
buttock located 3 cm from the anus. The skin over the
tumor is unchanged. Per rectum examination is
unreliable because of severe pain and difficulty in
carrying it out. What is the most appropriate procedure?
 A
Antibiotics.
1%
 B
 Transrectal ultrasonography.
1%
 C
Incision and drainage.
89%
 D
Ultrasound-guided drainage.
6%
 E
Per rectum examination under sedation.
A 56-year-old woman with craniocerebral trauma was
admitted to the hospital. She opens her eyes to painful
stimuli and there is extremity flexion (extremity with-
drawal). She is confused and in a limited contact; it is
difficult to gather the information. What is her Glasgow
Coma Scale (GCS) score?
 A
5.
6%
 B
7.
29%
 C
9.
58%
 D
11.
6%
 E
13.
A female patient complains of the numbness of fingers
and tingling around the lips three days after
thyroidectomy for follicular carcinoma. She is upset and
anxious. Recommend the correct therapeutic approach
in this case:
 A
Administering sedatives.
1%
 B
Administering calcium preparations intravenously.
97%
 C
Administering drugs that improve peripheral blood circulation.
1%
 D
Resurgery
 1%
 E
Psychological consultation.
To which of the following organs does distal esophagus
carcinoma metastasize, in order of decreasing
frequency?
 A
Bones, kidneys, liver.
4%
 B
Liver, lungs, bones.
83%
 C
Lungs, central nervous system (CNS), adrenals.
6%
 D
Liver, CNS, kidneys.
2%
 E
Stomach, bones, adrenals.
Which of the following is false?
1) incarcerated hernia is a synonym of irreducible
hernia;
2) incarcerated hernia is always an irreducible hernia;
3) femoral hernia is always an acquired hernia;
4) pseudohernia, unlike eventration, possesses hernia
sac;
5) femoral hernia orifice traverses below the inguinal
ligament.
The correct answer is:
 A
1,2.
48%
 B
1,4.
18%
 C
3,4.
12%
 D
2,5.
11%
 E
4,5.
 Which of the following, increasing and synergistic
factors are included in the trauma triad of death?
1) hypovolemia;   2) acidosis;   3)
anuria;   4) hypothermia;    5)
coagulopathy.
The correct answer is:
 A
1,2,3.
5%
 B
1,2,5.
17%
 C
2,3,5.
4%
 D
2,4,5.
71%
 E
3,4,5.
What diagnostic method is both quick and effective, and
allows to assess the trauma degree in post-injury
patient assessment?
 A
FAST ultrasound.
93%
 B
Abdomen CT scan.
5%
 C
X-ray.
2%
 D
Diagnostic peritoneal lavage.
1%
 E
Arteriography.
Prolonged paralytic ileus after abdominal surgery may
be caused by:
1) hypoalbuminemia;    4) increased intra-
abdominal hypertension syndrome;
2) acidosis;    5) intraperitoneal abscesses.
3) hypokalemia;
The correct answer is:
 A
1,3,4.
6%
 B
3,4,5.
8%
 C
2,3,4.
5%
 D
1,4,5.
10%
 E
All the above.
Which of the following is not a prognostic factor in
acute pancreatitis?
 A
Left pleural effusion.
12%
 B
Cullen's and Grey Turner's signs.
13%
 C
Serum lipase and amylase activities.
49%
 D
Body mass index (BMI).
24%
 E
Percentage of necrotic tissue on CT scan.
Upper gastrointestinal (UGI) endoscopy performed in a
55-year-old patient for the search of the cause of
anemia revealed a 6-cm tumor located in the body of
stomach. It was covered with normally looking mucosa,
except for 2-cm ulceration on the top of the tumor.
Tissue samples have been collected (biopsy).
Pathology exam revealed fusiform cells expressing
CD117 antigen. On CT scan: there were no pathological
changes except for the primary tumor. Indicate
recommended procedure:
 A
Total gastrectomy.
6%
 B
Total gastrectomy with D3 lymph nodes dissection.
21%
 C
Gastric wedge resection.
50%
 D
Gastric wedge resection with D2 lymph nodes dissection.
16%
 E
Subtotal gastrectomy with D2 lymph nodes dissection.
Which organ is the most common localization of the
metastatic development of other organs neoplasms?
 A
Brain.
2%
 B
Lungs
40%
 C
Liver.
55%
 D
Bones.
1%
 E
Skin.
In a patient on the first day after right hemicolectomy,
because of the severe abdominal pain, a plain abdomen
X-ray in the vertical position was done, where free gas
under the both phrenic archs was observed. Which
action would be the most adequate?
 A
Urgent relaparotomy because of the suspicion of stress ulcer perforation.
13%
 B
NMR scan to confirm the suspicion.
3%
 C
Explorative laparoscopy because of the suspicion of stress ulcer perforation.
6%
 D
A and C are correct.
28%
 E
None of the above.
In a 35-year-old patient, after the orthopedic
management of the broken ankle bone, muscle atrophia
and painful oedema of the ankle joint were observed.
After 3 weeks, bone atrophy appeared on the X-ray in
 the are around the fracture fissure. The symptoms
relate to:
 A
Sudeck's syndrome.
79%
 B
Volkmann's contracture
6%
 C
Pseudarticulation (rudimentary joint)
10%
 D
Physiological reparation of the injury.
2%
 E
None of the above.
The “T” Kehr drainage is used for:
 A
Pleural cavity drainage
6%
 B
Peritoneal drainage.
7%
 C
Ureteral drainage.
4%
 D
Bile duct drainage.
82%
 E
None of the above.
A 57-year-old patient with histological diagnosis of an
adenocarcinoma tumor located in the spleenic flexure.
No other changes except for the primary tumor are seen
on CT scans. He is classified ASA 2 by
anesthesiologist. The “gold standard” surgical approach
is:
 A
Right hemicolectomy.
7%
 B
Extended left hemicolectomy.
71%
 C
Colectomy.
8%
 D
 Segmental colon resection.
8%
 E
Transverse colon with spleen flexure resection.
A 25-year-old patient presented with itching and
periodic rectal spotting mainly after defecation. PMH:
periodic abdominal pains. Physical exam: periumbilical
tenderness; no other findings. On anoscopy: red
edematous mucosa of the anal canal with two anal
fissures: the first located posteriorly in the midline, the
other on the right lateral wall. Which of the following
diagnoses is the most probable?
 A
Ulcerative colitis.
13%
 B
Luetic rectitis and colitis.
2%
 C
Perianal changes in Crohn's disease.
69%
 D
Anal canal mycosis.
1%
 E
Mechanical damage of the anal canal.
A 75-year-old patient called the ambulance because of
severe left upper limb pain. The pain is located distally
from the elbow. The patient cannot move his limb. On
physical exam the limb is cold with cutaneous sensory
disturbances. Which ad hoc disposal should be
recommended?
 A
Angiography.
5%
 B
Heparin 5000 units.
74%
 C
Heparin intravenous infusion 18 units/h/kg of body weight.
16%
 D
Aspirin and clopidogrel.
3%
 E
 Fasciotomy.
A 45-year-old man referred to the ER because of a
furuncle in the right submandibular region. Past medical
history (PMH): aortic valve replacement because of RA;
no other medical problems. Physical exam: a red,
tender tumor with the apical white discoloration located
in the right submandibular region. Heart auscultation
revealed pronounced prosthetic valve sound in the
aortic area (second right intercostal space). No other
changes on the physical exam. What is the
recommended procedure?
 A
Incision and drainage.
8%
 B
Removal of necrotic plug and purulent content.
4%
 C
Incision, drainage and anticoagulants.
4%
 D
Oral antibiotics and topical antiseptics.
1%
 E
Removal of necrotic and purulent content, and oral antibiotics.
In traumatic spleen rupture:
1) splenectomy is always necessary;   4)
peritoneal bleeding is always present;
2) partial splenectomy is possible;   5)
extraperitoneal hematoma often occurs.
3) laparoscopic approach is possible;   
The correct answer is:
 A
1,3.
5%
 B
3,4.
2%
 C
2,3.
63%
 D
1,4.
 3%
 E
2,5.
Which of the following should be used as first choice
treatment (preferred method) In order to stop the UGI
bleeding (hematemesis)?
 A
Surgery.
1%
 B
Conservative treatment.
5%
 C
Endoscopic treatment.
93%
 D
Patient observation.
1%
 E
None of the above.
1
Humans are the only reservoir of this organism. The
infection is transmitted by droplets, through direct
contact and through the placenta. Infectivity for people
in the household contact exceeds 90%. The
asymptomatic course rarely occurs. The incubation
period lasts 10-21 days. This characteristic refers to:
 A
Rubella.
10%
 B
Varicella.
71%
 C
Infectious mononucleosis.
8%
 D
Mumps.
3%
 E
Measles.
Gallbladder polyps are indication for surgical treatment
(cholecystectomy) when the their diameter exceeds:
 A
3 mm.
5%
 B
5 mm.
 17%
 C
1 cm.
68%
 D
2 cm.
7%
 E
3 cm.
Which of the following concerning secondary
hyperparathyroidism is false?
1) it is always the indication for surgery;
2) calciphylaxis is the indication for surgical treatment;
3) surgery involves the removal of a single parathyroid
adenoma that is the most frequent cause of the
disease;
4) surgery involves the subtotal resection of the
parathyroid gland or total resection of the parathyroid
gland with the autotransplantation of one of them;
5) core treatment involves the correction of calcium and
phosphate levels into the normal reference range and of
iPTH level to be 2-9 times the upper limit value.
The correct answer is:
 A
1,2,4.
20%
 B
1,4,5.
14%
 C
1,3.
46%
 D
2,3.
8%
 E
All the above.
Which of the following can be used in the treatment of
patients with esophagus cancer?
 A
Chemotherapy.
4%
 B
Laser ablation.
 2%
 C
Photodynamic therapy.
0%
 D
A,B are correct.
16%
 E
A,B,C are correct.
In patients with Barrett's esophagus:
 A
There are symptoms of gastroesophageal reflux disease.
4%
 B
Lower resting pressure of the lower esophageal sphincter is found.
1%
 C
Antisecretory treatment eliminates regurgitation into the esophagus.
1%
 D
A,B are correct.
63%
 E
A,B,C are correct.
In patients with esophageal diverticulum:
 A
The main diagnostic test is contrast radiographic examination and treatment
includes only myotomy.
11%
 B
Endoscopy determines the treatment and the treatment consists only in endoscopic
excision of the diverticulum.
10%
 C
Disorders of the upper esophageal sphincter relaxation are among the causes of
the diverticulum and the treatment involves the excision of the diverticulum and
myotomy.
60%
 D
The most important diagnostic procedure is MRI and the treatment includes only
excision of the diverticulum.
2%
 E
All the above are false.
A female patient with right subcostal pain was
diagnosed with choledocholithiasis and the extrahepatic
bile ducts distention up to 12 mm. What is the most
proper approach?
 A
 Open cholecystectomy, choledochotomy and the removal of stones.
2%
 B
Preoperative retrograde cholangiopancreatography and laparoscopic
cholecystectomy.
91%
 C
Laparoscopic cholecystectomy.
6%
 D
Open cholecystectomy with cholangiography.
1%
 E
Magnetic resonance cholangiography.
An ICU patient with acute pancreatitis complained of
tingling around the mouth, paresthesia in the fingers of
both hands and cramps in both legs. These symptoms
began on the second day after the admission. ECG
shows sinus bradycardia with prolonged QT interval.
Which of the following therapeutic procedures is the
most correct one?
 A
Intravenous calcium supplementation
94%
 B
Modification of antibiotics
1%
 C
Dialysis
2%
 D
Antiarrhythmic drugs
2%
 E
Oxygen therapy
A 42-year-old man was admitted to the ER because of
pain in the anal area. He feels strong pain while sitting
and defecating. This has lasted for the last few days
and is gradually getting worse. The physical exam
shows: a painful lump on the left buttock 3 cm from the
anal canal. The skin is slightly reddened. Per rectum
exam gives strong pain and is not successful. What
is the most probable diagnosis?
 A
 Perianal abscess.
93%
 B
Hemorrhoidal thrombosis.
3%
 C
Anal fissure.
2%
 D
Post-injection gluteal abscess.
1%
 E
Rectal cancer.
It is the most frequent benign hepatic neoplasm, usually
asymptomatic. The risk of bleeding into the tumor or its
rupture occurs when its diameter is over 10 cm.
Surgical treatment is indicated when it is symptomatic
or when diameter is more than 10 cm. The above
characteristics refers to:
 A
Nodular liver hyperplasia.
2%
 B
Hepatic haemangioma.
84%
 C
Liver adenoma.
7%
 D
Liver cyst.
5%
 E
None of the above.
During the follow up of the patient with the history of
adrenal pheochromocytoma you find
hyperparathyroidism and elevated calcitonin level.
Which will be the most proper first-line curative
approach in this patient?
 A
Chemo-radiotherapy.
8%
 B
Complete thyroid resection.
22%
 C
Ablative radioiodine treatment.
 11%
 D
Complete thyroid resection and lymphadenectomy.
57%
 E
Dialysis.
In an ICU patient after an abdominal surgery and no
prior PMH you monitor various parameters of the
cardiovascular system. Which of the following
parameters make you decrease fluid administration?
 A
Mean arterial pressure approx. 72 mmHg.
6%
 B
Diuresis approx. 40 ml/h.
10%
 C
Central venous pressure approx. 22 mmHg.
70%
 D
Pulmonary capillary wedge pressure approx. 15 mmHg.
10%
 E
Pulse approx. 96/minute.
A patient with upper gastrointestinal (UGI) bleeding was
admitted to the surgical ER. Endoscopy shows active
bleeding from the duodenal bulb ulceration. Hemostasis
was obtained with local endoscopic saline and
adrenaline administration. The pulse and blood
pressure were stabilized after the correction of volemic
disorders. Twenty hours later the pressure dropped to
approx. 100/60 mmHg and the pulse increased to
120/minute. Which is the most proper approach?
 A
Increase the dose of proton pump inhibitors.
4%
 B
Surgery.
12%
 C
Transfusion of 2 units of packed red blood cells.
5%
 D
Administration of pressor amines.
4%
  E
Gastroscopy.
A 63-year-old man was diagnosed with a rectal tumor
located 8 cm from the edge of the anus.
Histopathological examination shows adenocarcinoma
infiltration. The abdominal and pelvic CT scan shows no
distant metastases. Transrectal ultrasound shows the
tumor that goes beyond the rectum wall and invades the
fatty tissue of the mesorectum. What is the correct
approach in this case?
 A
Rectum prosthesis.
2%
 B
Surgery with possible adjuvant chemotherapy.
12%
 C
Neo-adjuvant radiotherapy and surgery.
70%
 D
Neo-adjuvant chemotherapy and surgery.
11%
 E
Surgery.
Tenderness on palpation in the right lower quadrant of
the abdomen, temperature above 37.5 Celsius,
Blumberg's sign, tenderness on per rectum exam,
increased muscle tension are the signs of:
 A
Acute cholecystitis.
5%
 B
Acute pancreatitis.
2%
 C
Adnexitis.
3%
 D
Duodenal ulcer perforation.
2%
 E
Acute appendicitis.
Potential pathogens in diffuse peritonitis caused by the
perforation of the lower gastrointestinal tract are as
follows:
 A
G(-) bacilli, Enterococcus sp., anaerobes.
87%
 B
G(+) bacilli, Clostridium welchi, Helicobacter pylori.
1%
 C
G(-) bacilli, Morganella morgani, Staphylococcus aureus.
1%
 D
Anaerobes, Streptococcus aeruginosa, Campylobacter</i>.
3%
 E
G(+) bacilli, G(-) bacilli, anaerobes.
A 45-year-old man was admitted to the ER because of
diffuse abdominal pain which has been getting worse
for the last few hours. Patient says that the pain
radiates to the right groin and that it becomes the most
severe in this area. It is accompanied by retching,
gases and fecal retention and urinary problems (small
amounts of urine). PMH: patient underwent surgery for
a perforated duodenal ulcer years ago. Which of the
following initial diagnoses should be taken into account
first?
 A
Gastric ulcer, duodenal ulcer, diverticulitis, urolithiasis, incarcerated inguinal hernia.
17%
 B
Perforated gastric or duodenal ulcer, perforated diverticulum, testitis, bowel
obstruction.
12%
 C
Splenic rupture, appendicitis, renal colic, biliary colic.
2%
 D
Cholecystitis, adnexitis, bowel obstruction, appendicitis.
6%
 E
Incarcerated hernia, appendicitis, ureterolithiasis, Meckel's diverticulitis.
Which of the following factors have impact on the
occurrence of recurrent duodenal ulcer bleeding?
 A
Bleeding activity in Forrest classification, the size of the bleeding source,
localization, a type of treatment.
87%
 B
 Cardiovascular sufficiency, bleeding activity in Forrest classification, a type of
treatment, impaired motility.
4%
 C
Efficiency of the respiratory system and kidneys, bleeding activity in Forrest
classification, type of treatment.
2%
 D
Bleeding activity in Forrest classification, esophageal erosions, a type of treatment.
3%
 E
Esophageal varices, esophageal erosions, an ulcer clip in anamnesis, impaired motility.
You decide to start the pharmacological therapy in a
patient with endoscopically confirmed duodenal ulcer
disease. Helicobacter pylori infection is excluded. Which
of the following group of drugs has the smallest
therapeutic use?
 A
Proton pump inhibitors.
9%
 B
H2-receptor blockers.
3%
 C
Calcium- and magnesium-based antacids.
3%
 D
Antibiotics.
75%
 E
Prostaglandin derivatives.
Which of the following concerning thrombosis is true?
1. thrombosis rarely occurs in patients who underwent
surgery
2. degree of risk depends on individual features, clinical
condition, the type of interventions: either diagnostic,
surgical or preventive
3. a minority of patients is exposed to no more than 1
risk factor
4. prophylaxis is effective and justified clinically and
economically
5. it is recommended not to use ASA as the only
antithrombotic prophylaxis in any group of patients;
 6. prophylaxis is not effective clinically and increases
the costs of treatment
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
1, 2, 3
31%
 B
2, 4, 5
52%
 C
4, 5, 6
6%
 D
1, 3, 6
4%
 E
2, 4, 6
he content of the question is taken from the Polish guidelines for the prevention
and treatmentof venous thromboembolism. 2012 update. In Chapter 5 "Risk
factors" you can find the following text:
 Venous thrombosis is common in hospitalized patients. (item 1)
 The degree of risk (small, medium, large) depends on individual
characteristics, clinical conditions and on the type of diagnostic,
therapeutic and prophylactic intervention. (item 2)
 The majority of hospitalized patients are burdened with ≥1 VTE risk
factor. (item 3)
 Prevention is effective and also clinically and financially justifiable.
(item 4)
In the general recommendations, we can also read that:
 do not use ASA as the only method of antithrombotic prophylaxis in
any group of the patients. (item 5)
Source:
Polskie Wytyczne Profilaktyki i Leczenia ŻChZZ aktualizacja 2012

Large projectile vomiting, ulcer disease in anamnesis,

progressive loss of weight, gradual dehydration,
"splashing" symptom occur in:
 A
Gastric ulcer perforation.
11%
 B
Duodenal ulcer disease.
2%
 C
Pyloric stenosis.
79%
 D
Acute pancreatitis - severe form.
1%
  E
Early gastric cancer.
In the diagnosis of the achalasia the basic diagnostic
tests are:
 A
Barium swallow X-ray of the upper gastrointestinal tract, esophageal manometry
and endoscopic ultrasound (EUS).
33%
 B
Barium swallow X-ray of the upper gastrointestinal tract, endoscopy and
esophageal manometry.
57%
 C
Barium swallow X-ray of the upper gastrointestinal tract, abdominal computed
tomography and endoscopy.
5%
 D
Abdominal CT scan, EUS and esophageal manometry.
2%
 E
None of the above.
Murphy's sign is typical of:
 A
Acute pancreatitis.
10%
 B
Gallbladder cancer.
8%
 C
Acute cholecystitis.
73%
 D
Acute appendicitis.
8%
 E
Left adnexitis.
Which of the following concerning the anal fissure is
true?
1) transverse surgical sewing of the fissure is the
recognized method of treatment
2) before choosing the method of treatment you should
take tissue biopsy because it is a pre-cancerous
condition
3) main symptoms of the anal fissure are: itching and
burning sensation in the anal canal
4) anal fissure is most frequently localized within the
 anterior commissure
5) acute anal fissure always becomes the chronic anal
fissure
The correct answer is:
 A
3, 5
12%
 B
2, 3
13%
 C
1, 3, 5
28%
 D
2, 5
35%
 E
None of the above
Before large surgery on gastrointestinal tract the
prophylaxis of thromboembolism and the antimicrobial
prophylaxis should be used, because these operations
are associated with a high risk of bleeding, and the
hospital flora is drug-resistant.
 A
The first and the second sentences are true and there is a logical connection
between them
27%
 B
The first and the second sentences are true, but there is no logical connection
between them
44%
 C
The first sentence is true, the second sentence is false
16%
 D
The first sentence is false, the second sentence is true
9%
 E
Both sentences are false
There are following symptoms of acute abdomen:
 A
Stomachache.
3%
 B
Nausea and vomiting.
0%
 C
 Coprostasis and retention of gases.
2%
 D
All among above.
88%
 E
Only A and B answers.
In order to assess the capacity and patency of the deep
and superficial veins of the lower limbs we can do:
1) Trendelenburg test;
2) Perthes test;
3) Adson test;
4) compression ultrasonography;
5) venography.
The correct answer is:
 A
1,2.
5%
 B
1,2,4,5.
75%
 C
3,4,5.
2%
 D
1,4,5.
4%
 E
All above.
In patient with acute biliary pancreatitis the
recommended treatment is:
 A
First, conservative treatment. After 7 days performance of endoscopic retrograde
cholangiopancreatography (ERCP) with endoscopic sphincterotomy and
implantation of self-expanding prosthesis into the Wirsung 's duct.
25%
 B
Emergency laparotomy, cholecystectomy with biliary revision.
3%
 C
Percutaneous biliary drainage.
2%
 D
Emergency or early (within 24 hours) endoscopic retrograde
cholangiopancreatography with endoscopic sphincterotomy is the recommended
treatment.
66%
  E
Acute pancreatitis is always treated conservatively.
The most common cause of the upper gastrointestinal
tract hemorrhage is:
 A
Gastric ulcer.
20%
 B
Esophageal varices.
13%
 C
Duodenal ulcer.
65%
 D
Gastric cancer.
1%
 E
Mallory - Weiss syndrome.
Symptoms of sigmoid cancer:
1) alternating constipation and diarrhea
2) blood in the stool
3) narrow stools
4) anemia
5) cachexia
The correct answer is:
 A
1, 2, 5
5%
 B
1, 2, 4
75%
 C
1, 3, 4
2%
 D
1, 2, 3
13%
 E
1, 4, 5
While examining electrocuted patient you should
remember that:
 A
Tissue damage appear at the place where the current comes in.
3%
 B
Extension of skin burns may tell us about degree of inner tissue damage.
4%
 C
The patient may develop acute kidney failure.
86%
 D
Extra-low voltage does not cause cardiac arrhythmias.
2%
 E
Damage caused by thermal burns are greater than the damage caused by electric shock.
Femoral neck fracture in the elderly may be life
threatening due to the complications of immobility such
as:
1) thrombosis;
2) pulmonary embolism;
3) urinary tract infection;
4) cardiac arrhythmias;
5) ascites.
The correct answer is:
 A
1, 2, 3.
31%
 B
3, 4.
0%
 C
1, 2.
47%
 D
1,2,4.
3%
 E
All the above.
During the diagnosis of acute abdominal symptoms:
 A
Abdominal X-ray examination is always performed as the first one.
6%
 B
Abdominal X-ray is very useful in suspected gastrointestinal perforation and
intestinal obstruction.
87%
 C
Abdominal ultrasound allows to determine the presence of fluid in the abdominal
cavity above the amount of 500ml.
4%
 D
In the presence of intra-abdominal abscess in the first place abdominal CT scan
should be performed, followed by abdominal ultrasound to visualize more details.
2%
  E
To illustrate the complications of an aortic aneurysm the only useful examination is Doppler
ultrasound.
65-year old patients was admitted by a surgeon due to
episodes of fresh blood in stool, weight loss and pencil-
like stools. In DRE surgeon revealed infiltration in anal
canal so he took biopsy and got endorectal ultrasound
(ERUS) done. ERUS revealed infiltration through all
layers of bowel wall but without infiltration of anal
sphincters, in addition two metastatic lymph nodes were
described in perirectal tissues. The histologic
examination of biopsy specimen revealed
adenocarcinoma. Choose the best treatment option for
this patient:
 A
Radical radiochemotherapy.
4%
 B
Neoadjuvant radiotherapy then surgery.
83%
 C
Neoadjuvant chemotherapy then surgery.
7%
 D
Surgery without preoperative treatment.
5%
 E
Brachytherapy then chemotherapy.
Absolute indications for amputation - select
the false sentence:
 A
Necrolysis in diabetic foot.
3%
 B
Massive crushing limbs.
4%
 C
Extensive purulent wounds.
78%
 D
Gas gangrene when other treatments fail.
10%
 E
Critical limb ischemia when other methods of treatment fail.
 What is the most common extratestinal manifestation of
Crohn disease?
 A
Dermatitis.
12%
 B
Eye disorders.
5%
 C
Liver and bile ducts disorders.
11%
 D
Arthritis.
71%
 E
Pancreas disorders.
Pharyngoesophageal diverticulum (Zenker's
diverticulum) is:
1) the most frequent esophageal diverticulum;
2) caused mainly by the disorder of relaxation of upper
esophageal sphincter;
3) may cause complete esophageal obstruction;
4) may cause Mendelson's syndrome;
5) may cause hoarseness when large.
The correct answer is:
 A
1, 2, 4.
8%
 B
2, 3, 5.
6%
 C
1, 2, 3.
11%
 D
1,4,5.
17%
 E
All the above.
Nutritional treatment should be started:
 A
In critically ill patients when planned starvation is going to last more than 5 days.
1%
 B
When there is no effective oral nutrition for 7-10 days.
1%
 C
In patients with cachexia when oral nutrition is not possible or it does not cover
daily requirements.
2%
 D
True answers: A and C.
5%
 E
True answers: A, B, C.
Partial nail fold removal for the treatment of the first
right toe paronychia should be performed:
 A
In block anesthesia (Oberst's method).
68%
 B
In local anesthesia - conduction anesthesia.
20%
 C
With locally applied ethyl chloride.
1%
 D
True answers: B and C.
11%
 E
Anesthesia is not required.
Cholecystolithiasis may cause obstruction of
gastrointestinal tract because the large gallstone can
get through the fistula into the small intestine and stop
at the ileocecal valve (Bauhin's valve).
 A
Theorem is true, rationale is false.
10%
 B
Theorem is false, rationale is true.
4%
 C
Both theorem and rationale are false.
5%
 D
Both theorem and rationale are true, but there is no cause-effect relationship.
4%
 E
Both theorem and rationale is true, and there is a cause-effect relationship.
Indicate the set of features characteristic of Crohn’s
disease:
1) lesions can be observed in each part of the
gastrointestinal tract;
 2) lesions are limited to the mucosa and submucosa
only;
3) perianal fistulas are frequently observed in the
course of the disease;
4) surgical treatment of the disease is based on the
principle of conserving surgery;
5) excessive resection is preferred in surgical treatment
of the disease.
The correct answer is:
 A
1, 2, 4.
5%
 B
1,3,4.
19%
 C
2, 3, 5.
1%
 D
2, 3, 4.
68%
 E
1,3,5
Current recommendation for the surgical treatment of
inguinal hernia include the implementation of alloplasty
with the use of synthetic mesh, because this tension-
free repair is characterized by a smaller number of
infectious complications.
 A
Theorem is true, rationale is false.
61%
 B
Theorem is false, rationale is true.
2%
 C
Both theorem and rationale are false.
1%
 D
Both theorem and rationale are true and there is a cause-effect relationship.
23%
 E
Both theorem and rationale are true, but there is no cause-effect relationship.
Gastric cancer can by described by the following
sentences:
 1) one of the most frequently occurring cancers in men;
2) Lauren's classification is used for clinical
classification;
3) most frequently located in the proximal part of the
stomach;
4) gastric polyps of diameter more than 2 cm are
correlated with increased gastric cancer risk;
5) there is an increased risk of gastric cancer in patients
with pernicious anemia.
The correct answer is:
 A
1,2,3.
3%
 B
2,3,5
11%
 C
1,2,4,5
59%
 D
1,2,3,5
4%
 E
All the above.
Acute appendicitis:
1) can occur at any age;
2) can be treated with laparoscopic surgery;
3) starts with heavy vomiting;
4) is caused by E. coli infection;
5) accompanies upper respiratory tract infections.
The correct answer is:
 A
1, 2.
97%
 B
1, 3, 5.
1%
 C
3, 4, 5.
1%
 D
2, 4.
1%
  E
1, 5.
Perforation of gastric or duodenal ulcer:
1) causes hematemesis;
2) gives peritonitis symptoms;
3) needs urgent surgery;
4) occurs most frequently in men;
5) is diagnosed with the gastric endoscopy.
The correct answer is:
 A
1, 2, 4.
4%
 B
2, 3, 4.
67%
 C
3, 4, 5.
7%
 D
1, 2, 5.
15%
 E
1, 3, 5.
Sigmoid diverticulitis gives the following symptoms:
1) pain in left lower quadrant;
2) blood in the stool;
3) painful resistance above the left lower quadrant;
4) persistent diarrhea;
5) narrow stools.
The correct answer is:
 A
1,2.
11%
 B
2,3.
3%
 C
3,4.
1%
 D
1,3.
80%
 E
1,5.
 Felon:
1) is an infection located on the palmar surface of
fingers and metacarpus;
2) is an infection located on the plantar surface of a
foot;
3) its treatment is based on antibiotics and
immobilization;
4) its treatment is based on incision, drainage and
immobilization;
5) it is caused by trauma.
The correct answer is:
 A
1,3,5.
7%
 B
1,4,5.
88%
 C
2,3,5.
1%
 D
2,4.
1%
 E
2,4,5.
3
Hernias in surgical scar:
1) are the result of an abscess located in surgical
incision;
2) should be treated with hernia belt;
3) can become a place of bowel incarceration;
4) should be treated with tension-free surgical repair;
5) can frequently cause gastrointestinal bleeding.
The correct answer is:
 A
1,2,5.
2%
 B
1,3,4.
72%
 C
1,4,5.
4%
 D
 1,3,5.
7%
 E
1,2,3.
The most frequent causes of acute pancreatitis:
1) alcoholic hepatic cirrhosis;
2) vitamin A deficiency;
3) alcohol ingestion;
4) excess carbohydrates in food;
5) choledocholithiasis.
The correct answer is:
 A
1,2.
1%
 B
2,3.
0%
 C
1,3.
1%
 D
4,5.
1%
 E
3,5.
In pancreatic head cancer:
1) there is mechanical jaundice;
2) empyema of gallbladder develops;
3) coffee-grounds vomiting appears;
4) intrahepatic and extrahepatic ducts are being
expanded;
5) portal hypertension occurs.
The correct answer is:
 A
1,4.
96%
 B
1,5.
2%
 C
2,4.
1%
 D
4, 5.
 1%
 E
2,3.
Indicate true statements about acute pancreatitis:
1. The most common causes of acute pancreatitis
include cholelithiasis and alcohol.
2. The treatment of choice is surgical treatment.
3. Septic complications are the most common cause of
death in necrotizing acute pancreatitis.
4. Morphine is administered to combat pain.
5. We distinguish two forms of acute pancreatitis:
edematous and necrotizing.
 A
1, 2, 3
5%
 B
2, 3, 5
1%
 C
1, 3, 5
85%
 D
1, 2, 4
1%
 E
1, 3, 4
Indicate the true statements about stomach cancer:
1. Adenocarcinoma accounts for 50% of gastric cancers
2. There is an increase in the incidence of non-cardia
cancer
3. A special type is linitis plastica, which quickly gives
metastases to the lymph nodes
4. Spreads through lymphatic vessels
5. The basic method of treatment is chemotherapy
 A
1, 3, 4
23%
 B
4, 5
2%
 C
3, 4
64%
 D
2, 3, 5
9%
 E
1, 4, 5
Indicate true statements about acute appendicitis
(ACS):
1. occurs at any age, most often in the second and third
decade of life, and men suffer as often as women
2. there is a very strong, suddenly appearing pain, it
always varies in intensity, is usually accompanied by
peritoneal symptoms and shock quickly develops
3. painfulness at the McBurney point is found
4. there is no pain in per rectum examination
5. in women, a gynecological examination should be
performed to exclude changes in the reproductive
organs
 A
1, 2, 3
4%
 B
1, 3, 4
4%
 C
1, 3, 5
77%
 D
2, 4, 5
2%
 E
All statements are correct
The risk factor for surgical site infection (SSI) is not:
 A
Obesity (BMI> 30)
8%
 B
Age (>65 years old)
8%
 C
Alcoholism
2%
 D
Atrial fibrillation
78%
 E
Malnutrition
 Indicate the correct statements about whitlow:
1. it is a blood-borne infection
2. It covers the palmar area of the fingers and the hand
3. it is a result of a micro-injury
4. proper procedure includes incision, drainage and
immobilization
5. it covers the dorsal surface of the fingers and the
hand
 A
1, 2, 3
2%
 B
2, 3, 4
88%
 C
3, 4, 5
6%
 D
1, 2, 4
3%
 E
1, 2, 5
Laparoscopy is not the treatment of choice in the case
of:
 A
Unilateral inguinal hernia
59%
 B
Cholecystolithiasis
3%
 C
Acute appendicitis
4%
 D
Gastroesophageal reflux which does not respond to treatment
14%
 E
Achalasia of the esophagus
Patients with stage IV cancer are often subject to
palliative surgery (I), because it improves the comfort of
life and protects against some complications (II).
 A
Both statements are true and remain in a logical relation
90%
 B
 Both statement are true but remain without logical connection
3%
 C
The first statement is true and the second is false
3%
 D
The first statement is false and the second is true
2%
 E
Both statements are false
Indicate the false statement about duodenal ulcer:
 A
3% of ulcers are located outside the bulb
11%
 B
Finding an ulcer is an absolute indication for extraction of a sample for further
analysis
53%
 C
In 50% of cases the ulcer is located on the anterior part of the bulb
18%
 D
In 25% of cases the ulcer is located on the posterior part of the bulb
8%
 E
In 20% of cases there are multiple ulcers
In a woman, a 3 mm polyp and a gallstone of 7mm are
found in the gallbladder. The patient does not report any
symptoms. What procedure will you recommend?
 A
Another ultrasound in 6 months
74%
 B
No proceedings
6%
 C
Cholecystectomy
14%
 D
Ursodeoxycholic acid treatment
6%
 E
Computed tomography of the abdominal cavity
Choose correct statements about splenic artery
aneurysm:
1) is the second most frequent aneurysm among
abdominal aneurysms
2) in men it occurs 4 times more often than in women
 3) in 50% of cases, its rupture is the first symptom
4) in each case, the spleen should be removed
5) removal of the spleen should be considered when the
diameter of the aneurysm is greater than 2.5 cm
 A
1, 3, 5
64%
 B
1, 4, 5
4%
 C
2, 3, 4
6%
 D
1, 2, 3
11%
 E
1, 2, 5
Which statement about mechanical obstruction is true?
 A
In 70-80%, the cause of the obstruction is in the small intestine
3%
 B
Causes of large intestine obstruction according to the incidence are: cancer,
diverticulitis, sigmoid torsion
14%
 C
About 20% of colorectal cancers are manifested by acute obstruction
4%
 D
The correct answers are A, C
11%
 E
The correct answers are A, B, C
Treatment of gastric lymphoma involves:
 A
Surgical treatment
3%
 B
H. pylori eradication
11%
 C
Use of chemotherapy
4%
 D
A, B and C are correct
69%
 E
A and C are correct
 The most common complication after surgical treatment
of oesophageal cancer is:
 A
Complete narrowing of the anastomosis area
43%
 B
Arrhythmias
2%
 C
Stroke
0%
 D
Pulmonary complications (atelectasis, pleural effusion)
48%
 E
B and C
In esophageal cancer, to restore the continuity of the
digestive tract, the following are used:
 A
A transplant using stomach or large intestine
8%
 B
A transplant using small intestine
15%
 C
Only a transplant using the large intestine
2%
 D
Intubation of the esophagus with the placement of a stent
6%
 E
Correct A and B
Indicate the false statement:
 A
People with Crohn's disease have a higher chance of developing cancer
3%
 B
Colon polyps removal reduces the chance of cancer
2%
 C
The basic method of treatment of malignant colon cancer is preoperative
radiotherapy
67%
 D
Colon cancer is the second most common among women and men in terms of
morbidity and mortality
22%
 E
The patient may have normal CEA despite the presence of colon cancer
 The gold standard in the treatment of patients with
pancreatic necrosis is:
 A
Drainage under the control of an ultrasound
5%
 B
Surgical excision of necrotic lesions
86%
 C
Conservative treatment
3%
 D
Antibiotic therapy
3%
 E
None of the above
The clinical symptoms of pancreatic pseudocyst
include:
 A
Subfebrile temperatures
0%
 B
Epigastric pain
16%
 C
Symptom of mechanical jaivice
4%
 D
Correct A, B
13%
 E
Poprwne A, B, C
In the case of an inoperable carcinoma of the
pancreatic head, the further procedure is:
 A
Conservative treatment
4%
 B
Radiotherapy
4%
 C
Endoscopic prosthesis of the bile ducts
8%
 D
Bypass surgery
3%
 E
Correct answer C and D
The so called periampullary cancers include:
 A
Cholangiocarcinoma
1%
 B
Pancreatic head cancer
1%
 C
Ampullary cancer (ampulla of Vater)
12%
 D
Correct answer A and B
4%
 E
Correct answer A, B and C
Mark the correct characteristics of Crohn's disease:
1) Nonspecific, idiopathic inflammation affecting the
entire digestive tract is typical
2) The lesions are segmental
3) Characteristic granulomas may be present in all
involved layers of the intestinal wall
4) Infiltration only involves the mucous membrane
5) Infiltration involves the entire wall of the
gastrointestinal tract
 A
1,2
2%
 B
1,2,3
4%
 C
3,5
4%
 D
1,2,4
2%
 E
1,2,3,5
Indicate the false information about esophageal cancer:
 A
Most often occurs in the 6-7 decade of life
3%
 B
Regardless of age, esophageal cancer is more common in women than in men
88%
 C
The most common symptom of esophageal cancer is dysphagia
2%
 D
 Squamous cell carcinoma occurs 5-6 times more often in smokers than in non-smokers
2%
 E
Distant metastases are the most important prognostic factor of esophageal cancer
5
Which of the following is not used in nutritional therapy?
 A
PEG.
3%
 B
Intravenous
1%
 C
Sigmoidostomy.
27%
 D
Gastric tube.
51%
 E
All of these accesses are used in nutritional therapy.
Indicate the false statement regarding spleen injuries:
 A
Spleen injuries are often accompanied by a fracture of the ribs VIII-XI on the left
side
1%
 B
In subcapsular hematomas, bleeding can occur even after several weeks
1%
 C
The spleen is an organ that is most often injured by blunt abdominal injuries
3%
 D
Splenectomy is always indicated in spleen injuries
85%
 E
All statements mentioned above are true
Which can lead to short bowel syndrome:
 A
Resection of a large part of the small intestine
7%
 B
Fistula between the small bowel loops
1%
 C
Fistula between the stomach and large intestine
2%
 D
Enterocutaneous fistula
2%
 E
All of the above
 In the treatment of symptomatic cholecystolithiasis, the
gold standard involves laparoscopy, because it is a
cheaper and simpler method.
 A
The first and the second statements are true and remain in a logical relation
24%
 B
The first and the second statements are true, but they remain without logical
connection
8%
 C
The first statement is false and the second is true
2%
 D
The first statement is true and the second statement is false
61%
 E
Both statements are false
Intestinal necrosis may be a consequence of:
1. intestinal torsion
2. an incarcerated hernia
3. perforation of sigmoid diverticulum
4. embolus of the mesenteric artery and its branching
5. hyperkalemia
 A
1, 2, 3
2%
 B
2, 3, 4
3%
 C
1, 3, 5
1%
 D
1, 3, 4
4%
 E
1, 2, 4
What complications can result from the presence of
colon polyp?
1. colorectal cancer
2. sigmoid torsion
3. bleeding
 4. ulcerative colitis
5. a perianal fistula
 A
1, 5
4%
 B
2, 3
1%
 C
1, 3
93%
 D
3, 4
1%
 E
3, 5
According to the rule of nines, a burning of both lower
limbs and the scrotum in adult patients affects:
 A
19% of the body surface.
1%
 B
36% of the body surface.
15%
 C
37% of the body surface.
3%
 D
45% of the body surface.
80%
 E
Rule of nines is not related to burned body surfaces
The methods of tension-free hernia surgery are: 1.
Bassini 2. Lichtenstein 3. Shouldice 4. Rutkowa 5.
Halsetd Choose the answer:
 A
1, 2
6%
 B
2, 3
5%
 C
2, 4
85%
 D
3, 4
2%
 E
4, 5
 Choose the correct statements about peptic ulcers: 1.
The most common cause is Zollinger-Ellison syndrome.
2. The most common location is the angular incisure of
the stomach and the pre-billiary region. 3. All stomach
ulcers should be treated surgically. 4. The most
common surgery is Billroth I and II, vagotomy. 5.
Perforation of the ulcer presents as acute abdomen.
Choose answer:
 A
1, 2, 3
2%
 B
All correct answers
4%
 C
1, 4, 5
9%
 D
3, 4, 5
4%
 E
2, 4, 5
Indicate the correct statements about stomach cancer:
1. The incidence of peripheral cancer is declining, and
the incidence of cancer of the proximal stomach parts
and the cardia region increases. 2. Lauren's I intestinal
type has better prognosis. Environmental factors are
more significant than genetic factors in this type. 3.
Women get it more often. 4. The most common type is
squamous cell carcinoma. 5. The prognosis for the
majority of patients is good: 5 years survival is about 50.
Choose an answer:
 A
1
7%
 B
1, 2
73%
 C
1, 2, 3
6%
 D
2, 5
 10%
 E
2, 3, 4
A 44-year-old patient complains of persistent vomiting,
history of long-term ulcer disease. Last gastroscopy
showed pyloric stenosis. What kind of lab changes do
you expect in this patient? Choose answer:
 A
Alkalosis, hyponatremia, hypochloremia, hypokalemia
84%
 B
Alkalosis, hypernatremia, hypochloremia, hypomagnesemia
7%
 C
Acidosis, hypernatremia, hyperchloremia, hypokalemia
3%
 D
Alkalosis, hypernatremia, hyperchloremia, hypomagnesemia
2%
 E
Acidosis, hyponatremia, hypochloremia, hypokalemia
The most common causes of intestinal obstruction are:
1) adhesions 2) cancer of the small intestine 3) colon
cancer 4) trap of the hernia 5) diverticulitis Choose an
answer:
 A
1, 2, 3
7%
 B
2, 3, 4
2%
 C
1, 3, 4
72%
 D
1, 2, 4
5%
 E
1, 3, 5
Imaging studies considered the gold standard in the
diagnosis of patients with acute pancreatitis are:
Choose your answer:
 A
Endoscopic retrograde cholangiopancreatography
32%
 B
Cholangio-MR
 6%
 C
Magnetic resonance imaging of the abdominal cavity with gadolinium
2%
 D
Endoscopic ultrasonography
3%
 E
CT of the abdominal cavity
From the following sentences, select those that
correctly characterize Lynch syndrome: 1. occurs in the
4-5 decade of life 2. brain tumors in relatives 3. It
develops most often in the right half of the colon 4. It
develops most often from polypoid lesions 5. accounts
for about 20% of all colon cancers. Choose the answer:
 A
1, 3, 4
18%
 B
2, 5
8%
 C
2, 3, 4
6%
 D
1, 3
59%
 E
1, 2, 3, 4
Choose diseases that may result in internal or external
intestinal fistulas: 1. upper mesenteric artery occlusion
2. sigmoid colitis dicerticulitis 3. Crohn's disease 4.
chronic pancreatitis 5. chronic radiation proctitis 6.
peptic ulcer disease Choose your answer:
 A
1, 2, 4, 5
4%
 B
2, 3, 4
18%
 C
3, 4, 5, 6
20%
 D
2, 3, 5
53%
  E
1, 3, 5
Mechanical jaundice can be caused by: 1) deposits in
the bile ducts 2) portal hypertension 3) pancreatic
cancer 4) duodenal ulcer 5) pancreatic head cancer.
Choose the answer:
 A
1, 2
2%
 B
1, 3
5%
 C
3, 5
4%
 D
4, 5
1%
 E
1, 5
The complications of diverticular disease include: 1.
neoplastic transformation 2. diverticulitis 3. inflammation
of the peritoneum 4. bleeding into the gastrointestinal
tract 5. toxic dilation of the colon Choose an answer:
 A
1, 2, 3
4%
 B
2, 3, 4
73%
 C
3, 4, 5
2%
 D
1, 2
2%
 E
All the answers are correct
The symptoms of cancer of the cecum include: 1.
anemia 2. palpable resistance in the right lower
abdomen 3. enlarged inguinal lymph nodes 4. right-
sided hydronephrosis Choose an answer:
 A
1, 2
83%
 B
 2, 3
8%
 C
3, 4
1%
 D
2, 4
5%
 E
1, 3
True statements about breast cancer: 1. the most
common malignant neoplasm in European females 2.
most often develops from fibroadenoma 3. the
prognosis depends on the stage of advancement 4. the
risk of getting sick increases with genetic burden 5. it
never occurs in men. Choose the answer:
 A
1, 2, 3
4%
 B
2, 3, 4
11%
 C
3, 4, 5
1%
 D
1, 3, 4
84%
 E
1, 4, 5
A 39-year-old woman who has been suffering from
ulcerative colitis for 7 years has been hospitalized with
the symptoms of megacolon toxicum. Her general
condition is getting worse. What will be the most
appropriate procedure? Choose answer:
 A
Removal of the entire colon with the rectum and creation of ileostomy
27%
 B
Removal of the colon and creation of ileostomy
40%
 C
Removal of the colon and rectum and formation of the intestinal reservoir
9%
 D
Colon removal and small bowel to rectal anastomosis
 12%
 E
Transfer to ICU, the current condition of the patient is a contraindication for surgery
The risk of colon cancer is increased in patients with: 1.
familial polyposis syndrome 2. sigmoid colon
diverticulosis 3. ulcerative colitis 4. chronic pancreatitis
5. gout choose an answer:
 A
1, 4
2%
 B
1, 5
1%
 C
3, 4
1%
 D
1, 2
3%
 E
1, 3
The Allgower shock index is the ratio: Choose the
answer:
 A
Pulse to systolic pressure
79%
 B
Pulse to diastolic pressure
5%
 C
Systolic pressure to diastolic pressure
6%
 D
CVP to pulse
5%
 E
CVP to systolic pressure
The primary surgical method of GIST treatment is:
Choose your answer:
 A
Endoscopic mucosectomy
17%
 B
Endoscopic thermoablation
3%
 C
Endoscopic obliteration
3%
 D
Surgical resection
69%
 E
Operational fundoplication
Complications of GERD do not include: Choose your
answer:
 A
Stricture at the site of long-lasting oesophagitis
4%
 B
Pyloric stricture
81%
 C
Perforation of an ulcer
6%
 D
Bleeding from an ulcer
3%
 E
Barrett's esophagus
The main reason for reflux oesophagitis is: Choose your
answer:
 A
Premature spasm of the upper esophageal sphincter
4%
 B
Presence of the Schatzki ring
1%
 C
Presence of Zenker's diverticulum
2%
 D
Occurrence of prolonged relaxation time in the so-called lower esophageal
sphincter
88%
 E
Barrett's esophagus
Metaplasia in the Barrett's esophagus developing in
GERD leads to the development of this type of cancer:
Choose your answer:
 A
Squamous cell carcinoma
16%
 B
Melanoma
0%
 C
Squamous papilloma
 1%
 D
Meconium sarcoma
0%
 E
Adenocarcinoma
The most common type of hiatal hernia is: Choose the
answer:
 A
Sliding
90%
 B
Of the mixed type
1%
 C
Paraesophageal
7%
 D
Morgani's
1%
 E
Bochdalek's
The most common diverticulum arising at the border of
the throat and esophagus is: Choose the answer:
 A
Zenker's
97%
 B
Wolff's
0%
 C
Nissen's
1%
 D
Morgani's
1%
 E
Diverticula do not form in that place
In a 58-year-old patient with sigmoidal diverticulae, an
abscess in the left ilium has been detected in the CT.
The patient is hemodynamically stable, fever up to 39
degrees, positive local Blumberg sign. What is the most
appropriate procedure? Choose answer:
 A
Urgent laparotomy and abscess drainage
20%
 B
Urgent laparotomy and excision of the altered segment of the intestine
 10%
 C
Laparoscopy and abscess drainage
24%
 D
Percutaneous drainage under ultrasound guidance
34%
 E
Intensive antibiotic therapy
The consequence of damage to the middle meningeal
artery is: Choose your answer:
 A
Epidural hematoma
78%
 B
Subdural hematoma
12%
 C
Intracerebral hematoma
5%
 D
Answers A and B are correct
3%
 E
Answers A, B and C are correct
In patients with Crohn's disease surgery is necessary in
the case of: Choose the answer:
 A
Suspected perforation
1%
 B
Gastrointestinal obstruction
0%
 C
Massive bleeding
0%
 D
Correct answers are A and B
4%
 E
Correct answers are A, B and C
A 20-year-old man with abdominal pain and nausea
reported to the Hospital Emergency Department. During
the examination, tenderness was observed in the area
of the right hip. In additional tests, leucocytosis was
found (WBC = 14 G / L). The most appropriate
procedure is: Choose your answer:
 A
Laparoscopy z appnedectomy - urgent
14%
 B
Laparotomy with appendectomy - urgent
4%
 C
Conservative treatment
5%
 D
Answers A or B are correct, depending on the hospital equipment
73%
 E
None of the above answers is correct
Which of the polyps is non-cancerous: Choose your
answer:
 A
Tubular adenoma
13%
 B
Tubulovillous adenoma
1%
 C
Villous adenoma
6%
 D
Sessile serrated adenoma
11%
 E
Metaplastic polyp (hyperplastic)
What is not a complication of parathyroidectomy ?
Choose the answer:
 A
Hypothyroidism
52%
 B
Damage to the recurrent laryngeal nerve
2%
 C
Transient hypoparathyroidism
6%
 D
Recurrence of hyperparathyroidism
36%
 E
Persistent hypoparathyroidism
Klatskin tumor is: Choose the answer:
 A
Gallbladder cancer
10%
 B
Cholangiocarcinoma of right and left hepatic duct
76%
 C
Palpable, painless, enlarged gallbladder
5%
 D
Hepatocellular carcinoma
4%
 E
Pancreatic head cancer
4
Whipple's triad: Choose the answer:
 A
It is synonymous with Whipple's disease
1%
 B
This is a group of symptoms characteristic of gastrinoma
4%
 C
This is a group of symptoms characteristic of insulinoma
88%
 D
Three maneuvers that are always performed during the Whipple procedure
(pancreaticoduodenectomy ).
4%
 E
Goitre, exophthalmos, tachycardia
Colles' fracture is a fracture of: Choose the answer:
 A
Femoral neck
6%
 B
The distal epiphysis of the ulnar bone
10%
 C
I metacarpal bone
1%
 D
The distal epiphysis of radius
79%
 E
Area of the humeral epicondyle
Of the following medical conditions, urgent surgical
procedures will require: 1) acute appendicitis 2) acute
edematous pancreatitis 3) gastric ulcer perforation 4)
anal fissure 5) non-incarcerated inguinal hernia. Choose
the answer:
 A
1, 3, 5
 9%
 B
1, 2, 3
16%
 C
1, 3
68%
 D
2, 4, 5
1%
 E
All of them
The most common cause of death in men and women
due to malignant tumor in Poland is: Choose the
answer:
 A
Colorectal cancer
5%
 B
Breast cancer
3%
 C
Lung cancer
91%
 D
Stomach cancer
0%
 E
Pancreatic cancer
A patient with adrenal tumor suffers from
hypernatremia, hypokalemia and hypertension. The
most probable diagnosis is: Choose the answer:
 A
ACTH-dependent Cushing's syndrome
10%
 B
ACTH-independent Cushing's syndrome
16%
 C
Conn's syndrome
70%
 D
Congenital adrenal hyperplasia
2%
 E
MEN 2 syndrome
What pharmacological treatment is used in preparation
for pheochromocytoma surgery? Choose the answer:
 A
Alpha blockers and beta blockers
84%
 B
Proton pump inhibitors
2%
 C
H2-blockers
1%
 D
Steroidogenesis inhibitors
8%
 E
Angiotensin-converting enzyme inhibitors (ACEIs)
The liver colic should be differentiated from: 1. right-
sided renal colic 2. perforation of gastric or duodenal
ulcer 3. intestinal obstruction 4. acute pancreatitis 5.
myocardial infarction. Choose the answer:
 A
2
1%
 B
1, 2
4%
 C
1, 2, 3
5%
 D
1, 2, 3, 4
6%
 E
All of the above
The indication for the surgical treatment of tertiary
hyperparathyroidism is: Choose the correct answer:
 A
Deterioration of parathyroid hyperactivity after renal transplantation, threatening
graft damage
71%
 B
The patient is older than 60 years, with the accompanying increase in serum PTH
and Ca2 + levels
3%
 C
Each patient with the accompanying increase in serum PTH and Ca2 + levels
6%
 D
A kidney transplantation is planned in the future
6%
 E
 Tertiary hyperparathyroidism is not treated surgically
Choose the false statement about pneumothorax:
 A
Pneumothorax should always be drained if the patient has been qualified for
transport
16%
 B
Chest drain should always be inserted, if the patient is mechanically ventilated
10%
 C
Marginal pneumothorax (4 cm from the chest wall) is treated conservatively
63%
 D
The absolute indication for surgery is lack of lung re-expansion despite drainage
5%
 E
Chest drain is removed if complete lung re-expansion has occurred and the amount of fluid is
not greater than 150 ml / d
At what age is the consent of the minor obtained to
collect marrow or hematopoietic stem cells from the
peripheral blood if he is to be a donor for a sick sister or
brother in accordance with the so-called Transplantation
Act? Choose the correct answer:
 A
12 years old
7%
 B
13 years old
44%
 C
14 years old
7%
 D
16 years old
36%
 E
The law does not apply to obtaining consent from a minor
Early gastric cancer is defined as:
 A
Malignant neoplasm crossing the gastric wall, with metastases to the lymph nodes
but with no metastases to the distant organs.
70%
 B
Does not exceed the stomach wall
4%
 C
Malignant neoplasm of the stomach categorized as T2 by the TNM classification.
2%
 D
 Malignant neoplasm in mucous and submucous membranes, but not infiltrating the
muscle membrane of the stomach.
23%
 E
Malignant neoplasm of the stomach diagnosed in a patient under 50 years of age.
The most frequently mentioned source of nosocomial
infections is: Choose the answer:
 A
Patient's bedclothes
1%
 B
Neglected patient (poor hygiene)
2%
 C
Dressing materials
1%
 D
Hands of the staff
94%
 E
Dirty skin of the patient
Bowel obstruction due to strangulation is the most
common cause of intestinal necrosis. The first one that
undergoes necrosis is: Choose the correct answer:
 A
Mucous membrane
76%
 B
Submucosa
9%
 C
Muscular layer
6%
 D
The whole wall becomes necrotic at the same time
3%
 E
Serous membrane
Tension (valve) pneumothorax should be treated with a
following puncture: Choose the correct answer:
 A
With a thin needle in the second intercostal space in the anterior axillary line
7%
 B
With a thick needle in the second intercostal space in the midclavicular line
81%
 C
With a thick needle in the III intercostal space in the midclavicular line
6%
 D
Ith a thin needle in the VII intercostal space in the midclavicular line
5%
 E
Ith a thick needle in the VII intercostal space in any line
A 28-year-old patient was admitted to Emergency
Room; RR 80 mmHg, HR 110 / min, without any pain.
The patient reports that he vomited 'black contents', he
felt weak, but he did not faint. The most probable
diagnosis is: Choose the correct answer:
 A
Perforation of gastric ulcer
6%
 B
Perforation of the duodenal ulcer
15%
 C
Splenic rupture
1%
 D
Lower gastrointestinal bleeding
7%
 E
Upper gastrointestinal bleeding
The cause of pleural empyema can be: 1. spread of
lobar or bronchial pneumonia , 2. festering of initially
sterile exudate or hematoma, 3. spread of infection from
the chest wall or subdiaphragmatic abscess, 4. infective
endocarditis, 5. infection of the abdominal parenchymal
organs. Choose the correct answer:
 A
1, 2, 3
27%
 B
2, 3, 4
2%
 C
1, 2, 4
4%
 D
1, 2, 5
2%
 E
All mentioned above
The 4-year-old child fell down and hit his left costal
arch. Immediately after the accident he was transported
 to the Emergency Room: he was pale with hypotension
and tachycardia. What should be suspected? Choose
the correct answer:
 A
Small bowel mesentery injury
1%
 B
Diaphragmatic injury
2%
 C
Trauma and liver rupture
2%
 D
Splenic rupture
93%
 E
Gastrointestinal bleeding
The only effective treatment of bile duct cancer is:
Choose the correct answer:
 A
Radiotherapy
2%
 B
Chemotherapy
2%
 C
Surgical treatment
92%
 D
Radiochemotherapy
4%
 E
Antibody therapy
The videoscopic operation of the parathyroid glands is
indicated in case of: Choose the correct answer:
 A
Polyglandular form of primary hyperparathyroidism
6%
 B
A small adenoma and the ability to monitor the intraoperative level of parathyroid
hormone
59%
 C
No contraindications for subcutaneous emphysema
8%
 D
Ability of intraoperative monitoring of the recurrent laryngeal nerve
13%
  E
Videoscopic operations of parathyroid glands are not performed
Choose correct statements about hiatal hernia: 1. Hiatal
hernia is more common in women than in men. 2.
Paraesophageal hernias represent about 80-90% of all
hernias. 3. A sliding hernia, regardless of whether it is
symptomatic or asymptomatic, should be operated. 4.
Radiological examination is used to diagnose a sliding
hernia. 5. The method of choice of hiatal hernia
treatment is the laparoscopic method of Nissen. Choose
the answer:
 A
1, 4, 5
61%
 B
1, 3, 5
14%
 C
1, 2
3%
 D
1, 3, 4
8%
 E
2, 4, 5
The incorrect answer concerning tendinous whitlow is:
 A
The infection can easily spread between the fingers I and V
31%
 B
The most serious complication is necrosis of the tendons and hand contracture
3%
 C
Infection can easily spread between fingers II, III and IV
57%
 D
The inflammatory process results in the lack of active mobility in the infected finger .
The attempt to passively straighten it, causes severe pain.
6%
 E
It may develop by spreading through continuity or due to direct sheath injury
A 56-year-old patient calls an ambulance due to sudden
occurrence of a severe lower limb pain. The doctor
states that the limb is significantly cool, there is no
dorsalis pedis artery pulse and there are sensory
 disorders. What is the most propable diagnosis?
Choose the answer:
 A
The onset of shock and circulatory centralization
1%
 B
Venous thrombosis
7%
 C
Acute limb ischemia due to embolism
92%
 D
Sciatica
0%
 E
None of the above
Laparoscopy is not a surgery of choice in case of:
Choose the correct answer:
 A
Acute cholecystitis
2%
 B
Acute appendicitis
3%
 C
Right-sided colon cancer
70%
 D
Gastroesophageal reflux after unsuccessful conservative treatment
10%
 E
Achalasia
Which of the following medical conditions will require
urgent surgical intervention most likely?
 A
Anal fissure
3%
 B
Anal fistula
15%
 C
Perianal thrombosis
45%
 D
Hemorrhoidal disease
1%
 E
Disintegrating anal tumor
 The immediate treatment of cardiac arrest includes the
following except for:
 A
Intubation.
2%
 B
Open cardiac massage.
31%
 C
I.v. access.
1%
 D
Adrenaline i.v.
2%
 E
Ultrasonography.
Cancelled by CEM. Which of the vasoconstrictors in the
dose of 3 mg/kg of the body weight will raise the renal
perfusion?
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
Epinephrine.
8%
 B
Norepinephrine.
13%
 C
Dopamine.
55%
 D
Correct answer is A and C.
17%
 E
None of the answers are correct.
Cancelled by CEM, because an incorrect dose is stated in the question.
Vasopressors affecting renal function:
 adrenaline - renal spasm
 dobutamine does not affect kidney vessels
 dopamine - in small doses, 0.5-2 μg / kg bw / min increases renal and
visceral vessels, increases renal flow, glomerular filtration, urine
output and sodium loss; small doses have no effect on the heart.
Dopamine in medium doses - (2-10 μg / kg / min): stimulates alpha-adrenergic
receptors as well as β1 receptors in the heart, what causes: increase in cardiac
contractility, stroke volume and cardiac output, leading to accelerating cardiac
function, increase in arterial blood pressure, especially systolic - increases the
pressure amplitude, improves coronary flow.
Dopamine in doses greater than 10 μg / kg / min: the mechanism of
contracting blood vessels begins to predominate; increase of systolic and diastolic
blood pressure, increase of central venous pressure and pulmonary artery pressure
 and decrease of renal flow and cardiac output. The effect of dopamine starts 5
min after the beginning of iv administration and lasts for 10 min after its
completion.

Which of the pathological findings will be characteristic

of malignant nature of breast tumour?
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
Fibroadenoma.
10%
 B
Fibrosclerosis.
9%
 C
Cystes.
6%
 D
Tumor phyllodes.
38%
 E
All of the above are benign.
Discussion: The question is not entirely clear, because despite of the benign
nature of the above changes ( fibrosclerosis is also a benign lesion), the phyllodes
tumor can transform into a malignant form .
Benign breast neoplasm:
 Cyst - cystis - resulting from the proliferation of the epithelium of
milk ducts and their atresia, does not significantly increase the risk of
breast cancer
 Fibroadenoma - a single lesion with clearly defined edges, the risk of
transformation into a malignant lesion is small
 Duct ectasia of breast - it resembles malignant neoplasms, but there is
no risk of malignant transformation
 Intraductal papillomas - characterized by the presence of serous or
bloody secretion from the nipples
 Phyllodes tumor - tumor phylloides - grows quickly, it can transform
into a malignant lesion

A patient has fallen down on the ground (from 4 meter

height). The following signs and symptoms are present:
dyspnoea, cyanosis, tachycardia, nausea, vomiting,
decreased vesicular breath sound over the right lung.
The physician should suspect:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
Pneumothorax.
66%
 B
 Haemothorax.
14%
 C
Injury of oesophagus.
5%
 D
Rupture of diaphragm and translocation of viscera into chest.
12%
 E
Pneumomediastinum.
Question canceled by CEM (Center of Medical Exams)
Discussion: The question has been invalidated most probably because of too little
data from medical interview and examination of the patient to be able to diagnose
any of the diseases listed above. You should perform percussion, and possibly also
auscultation to decide whether the peristaltic sounds are audible over the chest,
possibly assess vocal fremitus, observe tracheal shift and chest movements.
pneumothorax is the presence of air in the pleural cavity, due to damage to the
chest wall or lung, the air oppresses the lung and worsens gas exchange,
symptoms:
 pleural pain in the chest
 shortness of breath, cough
 diminished vesicular breath sound on the side of the pneumothorax
 dramatically increasing dyspnoea, hypotension and symptoms of hypoxemia,
up to cardiac arrest
pneumomediastinum is the presence of air in the mediastinum, as a result of the
rupture of the alveoli, but it can also occur due to, for example, perforation of the
esophagus, symptoms:
 retrosternal pain, which is intensified by respiratory movements and
changing position of the body
 dyspnoea
 neck discomfort
 crackling in the palpation of the neck
 Hamman's sign (crunching or creaking sound, like walking on snow,
auscultated over the precordium, synchronous with the heart beat,
intensifies during inhalation and in left side position)
pleural hematoma is the accumulation of blood in the pleural cavity as a result of
injury or surgery, symptoms of the fluid (also hematoma) in the pleural cavity:
 symptoms of blood loss
 symptoms of complications: bacterial infection, pleural empyema, pleural
fibrosis
 weaker chest movements on the liquid side
 dull percussion note
 decreased vocal fremitus
 lack of vesicular breath sound
 mediastinum is shifted to the other side
pathology: chest movements Percussion Vocal fremitus Breath sounds Mediasti
note nal shift
infiltration weaker dull increased rales, bronchial no
on its side sound
atelectasis weaker/ lack on the dull depending on the  diminished towards
side of atelectasis etiology: vesicular the
 oppressio or atelectasis
n- bronchial
increased  possible
  oclussion rales
-
decreased
fibrosis symmetrically slightly slightly decreased  diminished no
(usually slightly weaker dull vesicular s
bilateral) ound
 crackles +/
- rales
fluid in the weaker dull decreased  lack towards
pleural on the side of fluid  pleural the
cavity rub (in opposite
case side
of little
fluid)
airway  symmetricall resonant or normal /  wheeze, no
obstruction y increased hyperreson decreased rhonchi
 visible ant  a long
additional exhale
respiratory  diminished
muscles vesicular
sound
 in extreme
cases: quie
t chest
pneumotho weaker on the side hyperreson lack lack towards
rax of pneumothorax ant the
opposite
site
Source:
https://www.mp.pl/interna/chapter/B16.II.3.18.
https://www.mp.pl/interna/chapter/B16.II.3.19.
https://www.mp.pl/interna/chapter/B16.II.3.17.3.

A 26-year-old patient suffered from a low abdominal

injury (run over by a tractor). Unstable pelvic fracture
complicated with massive bleeding and a rectum injury
were diagnosed. The primary surgical procedure is:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
Fixation of the pelvic fractures with a blocked plate.
17%
 B
Placement of an external pelvis fixator.
27%
 C
Laparotomy to stop the bleeding and peritoneal drainage.
28%
 D
 Laparotomy: pelvic packing.
24%
 E
Exteriorization of the rectum.
Question canceled by CEM due to a technical error in the English-language version
of the question.
Pelvic fracture:
 it is usually a serious injury that leads to shock, it is always an indication for
CT
Types of pelvic fractures:
 stable, most cases
 unstable (20%): with haemorrhage, damage to the ureters, bladder,
urethra, blood vessels, reproductive organs and rectum
symptoms:
 limb asymmetry
 pain during pressure on the wing of ilium and pubic symphysis and when
moving the limbs
Treatment:
 at the accident place: immediate stabilization
 in the hospital:
o putting on the C clamp
o packing
o internal stabilization
Source:
Chirurgia - Repetytorium, Wojcech Noszczyk; PZWL; Wydanie I - 7 dodruk; 2016; ISBN: 978-
83-200-4555-0; strona 260-261

Cancer of the gallbladder coexists with gallbladder

stones in:
 A
30% of patients.
17%
 B
50% of patients.
6%
 C
60% of patients.
10%
 D
80% of patients.
55%
 E
95% of patients.
Which of the following concerning secondary
hyperparathyroidism is false?
1) it is always the indication for surgery;
2) calciphylaxis is the indication for surgical treatment;
3) surgery involves the removal of a single parathyroid
adenoma that is the most frequent cause of the
 disease;
4) surgery involves the subtotal resection of the
parathyroid gland or total resection of the parathyroid
gland with the autotransplantation of one of them;
5) core treatment involves the correction of calcium and
phosphate levels into the normal reference range and of
iPTH level to be 2-9 times the upper limit value.
The correct answer is:
 A
1,2,4.
10%
 B
1,4,5.
8%
 C
1,3.
74%
 D
2,3.
5%
 E
All the above.
A patient with upper gastrointestinal (UGI) bleeding was
admitted to the surgical ER. Endoscopy shows active
bleeding from the duodenal bulb ulceration. Hemostasis
was obtained with local endoscopic saline and
adrenaline administration. The pulse and blood
pressure were stabilized after the correction of volemic
disorders. Twenty hours later the pressure dropped to
approx. 100/60 mmHg and the pulse increased to
120/minute. Which is the most proper approach?
 A
Increase the dose of proton pump inhibitors.
1%
 B
Surgery.
3%
 C
Transfusion of 2 units of packed red blood cells.
2%
 D
Administration of pressor amines.
1%
  E
Gastroscopy.
Which of the following should be performed in gastric
cancer?
 A
Resection (modo Rydygier) and the restoration of the proper passage.
2%
 B
Partial gastrectomy with lymphadenectomy.
8%
 C
Gastrectomy with lymphadenectomy.
84%
 D
Tumor excision.
1%
 E
Gastric resection (modo Billroth II).
Which of the following factors have impact on the
occurrence of recurrent duodenal ulcer bleeding?
 A
Bleeding activity in Forrest classification, the size of the bleeding source,
localization, a type of treatment.
93%
 B
Cardiovascular sufficiency, bleeding activity in Forrest classification, a type of
treatment, impaired motility.
2%
 C
Efficiency of the respiratory system and kidneys, bleeding activity in Forrest
classification, type of treatment.
1%
 D
Bleeding activity in Forrest classification, esophageal erosions, a type of treatment.
2%
 E
Esophageal varices, esophageal erosions, an ulcer clip in anamnesis, impaired motility.
Caroli disease is characterized by the congenital cystic
expansion of intrahepatic bile ducts. Which of the
following concerning this disease is false?
 A
Occurs predominantly in men.
9%
 B
In some cases is limited to one hepatic lobe only.
4%
 C
Cholelithiasis develops in extended bile ducts.
10%
 D
Biliary tract cancer never develops in the course of the disease.
71%
 E
Recurrent inflammations of the biliary ducts may start during childhood.
There are following symptoms of acute abdomen:
 A
Stomachache.
3%
 B
Nausea and vomiting.
0%
 C
Coprostasis and retention of gases.
1%
 D
All among above.
90%
 E
Only A and B answers.
Gastric cancer can by described by the following
sentences:
1) one of the most frequently occurring cancers in men;
2) Lauren's classification is used for clinical
classification;
3) most frequently located in the proximal part of the
stomach;
4) gastric polyps of diameter more than 2 cm are
correlated with increased gastric cancer risk;
5) there is an increased risk of gastric cancer in patients
with pernicious anemia.
The correct answer is:
 A
1,2,3.
3%
 B
2,3,5.
3%
 C
1,2,4,5.
79%
 D
1,2,3,5.
3%
 E
All the above.
 Mechanical ileus:
1) most frequently is caused by colon cancer;
2) starts with frequent urge to defecate;
3) gives slow heartbeat;
4) most frequently is caused by peritoneal adhesions;
5) most frequently refers to small intestine.
The correct answer is:
 A
1,2.
23%
 B
2,3.
1%
 C
4,5.
71%
 D
2,5.
3%
 E
,4.
Mark the correct characteristics of Crohn's disease:
1) Nonspecific, idiopathic inflammation affecting the
entire digestive tract is typical
2) The lesions are segmental
3) Characteristic granulomas may be present in all
involved layers of the intestinal wall
4) Infiltration only involves the mucous membrane
5) infiltration involves the entire wall of the
gastrointestinal tract
 A
1,2
1%
 B
1,2,3
4%
 C
3,5
2%
 D
1,2,4
1%
 E
1,2,3,5
 Indications for splenectomy are:
1. Splenic cyst > 5 cm
2. Splenic abscesses
3. Splenic tumors
4. Chronic thrombocytopenia
5. Splenic artery aneurysm > 1.5 cm
 A
1, 2, 3
8%
 B
1, 3, 4
8%
 C
2, 3, 4
37%
 D
3, 4, 5
6%
 E
All of the above
Indicate the correct statement characterizing the
Mallory-Weiss syndrome:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
It is a rupture of the mucosa and submucosa in the area of the gastroesophageal
junction
70%
 B
Is caused by LES relaxation disorder
5%
 C
Represents 20% of causes of upper gastrointestinal bleeding
6%
 D
It is necessary to take specimens for histopathological examination from the rupture
edges
5%
 E
Bleeding in this syndrome usually ceases spontaneously
Mallory-Weiss syndrome
 definition : bleeding as a result of the rupture of the mucous
membrane around the gastroesophageal junction
 the effect of pressure increase in the abdominal cavity (usually vomiting)
 3-10% of all cases of upper gastrointestinal bleeding
 in 80-90% of cases, there is a spontaneous reduction of bleeding
 treatment :
o endoscopic:
  indicated if during the endoscopy active bleeding or visible
non-bleeding vessel is found, and also when the hemorrhage
led to shock
 methods:
 banding
 hemostatic clips
 adrenaline injection
Source:
https://www.mp.pl/gastrologia/przypadki/86382,38-letni-mezczyzna-z-krwawieniem-z-
przewodu-pokarmowego,1
Chirurgia - Repetytorium, Wojcech Noszczyk; PZWL; Wydanie I - 7 dodruk; 2016; ISBN: 978-
83-200-4555-0; strona 319

Which type of gastric resection is used in the surgical

treatment of morbid obesity?
 A
Subtotal gastrectomy
4%
 B
Proximal gastrectomy.
2%
 C
Hemigastrectomy
4%
 D
Gastric wedge resection
11%
 E
Gastric sleeve resection.
Which of the following must be performed first in the
case of a patient with a liver tumor diagnosed
incidentally on ultrasound and a suspicion of cancer
metastasis?
 A
Accurate medical history, contrast enhanced CT of the abdomen, endoscopy of the
upper and lower gastrointestinal tract.
76%
 B
Accurate medical history and core needle biopsy of the tumor for histopathological
examination.
10%
 C
Accurate medical history and PET-CT as soon as possible.
6%
 D
Accurate medical history, contrast enhanced CT of the abdomen and urgent
decision on laparotomy and partial hepatectomy with tumor resection.
7%
 E
All the above statements are false.
 The access routes for nutritional therapy do not include:
 A
PEG
2%
 B
Duodenostomy
2%
 C
Sigmoidostomy
79%
 D
Nasogastric tube
2%
 E
All of the above are possible access routes for nutritional therapy
Which of the following clinical symptoms is an indication
for urgent surgery in Crohn’s disease?
 A
Recurrent diarrhea.
1%
 B
Impermeable intestinal obstruction.
0%
 C
Massive bleeding.
1%
 D
B and C are true.
82%
 E
A, B, C are true.
Early stomach cancer:
 A
Exceeds the muscular layer, lymph node metastases are present, with no distant
metastases
8%
 B
Exceeds the submucosa, but does not exceed the stomach wall
8%
 C
Stage T2 in the TNM classification
1%
 D
It infiltrates the mucosa and submucosa, it does not infiltrate the muscular layer
82%
 E
It is a stomach cancer in a patient under 50
Which of the following should you suspect in a female
patient complaining of cyclic regular hypogastric pain
 occurring for a longer time and rectal bleeding that
accompanies menstruation?
 A
Meckel's diverticulum
6%
 B
Hyperthyroidism
1%
 C
Intestinal tract endometriosis
88%
 D
Haemorrhagic diathesis.
2%
 E
None of the above
Clinical manifestations related to Zenker's diverticulum
include:
 A
Regurgitation, chest pain, functional obstruction.
6%
 B
Regurgitation, aspiration, functional obstruction.
10%
 C
Dysphagia, aspiration, functional obstruction.
45%
 D
Dysphagia, aspiration, chest pain.
34%
 E
Dysphagia, chest pain, functional obstruction.
In Billroth I gastrectomy the reconstruction is completed
with anastomosis between:
 A
Esophagus and jejunum.
17%
 B
Esophagus and ileum.
4%
 C
Stomach and jejunum.
17%
 D
Stomach and duodenum.
60%
 E
Stomach and ileum.
The obstructive jaundice is characterized by:
 A
Dark urine, increased AST level, elevated unconjugated bilirubin
7%
 B
Dark urine, high ALT level, raised total bilirubin level.
12%
 C
Dark urine, white stool, high ALP level.
76%
 D
High AST level, high ALT level, normal ALP level.
1%
 E
High AST level, high ALT level, raised total bilirubin level.
Which of the following primarily affects the incidence of
postoperative complications after surgical treatment of a
peptic ulcer?
 A
Ulcer ethiology.
11%
 B
Previous therapy with proton pomp inhibitors.
8%
 C
Previous therapy with H2-blockers.
1%
 D
Time from the first perforation symptoms to the surgery.
79%
 E
Patient sex.
The local complications of acute pancreatitis include:
1. portal vein thrombosis
2. true pancreatic cyst
3. pancreatic pseudocyst
4. pancreatic fistula
5. abscess
The correct answer is:
 A
1, 2, 4, 5
48%
 B
1, 3, 4, 5
20%
 C
2, 3, 4, 5
17%
 D
2, 4, 5
15%
 E
1, 2, 3
A patient with decompensated diabetes mellitus and
severe ketoacidosis complains of abdominal pain,
nausea and vomiting. There are no obvious signs of
peritonitis on physical examination. The first-line
approach in this patient is:
 A
Laparotomy.
2%
 B
Minimally invasive exploratory laparotomy.
1%
 C
Detailed abdomen diagnostics (CT, MRI).
2%
 D
Appropriate hydration and correction of metabolic disturbances.
86%
 E
None of the above.
A 48-year-old gentleman with sudden severe epigastric
pain was referred to the ER. Severe tenderness with a
guarding and rebound sign over the upper, middle and
lower abdominal regions was found on physical exam.
Pulse rate was 120/min and blood pressure 100/60
mmHg. Blood testing revealed WBC 18.3 K/µL; serum
amylase 85 U/L; serum lipase 42 U/L; CRP 183 mg/dL;
total bilirubin 0.56 mg/dL. On abdominal imaging the
empty gall bladder, CBD of 5mm in diameter and
normal sized heterogenous pancreas with free fluid in
the upper part of the peritoneal cavity. The results of the
plain chest x-ray are shown in the picture. Which
 management would you recommend to this patient?

 A
A discharge with prescribed pain killers, proton pump inhibitors and antibiotics and a follow-up
visit the next day.
2%
 B
In-hospital intensive conservative treatment with pain killers, proton pump inhibitors and
antibiotics.
3%
 C
In-hospital intensive conservative treatment with pain killers, proton pump inhibitors and
antibiotics and performing upper endoscopy if clinical worsening occurs
6%
 D
In-hospital intensive conservative treatment with pain killers, proton pump inhibitors and
antibiotics and performing laparotomy if clinical worsening occurs.
15%
 E
In-hospital treatment with urgent surgery with concomitant pain killers, proton pump inhibitors
and antibiotics.
74%
Which of the following is the most common malignant
tumor found in the liver?
 A
Hepatocellular carcinoma (HCC)
30%
 B
Cholangiocarcinoma (CCC)
3%
 C
Focal nodular hyperplasia (FNH)
1%
 D
Colon cancer metastasis
66%
 E
Cystadenocarcinoma
Indicate tests that should be ordered before the
abdominal puncture in a patient with hepatic cirrhosis:
 A
Ultrasound imaging, whole blood count, PET, AlAT, AspAT, Na, K, Cl.
5%
 B
Whole blood count, clotting tests, abdominal ultrasound imaging.
82%
 C
Whole blood count, abdominal CT scan, ultrasound imaging, alkaline phosphatase,
ammonia.
4%
 D
Abdominal CT scan, glucose, urea, bilirubin, whole blood count.
3%
 E
Clotting tests, AlAT, AspAT, bilirubin, albumin.
A Sengstaken-Blakemore tube is used in the
management of:
 A
Esophageal varices bleeding
92%
 B
Duodenal ulcer bleeding
5%
 C
Stomach erosion bleeding.
1%
 D
Dieulafoy's lesion bleeding.
1%
 E
Hepatic cirrhosis.
Abdominal compartment syndrome does not arise as a
result of:
 A
Growing ascites.
3%
 B
Excessive swelling of the intestine wall.
12%
 C
Bleeding into the peritoneal cavity.
5%
 D
Intestine distention due to gas accumulation.
6%
 E
Lack of urine outflow.
Which type of intracranial hemorrhage is caused by the
injury of the middle meningeal artery?
 A
Epidural.
20%
 B
Frontotemporal.
9%
 C
Subdural.
5%
 D
Intracerebral
2%
 E
Occipito-parietal.
Which of the following diseases is not associated with
the presence of colon polyps?
 A
Gardner syndrome
8%
 B
Peutz-Jeghers-Touraine’s syndrome
10%
 C
Hereditary non-polyposis colorectal cancer (HNPCC)
76%
 D
Familial adenomatous polyposis
4%
 E
Juvenile polyposis syndrome
Choose the correct statement about colon cancer:
 A
Endoscopic biopsy and histopathological examination are performed to diagnose
the colorectal cancer
6%
 B
It develops most often from a polyp
3%
 C
It metastasizes to the liver rarely and is the most common cause of gastrointestinal
obstruction
1%
 D
 Correct answers: A, B and C
9%
 E
Correct answers: A and B
Short bowel syndrome may be caused by:
 A
Extensive resection of the small intestine.
4%
 B
Fistula between the stomach and the transverse colon.
1%
 C
Cecum-skin fistula.
1%
 D
A, B, C are true.
40%
 E
A and B are true.
What procedure should be implemented in a patient
suffering from a perforated sigmoid diverticulum?
 A
Sigmoid resection and end-to-side anastomosis
6%
 B
Sigmoid resection with the Hartmann's method
78%
 C
Sigmoid resection and end-to-end anastomosis
13%
 D
Peritoneal drainage
2%
 E
Abdominoperineal resection of the rectum
Mitotane is used as a complementary treatment of:
 A
Pancreatic cancer
9%
 B
Gastric cancer
6%
 C
Malignant melanoma
8%
 D
Adrenocortical carcinoma
68%
 E
Thyroid cancer
 Total gastrectomy is one of the surgical methods in the
treatment of gastric cancer. Reconstruction of the
digestive tract continuity is performed during this
procedure. Which type of anastomosis is used in this
technique?
 A
Esophago-duodenal and entero-enteric
41%
 B
Esophago-intestinal and entero-enteric
54%
 C
Gastroenteric and entero-enteric.
2%
 D
Entero-enteric only.
1%
 E
Esophago-transverse and entero-enteric.
In which of the following breast areas breast cancer
most frequently resides?
 A
Retroareolar
1%
 B
Upper inner quadrant
4%
 C
Lower outer quadrant
8%
 D
Lower inner quadrant
1%
 E
Upper outer quadrant
Symptoms suggesting the rectal cancer are:
1) tarry stools
2) bleeding during defecation
3) change in bowel habits
4) pruritus
5) leukocytosis
6) pencil-thin stools.
The correct answers are:
 A
 1, 5, 6
1%
 B
2, 3, 4
7%
 C
1, 3, 6
3%
 D
2, 3, 6
87%
 E
1, 2, 3
A patient weighing 80 kg had burns of an upper right
limb, a lower left limb and a crotch. What amount of
fluids should be administered within the first 24 hours?
 A
1 liter
3%
 B
9 liters
81%
 C
15 liters
10%
 D
18 liters
5%
 E
In a patient with such a small area of burns there is no need to administer fluids
A woman comes to the ER and complains of left side
hypogastric pain which started the previous evening,
temperature 39°C. A hardly movable tumour is palpable
in the left lower quadrant of the abdomen. You should
suspect first:
 A
Irritable bowel syndrome
1%
 B
Acute diverticulitis
84%
 C
Crohn's disease
2%
 D
Colon cancer.
11%
 E
 Acute pancreatitis
The indication for splenectomy is not:
 A
Splenic abscess
18%
 B
A malignant tumor located near the spleen
44%
 C
Hereditary spherocytosis
8%
 D
Congenital haemolytic anemia
16%
 E
Parasitic cyst of the spleen
What is removed during the Whipple procedure ?
 A
Gallbladder, pancreatic head, duodenal bulb, pyloric part of the stomach
27%
 B
Common hepatic duct, pancreatic head, duodenum, pyloric part of the stomach
11%
 C
Gallbladder, pancreatic head, duodenum, the pyloric part and the body of the
stomach
12%
 D
Common bile duct, pancreatic head, duodenum, pyloric part of the stomach
39%
 E
Common bile duct, pancreatic head, duodenal bulb, pyloric part of the stomach
The Roux-en-Y method after total gastrectomy consists
of:
 A
Side-to-side method of the esophago-intestinal anastomosis and the end-to-end
method of the enteroenterostomy formed by a stapler
10%
 B
Manual end-to-side method of the esophago-intestinal anastomosis and the side-to-
end method of the enteroenterostomy
49%
 C
Manual end-to-end method of the esophago-intestinal anastomosis and the end-to-
side method of the enteroenterostomy
27%
 D
Manual end-to-end method of the esophago-intestinal anastomosis and the end-to-
end method of the enteroenterostomy
6%
  E
Side-to-side method of the esophago-intestinal anastomosis and the side-to-side method of
the enteroenterostomy formed by a stapler
Which of the following ways of treatment restores the
anti-reflux barrier in gastroesophageal reflux disease?
 A
Prokinetic drugs
2%
 B
Roton pump inhibitors.
16%
 C
Cardiomyotomy
2%
 D
Cardioplasty
2%
 E
Fundoplication
Regional anaesthesia does not include:
 A
Epidural anaesthesia.
4%
 B
Spinal anaesthesia.
6%
 C
Plexus anaesthesia.
2%
 D
Analgosedation.
80%
 E
Infiltrative anaesthesia.
In which of the following patients is an increased risk of
perioperative complications observed?
1) obese;
2) above 30;
3) with coronary artery disease;
4) with diabetes mellitus;
5) classified to a ASA PS category I according to the
American Society of Anesthesiologists.
The correct answer is:
 A
1,2,3,4.
77%
 B
3,4,5.
1%
 C
1,3,5.
2%
 D
1,3,4.
18%
 E
2,3,4.
The most frequent complication after thyroid surgery is:
 A
Bilateral recurrent laryngeal nerve paresis.
15%
 B
Post-surgical hypocalcaemia.
17%
 C
Bleeding into the post-surgical wound.
11%
 D
Keloid.
4%
 E
Thyroid storm.
Which of the following symptoms indicate the need for
rectal cancer diagnosis ?
1) tarry stools
2) bleeding during defecation
3) change in bowel habits
4) anal itching
5) elevated leukocytosis
6) pencil-thin stools
 A
1, 5, 6
2%
 B
2, 3, 4
3%
 C
1, 2, 6
5%
 D
1, 3, 4
1%
 E
2, 3, 6
 Which of the following are not classified as internal
abdominal hernias:
 A
Diaphragmatic hernias.
12%
 B
Hernias of the paraduodenal recess.
2%
 C
Pericaecal hernias.
3%
 D
Hernias of the omental bursa.
3%
 E
Lumbar hernias.
A 30-year-old woman, weighing 60 kg, was referred to
the ER with III degree burnings of the left upper
extremity, left lower extremity and of the groin. What
volume of fluids should be administered within 24
hours?
 A
Approx. 7 litres.
89%
 B
Approx. 2 litres
2%
 C
Approx. 15 litres.
8%
 D
She needs only oral fluids.
1%
 E
Described degree and extent of burns do not need intensive fluid therapy.
Which of the following accesses to the digestive tract
can be used in nutritional therapy?
 A
Naso-gastric tube, gastrostomy, jejunostomy.
37%
 B
Naso-gastric tube, gastrostomy, ileostomy.
10%
 C
Esophagostomy, gastrostomy, jejunostomy.
32%
 D
 Gastrostomy, jejunostomy, ileostomy
18%
 E
Jejunostomy, ileostomy, colostomy
Colles' fracture is a following fracture:
 A
Fracture of femoral neck
2%
 B
Fracture of the distal epiphysis of the ulnar bone
5%
 C
Racture of I metacarpal bone
1%
 D
Fracture of the distal epiphysis of radial bone in the typical place
89%
 E
Supracondylar humerus fracture
Ogilvie syndrome is:
 A
Inherited lack of colon autonomic innervations.
8%
 B
Acute pseudo-obstructive large bowel dilatation.
78%
 C
Mechanical large bowel obstruction.
6%
 D
Hereditary non-polyposis colon cancer.
3%
 E
Ruptures of a ventral part of the oesophageal mucosa caused by vomiting.
Contraindications to laparoscopic surgery include:
1) surgery in anamnesis;
2) peptic ulcer of the stomach rupture;
3) cardio-respiratory failure;
4) surgery because of cancer disease;
5) clotting disorders;
6) lack of patient’s consent to this surgery.
The correct answer is:
 A
1,3,6.
3%
 B
2,4,6.
8%
 C
3,5,6
69%
 D
Only 6.
6%
 E
4,3,6.
14
A 65-year-old patient 10 years after aorto-aortic
prosthesis because of ruptured aortic aneurysm. For the
last 3 months periodical fever. Today admitted to the
ER with the symptoms of heavy upper gastrointestinal
bleeding. On CT features of inflammatory infiltration
around the prosthesis with gas vesicles. You should first
suspect in this patient:
 A
Trapped gas syndrome after aortic aneurysm surgery.
18%
 B
Necrotic haemorrhagic pancreatitis.
61%
 C
Bleeding from an aorto-duodenal fistula.
16%
 D
Forming of perianastomotic aneurysm.
3%
 E
Oesophageal perforation.
The following symptoms, such as rapid and irregular
breathing, extension of the limbs in reaction to external
stimuli, bilateral Babinski sign, impaired pupil reaction to
light, increased blood pressure, pulse acceleration and
increased sweating indicate the contusion of:
 A
Brain stem.
81%
 B
Cerebellar hemisphere.
4%
 C
Frontal lobes.
4%
 D
Occipital lobe.
7%
  E
Temporal lobe.
The symptoms of Whipple’s triad comprise:
1) consciousness disorders;
2) hypoglycaemia;
3) hyperglycaemia;
4) disappearance of symptoms after intravenous
glucose administration;
5) gallstones.
The correct answer is:
 A
,2,4.
20%
 B
,3,5.
2%
 C
,4,5.
5%
 D
,2,5.
4%
 E
,2,3.
Tertiary hyperparathyroidism develops as a
consequence off:
 A
Ncreased release of tropic hormone
4%
 B
Chronic renal failure and dialysis therapy
30%
 C
Autonomic, increased PTH release occurring after kidney transplantation
60%
 D
Parathyroid carcinoma
2%
 E
Parathyroid adenoma
The most frequent origin of metastasis in the liver is:
 A
Prostate cancer.
1%
 B
Colon cancer.
97%
 C
Kidney cancer.
1%
 D
Thyroid cancer.
0%
 E
Parathyroid carcinoma.
Indicate the true statement concerning Charcot’s triad:
 A
Refers to cholecystitis.
20%
 B
Refers to colon diverticulitis.
1%
 C
Is characterized by epigastric pain, jaundice, recurrent fever and chills.
74%
 D
Is characterized by left side hypogastric pain, diarrhoea, recurrent fever and chills.
4%
 E
Is an indication for cholecystectomy.
Which of the following is used in colon cancer
prophylaxis in the course of familiar adenomatous
polyposis:
 A
Lipoxygenase inhibitors
6%
 B
Cyclooxygenase inhibitors
74%
 C
High-protein diet
3%
 D
Glucocorticosteroids
9%
 E
Low-carbohydrate diet
Which of the following is not an indication for liver
transplantation:
 A
Post-inflammatory liver cirrhosis
6%
 B
Budd-Chiari syndrome.
3%
 C
 Wilson's disease
6%
 D
Primary and secondary biliary liver cirrhosis.
6%
 E
Disseminated hepatocellular carcinoma
Endemically iodine deficient areas are characterized by
an increased incidence of the following cancer:
 A
Papillary carcinoma.
16%
 B
Anaplastic carcinoma.
51%
 C
Follicular carcinoma.
16%
 D
Medullary carcinoma.
7%
 E
Papillary and follicular carcinoma.
Colon cancer most frequently is located within:
 A
Cecum
3%
 B
Liver and spleen flexure.
1%
 C
Descending colon
2%
 D
Sigmoid colon
20%
 E
Rectum
Lynch1 syndrome is characterized by occurrence of the
following neoplasms:
 A
Colorectal cancer, endometrial cancer, ovarian cancer
29%
 B
Colorectal cancer, stomach cancer, small intestine cancer
10%
 C
Colorectal cancer, breast cancer, thyroid cancer
5%
 D
Thyroid cancer, parathyroid cancer, retinoblastoma
 2%
 E
Colorectal cancer
55
The essential element of hernia surgery is:
 A
Skin plasty over the hernia sac
3%
 B
Removal of the intestines from the hernia sac
27%
 C
Shortening and / or deep placement of the hernia sac
5%
 D
Plasty of the fascial and muscular layer
59%
 E
Closure of the transverse fascia with sutures
Which of the following concerning carcinoma of the
ampulla of Vater is false?
 A
Predominant sign of carcinoma of the ampulla of Vater is painless mechanical
jaundice.
4%
 B
Carcinoma of the ampulla of Vater may lead to so called Courvoisier’s sign.
5%
 C
Percentage of resection operations in carcinoma of the ampulla of Vater is
significantly lower than in pancreatic head cancer.
33%
 D
Long term results of treatment are better in carcinoma of the ampulla of Vater than
in pancreatic cancer.
18%
 E
Its incidence in males and females is similar.
Which of the following is not an indication for the
surgical treatment of chronic pancreatitis in every case?
 A
Severe pain that demands the use of opiates.
9%
 B
Suspicion of a neoplastic tumor.
3%
 C
Duodenal ileus.
2%
 D
 Pancreatic fistula
1%
 E
Any pseudocyst.
Which of the following concerning pancreatic cancer is
false?
 A
More than 95% of cases of pancreatic cancer is ductal cancer, usually located in
the body of pancreas.
79%
 B
Mechanical jaundice may be the first sign of pancreatic cancer.
2%
 C
About 15-30% of pancreatic cancers are resectable at diagnosis.
5%
 D
Primary surgical technique used in the treatment of cancer of the body of the
pancreas is partial pancreatic resection.
12%
 E
TNM classification is the most commonly used method for the evaluation of tumour staging.
Pulse palpation in clinical settings is possible on the
following arteries, except for:
 A
Ulnar artery
3%
 B
Dorsalis pedis artery.
1%
 C
Posterior tibial artery.
78%
 D
Common iliac artery.
16%
 E
Pulse can be examined on all the above arteries.
In the Forrest classification of hemorrhages the grade II
denotes:
 A
Recent hemorrhage.
23%
 B
Active hemorrhage.
71%
 C
Hemorrhage in the past.
2%
 D
No hemorrhage.
2%
 E
Recurrent hemorrhage from non-healing wounds.
Leśniowski-Crohn's disease:
1) May affect every segment of the digestive tract.
2) The inflammatory process only affects the mucosa
and submucosa.
3) The perianal fistulas are common.
4) Surgical treatment consists of performing intestine-
saving procedures.
5) Surgical treatment involves extensive resection
procedures.
The correct answers are:
 A
1, 2, 4
3%
 B
2, 3, 4
1%
 C
2, 3, 5
1%
 D
1, 3, 4
90%
 E
1, 2, 3, 4
Which of the following is relative contraindication to
conservative surgery in breast cancer?
 A
Tumour diameter exceeding 3 cm.
55%
 B
Lack of patient’s consent to conservative surgery.
12%
 C
Synchronous bilateral breast cancer.
20%
 D
Contraindications to radiotherapy.
8%
 E
Breast cancer in males.
Kwashiorkor is a disease resulting from a deficiency:
 A
Carbohydrates
2%
 B
Proteins
91%
 C
Carbohydrates and water
1%
 D
Carbohydrates and proteins
5%
 E
Proteins and water
Which of the following is not an indication for urgent
exploratory laparotomy after abdomen trauma?
 A
Free gas in the peritoneal cavity
10%
 B
Peritoneal signs on physical examination.
40%
 C
Totally absent peristalsis.
22%
 D
Hock of unknown origin.
7%
 E
Dissection of the ascending aorta.
Pringle maneuver consists in the compression of:
 A
Hepatoduodenal ligament
87%
 B
Aorta
3%
 C
Inferior mesenteric artery.
5%
 D
Superior mesenteric artery.
2%
 E
Splenic artery
The most common neuroendocrine pancreatic tumor is:
 A
Gastrinoma.
11%
 B
 Somatostatinoma.
1%
 C
VIPoma.
2%
 D
Glucagonoma.
3%
 E
Insulinoma.
Which of the following concerning intestinal obstruction
is false ?
 A
Classical symptoms of intestinal obstruction include: abdominal pain, nausea and
vomiting, abdominal distension and constipation.
3%
 B
In the case of mechanical obstruction of the small intestine, the pain is colic,
intermittent, related to peristaltic waves.
7%
 C
Most common causes of mechanical obstruction of the small intestine are
peritoneal adhesions resulting from previous surgery, hernias and neoplasms.
6%
 D
Most common causes of mechanical obstruction of the large intestine are colon
cancer, diverticulitis and sigmoid volvulus.
7%
 E
Relatively weak pain occurring in waves, located mainly in the umbilical and lumbar regions is
observed in obstruction caused by acute intestinal ischemia.
Internal hernias do not include:
 A
Diaphragmatic hernia
6%
 B
Parastomal hernia
81%
 C
Paracecal hernia
3%
 D
Paraduodenal hernia
3%
 E
Foramen of Winslow hernia.
Which of the following concerning Meckel’s diverticulum
is false?
 A
It is present in about 2% of population.
 6%
 B
Gastric mucosa or pancreatic tissue may be present in Meckel’s diverticulum.
9%
 C
Most common complication of Meckel’s diverticulum is mechanical obstruction
(volvulus or intussusception).
17%
 D
It is recommended to remove Meckel’s diverticulum during the surgical treatment of
diffuse peritonitis induced by other causes.
57%
 E
Second most common complication of Meckel’s diverticulum is bleeding.
A 27-year-old woman with severe abdominal pain was
admitted to the ER. She had fainted at home. She
complains of the pain of the whole abdomen, lasting for
2 hours. The pain had acute onset in the epigastric
area. She can’t remember the date of her last
menstruation period, but she confirms no periods for
more than a month. On palpation increase muscle tone
and tenderness are observed. Other findings include
pale skin, BP 80/60 mmHg, HR 120/min. Which
condition should be excluded in the first place?
 A
Ruptured ectopic pregnancy
94%
 B
Vulation pain.
1%
 C
Appendicitis
1%
 D
Irritable bowel syndrome.
3%
 E
Adnexitis
One of the tension-free methods of inguinal hernia
repair is:
 A
Bassini's
3%
 B
Shouldice's
1%
 C
Lichtenstein's
92%
 D
Halsted's
3%
 E
Girard's
In the TNM classification of colon cancer T1 denotes
infiltration of:
 A
Mucous membrane.
41%
 B
Submucous membrane.
53%
 C
Muscle membrane.
4%
 D
Serous membrane.
1%
 E
Neighboring organs.
The ankle-brachial pressure index (ABPI) in healthy
people is at least 1. ABPI score <0.5 indicates:
 A
Critical limb ischaemia
86%
 B
Superficial vein thrombosis
3%
 C
Deep vein thrombosis
8%
 D
Pulmonary embolism
1%
 E
It is not possible to obtain such a result
The proper management in the case of rectal
perforation accompanied by fecal peritonitis is:
 A
Partial resection of the rectum and making primary anastomosis.
12%
 B
To create a colostomy.
58%
 C
 Application of a prosthesis
1%
 D
To create an anastomosis bypass.
3%
 E
Peritoneal lavage and drainage
In which case you can perform a percutaneous
endoscopic gastrostomy (PEG):
 A
Esophageal tumor closing the GI tract lumen
6%
 B
Throat tumor closing the GI tract lumen
3%
 C
Cardiac (stomach) tumor closing the GI tract lumen
5%
 D
Pyloric tumor closing the GI tract lumen
63%
 E
All of the above
23
Early stomach cancer
 A
Affects the mucosa and submucosa, it can metastasize to regional lymph nodes
69%
 B
Qualified as T2
2%
 C
Occurs below 50 years of age
1%
 D
Does not exceed the stomach wall, metastases in the lymph nodes, without distant
metastases
10%
 E
It exceeds the submucosa, but does not exceed the stomach wall
According to the rule of nines, a burning of both lower
limbs and the scrotum in adult patients affects:
 A
19% of the body surface.
10%
 B
36% of the body surface.
4%
 C
37% of the body surface.
83%
 D
45% of the body surface
2%
 E
Rule of nines is not related to burned body surfaces.
Positive Chvostek, Trousseau and Erb’s signs suggest:
 A
Acute cholecystitis.
7%
 B
Acute pancreatitis.
12%
 C
Hyperthyroidism.
4%
 D
Adrenocortical hyperfunction.
3%
 E
Hypoparathyroidism.
Which of the following is recommended in the case of
stage T3 cecum cancer?
 A
Endoscopic mucosal resection
1%
 B
Right hemicolectomy
72%
 C
Esection of the cecum with appendectomy
10%
 D
Ileo-transverso-anastomosis bypass.
3%
 E
Hartmann procedure.
To what organ do other organs' neoplastic tumors
metastasize to most frequently?
 A
Brain
2%
 B
Lungs
55%
 C
Bones
1%
 D
Skin
1%
  E
Liver
Indicate the false statement concerning gastrointestinal
stromal tumors (GIST):
 A
Genetic disorders play an important role in their etiology.
64%
 B
Their most common localization in the gastrointestinal tract is the stomach.
5%
 C
First-line treatment is their surgical removal.
11%
 D
Hey are of epithelial origin.
6%
 E
Djuvant treatment is chemotherapy with imatinib.
A patient is referred to the surgical outpatient clinic
because of two tumours: one in the right adrenal gland
with the diameter of 4.8 cm and the other in the left
adrenal gland with the diameter of 2.1 cm (described as
probable adenoma in CT). Laboratory tests excluded
hormonal activity of the tumours. Which of the following
is the management of choice in this patient?
 A
Left adrenalectomy.
6%
 B
Right adrenalectomy.
1%
 C
Bilateral adrenalectomy.
19%
 D
Fine-needle aspiration biopsy of both tumours.
15%
 E
Observation and reevaluation after 12 months.
A 52-year-old obese woman went to see a gynecologist
because of periodic bleeding from the reproductive
tract. The abdominal ultrasound exam revealed
incidentally a stone in the gallbladder of 2.5 cm in
diameter. The patient was not aware of the
cholelithiasis and she denies having any symptoms
 suggesting the disease. Which of the following is the
optimal management?
 A
Calming the patient and clinical follow-up.
32%
 B
Referral to the surgeon in order to perform elective cholecystectomy.
4%
 C
Urgent cholecystectomy.
50%
 D
Removal of the stone during endoscopic retrograde cholangiopancreatography
(ERCP).
7%
 E
Referral for computed tomography in order to extend the diagnostics.
Klatskin tumor is a term given to:
 A
Gallbladder cancer
7%
 B
Cancer of the ampulla of Vater
7%
 C
Hepatocellular carcinoma originating in a cirrhotic liver affected by hepatitis type B.
6%
 D
Cholangiocarcinoma
78%
 E
Pancreatic cancer in the head of the pancreas.
A 55-year-old patient came to the surgeon office with
the following complaints: for several years fresh blood
bleeding from the anus, which recently intensified,
occasionally itching and burning sensation in this area;
recently after defecation he repositions prolapsing
nodules with his finger. This clinical picture allows of the
diagnosis of hemorrhoids of:
 A
I
2%
 B
II
25%
 C
III
 67%
 D
IV
5%
 E
V
A patient hospitalized due to acute pancreatitis for two
weeks, felt epigastric pain accompanied by increasing
fever about three weeks after the discharge from the
ward. There is a tumour palpable in the epigastrium.
Which of the following is the most probable diagnosis?
 A
Pseudocyst.
27%
 B
Abscess.
69%
 C
True cyst.
2%
 D
Pancreatic cancer.
2%
 E
Recurrence of pancreatitis.
A 68-year-old patient, previously in good health, who
has not needed medical attention for the last year, is
referred to the surgical outpatient clinic because of a
yellowish shade of his skin observed for 7 days. The
physical examination shows the enlarged nonpainful
gallbladder. Which of the following is the most probable
diagnosis?
 A
Primary biliary cirrhosis
1%
 B
Primary sclerosing cholangitis
7%
 C
Acute cholecystitis
6%
 D
Acute cholangitis
6%
 E
Pancreatic cancer in the head of the pancreas
 Nowadays the classic X-ray of the abdomen is still
useful in the diagnostics of the following acute diseases
of the abdomen: 1) perforation of the gastrointestinal
tract; 2) bleeding into the peritoneal cavity; 3) ileus; 4)
acute appendicitis; 5) torsion and perforation of the
ovarian cyst. The correct answer is:
 A
1, 3
80%
 B
1, 4, 5
1%
 C
1, 3, 5
8%
 D
1, 2, 3, 4
3%
 E
All
The main symptoms of the large bowel obstruction are:
1) vomiting at the early stage of the disease;
2) alkalosis followed by metabolic acidosis;
3) immobilization of extracellular fluid in the so-called
third space;
4) increased concentration of hemoglobin and
hematocrit;
5) bowel distension with fluid accumulation.
The correct answer is:
 A
1,2,5
3%
 B
3,4,5
51%
 C
1,5
34%
 D
1,2
1%
 E
1,4,5
 The symptoms of the acute appendicitis with the
appendix located behind the cecum include:
 A
Positive psoas sign.
89%
 B
Cullen's sign
5%
 C
Charcot's sign
2%
 D
Gray Turner's sign
2%
 E
Halsted's sign
Arterial embolism most commonly occurs:
 A
In the subclavian artery.
4%
 B
In the brachial artery.
2%
 C
In the splenic artery.
6%
 D
At the point of origin of the internal carotid artery.
11%
 E
At the point of origin of the deep femoral artery.
The characteristic feature of Leriche syndrome is:
 A
Occlusion of both femoral arteries.
11%
 B
Occlusion of both mesenteric arteries (superior and inferior).
65%
 C
Occlusion of both common carotid arteries.
3%
 D
Occlusion of the distal part of the abdominal aorta or both common iliac arteries.
16%
 E
Occlusion of both renal arteries.
The urgent surgical method most frequently used in a
patient with perforation of a sigmoidal diverticulum is:
 A
 Left hemicolectomy.
3%
 B
Miles’ operation.
72%
 C
Lower anterior resection of the rectum.
7%
 D
Hartmann’s operation.
17%
 E
Sigmoid resection with immediate anastomosis.
What is the most common reason for the obstruction of
the lower gastrointestinal tract?
 A
Colon cancer.
5%
 B
Crohn’s disease.
42%
 C
Intraperitoneal adhesions.
15%
 D
Diverticulosis.
38%
 E
Ulcerative colitis.
Standard treatment for stomach ulcers is:
 A
Total stomach resection.
2%
 B
Pharmacological treatment.
91%
 C
Subtotal stomach resection.
1%
 D
Highly selective vagotomy.
3%
 E
Light diet.
The Sudeck syndrome can be caused by:
 A
Head injury
4%
 B
Bleeding from the gastrointestinal tract
 7%
 C
Immobilization of a limb
84%
 D
Tumor lysis
4%
 E
Heart attack
The Monteggia fracture is:
 A
Femoral intertrochanteric fracture
67%
 B
Facial fracture.
3%
 C
First metacarpal bone fracture with dislocation.
2%
 D
Shaft of the ulna fracture with dislocation and luxation of the head of the radius
25%
 E
Fracture of the surgical neck of the humerus.
Type I in the Forrest bleeding classification:
 A
Recent hemorrhage.
75%
 B
Active hemorrhage.
15%
 C
Ld hemorrhage.
2%
 D
No sign of hemorrhage.
1%
 E
Forrest classification does not refer to gastrointestinal hemorrhage.
Which of the following is not an indication for the pleural
drainage?
 A
Tension pneumothorax without dyspnea.
12%
 B
Bilateral pneumothorax with an air rim of 2.5 cm.
29%
 C
Pleural effusion in acute pancreatitis.
12%
 D
Pleural empyema.
43%
 E
Traumatic hemothorax
The most frequent cause of chronic bleeding in the
lower gastrointestinal tract is:
 A
Colon polyps.
5%
 B
Ulcerous colitis.
2%
 C
Colon cancer.
8%
 D
Hemorrhoids.
70%
 E
Diverticulosis.
The positive Homans' sign is characteristic of:
 A
Acute appendicitis
3%
 B
Inguinal hernia
5%
 C
Calf deep vein thrombosis.
87%
 D
Mallory - Weiss syndrome
3%
 E
Right colon cancer.
Super obesity is an important risk factor for the cancer
of:
 A
Pancreas
19%
 B
Gall bladder.
22%
 C
Stomach.
5%
 D
Colon.
53%
  E
Thyroid.
Which of the following colon lesions bears the highest
risk of malignant transformation?
 A
Tubulovillous adenoma.
73%
 B
Tubular adenoma.
7%
 C
Villous adenoma.
14%
 D
Hyperplastic polyp.
2%
 E
Juvenile polyp.
4
Patient after chest injury, with increasing dyspnea and
cyanosis. Where should you install the drain?
 A
You install the drain in II ICS, enter the drain on the upper edge of the rib
37%
 B
You install the drain in II ICS, enter the drain on the lower edge of the rib
7%
 C
Anywhere in the chest on the lower edge of the rib
0%
 D
In the IV-VI intercostal space in the middle axillary line on the lower edge of the rib
5%
 E (ONLY E IS CORRECT)
In the IV-VI intercostal space in the middle axillary line on the upper edge of the rib

The most common symptoms of so-called ‘acute

abdomen’ do not include:
 A
Positive Blumberg sign.
3%
 B
Increased peristaltic sounds, a so-called ‘storm over the abdomen’.
84%
 C
Vomiting.
7%
 D
Abdominal guarding.
2%
 E
 Abdominal distension.
Indicate the true statements concerning esophageal
cancer: 1) it has a good prognosis; 2) most common
type of esophageal cancer is adenocarcinoma; 3)
achalasia is one of its risk features; 4) it infiltrates
surrounding tissues at early stages and metastases to
the lymph nodes; 5) surgery is the primary mode of
treatment. The correct answer is:
 A
1, 2, 3, 5
10%
 B
1, 2, 3
2%
 C
1, 2, 5
4%
 D
3, 4
8%
 E
3, 4, 5
In the second day of treatment of acute pancreatitis in
the intensive care unit, the patient reports tingling
around the mouth, paresthesia of the fingers of both
hands and spasms of the lower limbs. ECG shows sinus
bradycardia and QT prolongation. The treatment of
choice is / are:
 A
Calcium salts intravenously
95%
 B
Change in antibiotic therapy
1%
 C
Dialysis therapy
2%
 D
Anti-arrhythmic drugs
2%
 E
Oxygen therapy
Acute pancreatitis: 1) mild course in 80% of cases 2)
frequent complication is true cysts 3) recurrent in case
 of alcohol abuse 4) treatment of choice is surgical 5)
pain worsens in standing position
 A
1, 2, 3
13%
 B
1, 3, 5
77%
 C
2, 3, 4
3%
 D
3, 4, 5
5%
 E
2, 3, 4
Meckel diverticulum includes:
 A
Ll layers of the intestinal wall.
82%
 B
Mucous membrane only
1%
 C
Muscular layer only
4%
 D
Serous membrane only
1%
 E
Serous membrane and muscular layer.
Volkmann's syndrome from ischemia usually occurs
after a fracture of:
 A
Femoral bone.
6%
 B
Clavicle.
20%
 C
Radius.
4%
 D
Fibula.
7%
 E
Humerus.
Paralytic ileus can be caused by:
 A
 Hypokaliemia.
1%
 B
Uremia.
1%
 C
Acute porphyria.
2%
 D
Uncontrolled diabetes.
1%
 E
All the above.
Which stage of lower limb ischemia in the Fontaine
classification is characterized with intermittent
claudication?
 A
I
2%
 B
II
11%
 C
III
56%
 D
IV
24%
 E
V
Which of the following organs is resected during
Whipple's operation with Traverso modification?
 A
Rectum
2%
 B
Spleen
7%
 C
Pancreas
89%
 D
Thymus
1%
 E
Liver
Ogilvie syndrome means:
 A
Jaundice in the course of pancreatic head cancer.
 10%
 B
Paralytic ileus in porphyria.
10%
 C
Colonic pseudo-obstruction without any mechanical obstruction.
15%
 D
Tumor of the porta hepatis that causes jaundice.
57%
 E
None of the above
Indicate the true statements concerning bile peritoniti:
1) it results from the irritation of the peritoneum by the
bile;
2) diagnostic puncture of the peritoneal cavity that
shows the fluid stained with blood allows formulating the
diagnosis;
3) evolution of the symptoms (their temporal regression)
may resemble the perforation of the gastric ulcer;
4) if the diagnosis is confirmed, the first-line treatment is
conservative, with broadspectrum antibiotic therapy;
5) the diagnosis is possible if there is a perforation of
the gallbladder wall;
6) medical history of cholecystectomy allows excluding
the diagnosis.
The correct answer is:
 A
1,2,4,5
8%
 B
1, 3, 5, 6
17%
 C
2, 5, 6
3%
 D
1, 3
62%
 E
1, 4, 5, 6
Indicate the false statement concerning the
epidemiology of pancreatic cancer:
 A
Etiological factors include high-lipid, high-protein diet and smoking.
3%
 B
Tumour most commonly develops in the pancreatic body.
89%
 C
About 10-30% of the patients can by treated with the resection (pancreaticoduodenectomy).
4%
 D
5-year survival rate is low (<10%).
2%
 E
Duodenal ileus caused by the tumor is observed in about 10% of the patients.
3
Extranodal lymphoma is most commonly localized in:
 A
Stomach.
77%
 B
Duodenum.
4%
 C
Small intestine.
7%
 D
Colon.
10%
 E
Rectum.
Which of the following is a late symptom of acute limb
ischemia?
 A
Paresthesias.
11%
 B
Muscle weakness.
19%
 C
Flattened superficial veins.
10%
 D
Oedemas.
48%
 E
Coldness of ischemic parts of the limb.cooling
Which of the following can be classified as the grade II
according to Hinchey classification of complications
caused by diverticulitis?
 A
Diverticulitis with para-colonic abscess.
 37%
 B
Diverticulitis with pelvic abscess.
42%
 C
Diverticulitis with purulent peritonitis.
11%
 D
Diverticulitis with feculent peritonitis.
4%
 E
Hinchey classification is not related to diverticulitis.
Emergency indications for surgery in a patient with
Crohn disease:
 A
Enterocutaneous fistula.
20%
 B
Appearance of neoplasms (colon adenocarcinoma, intestinal lymphoma).
29%
 C
Chronic subileus.
11%
 D
Perianal fistula.
26%
 E
Anorectal abscess.
A 58-year-old, obese patient called at the family doctor
because of abdominal pain, high fever with shivering
and a yellowish shade of the eye whites which occurred
several hours before her visit. After arriving at the
emergency department CNS symptoms occurred in the
form of conscious disturbances. The described signs
and symptoms indicate:
 A
Viral meningitis.
2%
 B
Abdominal abscess.
75%
 C
Acute cholangitis.
19%
 D
Aggravation of viral hepatitis
3%
  E
Acute coronary syndrome (the inferior wall).
Which of the following diseases leads to loss of angle of
Hiss?
 A
Sliding hiatal hernia.
60%
 B
Morgagni hernia
4%
 C
Bochdalek hernia
3%
 D
Paraesophageal hernia
15%
 E
B and D are correct.
Which of the following is the most common cause of the
mechanical ileus in the lower
gastrointestinal tract?
 A
Diverticulosis of the colon.
5%
 B
Peritoneal adhesions.
63%
 C
Meckel's diverticulum
2%
 D
Neoplastic tumors.
30%
 E
Bezoars.
Which of the following operations can be performed in
the case of adenocarcinoma
localized in the sigmoid colon?
 A
Aparoscopic sigmoid resection.
3%
 B
Hartmann’s procedure by means of laparotomy.
10%
 C
Sigmoid resection by means of laparotomy.
14%
 D
 Laparoscopic Hartmann operation.
17%
 E
All the above.
A patient was admitted to the surgical ward in duty
hours. The patient needs urgent surgery but he receives
chronic anticoagulant therapy with vitamin K antagonist
(VKA). Which of the following should be used to reverse
VKA action promptly?
 A
Platelet concentrate.
2%
 B
Fresh frozen plasma.
11%
 C
Serum albumin.
10%
 D
Vitamin K intravenously.
55%
 E
A and D are correct.
Where are the thrombi in the peripheral arteries most
often located?
 A
Bifurcation of the common femoral artery to the deep and superficial femoral artery
62%
 B
Bifurcation of the popliteal artery
16%
 C
Common carotid artery
2%
 D
Dorsal metacarpal artery
0%
 E
Popliteal artery
Laparoscopic inguinal hernia repair with alloplastic
material is classified as:
 A
Endoscopic operation - accompanied by tension.
14%
 B
Endoscopic operation - tension-free.
69%
 C
 Open operation - tension-free.
4%
 D
Open operation - accompanied by tension.
7%
 E
None of the above.
The 3rd class in ASA (American Society of
Anesthesiologists) physical status classification system
denotes:
 A
Healthy patient, without any comorbidities.
1%
 B
Patient with a mild systemic disease.
1%
 C
Patient with a severe but controlled systemic disease.
86%
 D
Patient with a severe systemic disease posing a threat to their life.
12%
 E
Patient who will probably not survive next 24 hours regardless the surgery.
The risk factor for breast cancer is not:
 A
Age over 35
6%
 B
Regular consumption of alcohol
10%
 C
Obesity
4%
 D
Late menarche and early menopause
69%
 E
Use of hormone replacement therapy including oral contraceptives
Which of the following is not observed in the course of
pulmonary embolism?
 A
Marked increase in arterial pressure.
66%
 B
Jugular vein distension.
8%
 C
Achypnea and tachycardia.
 2%
 D
Cold sweats.
6%
 E
Agitation.
Which of the following does not suggest the
development of malignant melanoma from a nevus?
 A
Enlargement of the nevus.
2%
 B
Bleeding nevus.
2%
 C
Equal distribution of pigment in the nevus.
92%
 D
Inflammation in the nevus.
3%
 E
Ulceration within the nevus.
Indicate a false statement about kwashiorkor
malnutrition:
 A
It is acute malnutrition presenting with hypoalbuminemia, oedemas,
dyselectrolytemia, and consciousness impairment.
11%
 B
It usually occurs as a consequence of an acute disease, trauma or surgery in
overweight or obese patients, who receive crystalloids only without protein
supplementation.
15%
 C
Weight loss is always observed in affected patients.
68%
 D
Parenteral nutrition is recommended in this type of malnutrition.
4%
 E
Fluid retention and oedemas occur.
Which of the following is not a complication of blood
transfusion?
 A
Fever
2%
 B
Dyspnea
4%
 C
Pain in the lumbar region
15%
 D
Hemoglobinuria
5%
 E
Decrease in bilirubin concentrations in the blood.
The causes of hypertonic dehydration do not include:
 A
Insufficient water supply.
4%
 B
Hyperventilation.
9%
 C
Hypoventilation.
74%
 D
Watery diarrhea.
6%
 E
Sweating.
The most common thyroid cancer is cancer:
 A
Medullary
9%
 B
Papillary
73%
 C
Follicular
18%
 D
Anaplastic
1%
 E
Signet ring cell
Cyanotic painful swelling of the limb (phlegmasia
cerulea dolens) is caused by:
 A
Embolism.
21%
 B
Thrombosis in one of the branches of the aortobifemoral bypass
5%
 C
Lymphoedema
4%
 D
 Thrombosis in varices of the lower limbs.
16%
 E
Generalized thrombosis of superficial and deep veins
Rest pain is classified on the Fontaine scale as:
 A
I
2%
 B
II
56%
 C
III
32%
 D
IV
9%
 E
V
Anastomosis of stomach with the intestine by Billroth I
consists in:
 A
Anastomosis of stomach with small intestine
22%
 B
Anastomosis of stomach with ascending colon
2%
 C
Anastomosis of stomach with the duodenum
71%
 D
Anastomosis of stomach with descending colon
1%
 E
B or D are true
The most common direct cause of acute peritonitis is:
 A
Acute liver insufficiency.
2%
 B
Intussusception of the small intestine into the large one.
2%
 C
Perforation of the gastrointestinal tract.
86%
 D
Large bowel obstruction.
4%
 E
Acute pancreatitis.
 Surgical complications from gastric and duodenal ulcers
have become less common in the last decade. What is
the main cause of this phenomenon?
 A
Use of truncal vagotomy
1%
 B
Use of truncal vagotomy together with antrectomy
2%
 C
Use of selective vagotomy
6%
 D
Use of highly selective vagotomy
69%
 E
Mproved methods of conservative treatment.
In which organ are the most common cancer
metastases from the organs of the digestive system?
 A
Lungs
10%
 B
Adrenal glands
1%
 C
Bones
1%
 D
Brain
1%
 E
Liver
Indicate features characterizing Crohn’s disease: 1)
lesions can occur in any part of the digestive tract; 2)
lesions are limited only to mucosa and submucosa; 3)
there are perianal fistulas in the course of the disease;
4) surgical treatment of this disease is based on the
principle of conservative procedures; 5) extensive
resection procedures are indicated in the surgical
treatment of this disease. The correct answer is:
 A
1,2,4
6%
 B
 2,3,4
66%
 C
2,3,5
1%
 D
1,3,4
22%
 E
1,2,3,4.
Persistent vomiting can lead to:
 A
Hyperchloremia, hyperkalemia, metabolic alkalosis
2%
 B
Hypochloremia, hyperkalemia, metabolic alkalosis
9%
 C
Hypochloremia, hypokalemia, metabolic alkalosis
84%
 D
Hyperchloremia, hyperkalemia, metabolic acidosis
2%
 E
Hypochloremia, hyperkalemia, metabolic acidosis
Which of the following should be performed in a patient
who was referred to the surgical outpatient clinic
because of yellowish skin?
1) laboratory exams: bilirubin, alkaline phosphatase,
ALT, AST, GGT;
2) abdominal ultrasound;
3) hospitalization in order to perform endoscopic
retrograde cholangiopancreatography;
4) magnetic resonance cholangiopancreatography
(MRCP).
The correct answer is:
 A
1,2
77%
 B
1,3
3%
 C
1,4
1%
 D
 2,3
1%
 E
1,2,3
The Lauren classification concerns:
 A
Colon cancer
8%
 B
Stomach cancer
82%
 C
Pancreatic cancer
5%
 D
Liver cancer
2%
 E
Extensions of gastric inflammatory changes
Hemangioma of the liver:
 A
In the majority of patients, it is asymptomatic and is detected by chance during
imaging examinations
77%
 B
When it is detected it always requires surgical treatment due to possible
haemorrhagic complications
1%
 C
Most often it gives nonspecific postprandial pain symptoms located under the right
rib arch
2%
 D
Correct answers A, B
15%
 E
Correct answers B, C
Surgical treatment of asymptomatic cholelithiasis should
be considered in the case of:
1. a patient in an early age
2. diabetic
3. sick person before extensive cardiac surgery or
organ transplantation
4. when the peptic ulcer of the stomach or duodenum is
present
5. expressed wish by the patient
 A
 1, 2, 3, 4
8%
 B
1, 2, 3, 5
40%
 C
2, 3, 4
17%
 D
1, 3, 4, 5
12%
 E
1, 2, 3
The Mayo operation is performed to treat the following
hernia:
 A
Inguinal
11%
 B
Hiatal
12%
 C
Femoral
8%
 D
Obturator
4%
 E
Umbilical
The complication after removing the thyroid may be:
 A
Hyperthyroidism
4%
 B
Hearing impairment.
1%
 C
Hypersalivation
1%
 D
Facial nerve palsy.
2%
 E
Hypoparathyroidism.
The surgical treatment of inguinal hernias with the
Lichtenstein technique:
 A
Consists in laparoscopic inguinal canal plasty.
8%
 B
 Consists in inguinal canal plasty by placing sutures on the deep inguinal ring.
8%
 C
Consists in open inguinal canal plasty with the use of synthetic mesh.
81%
 D
Has been forbidden for many years.
1%
 E
Is not an existing method of surgical treatment.
Which of the following is the best option of surgical
palliative treatment in the case of a non-resectable
tumor of the head of the pancreas that causes
mechanical jaundice and 45 z 83 duodenal obstruction?
 A
Bypass anastomoses: gastric-intestinal, intestinal-intestinal and ductal- or
bladderintestinal.
88%
 B
Cholecystostomy.
2%
 C
Nutritional gastrostomy.
5%
 D
Ttempt of non-radical tumor resection.
4%
 E
Diagnostic laparotomy only
The signs of Jaworski, Rovsing and Blumberg are
typical signs of:
 A
Cholecystitis
5%
 B
Renal colic
1%
 C
Cecum cancer
0%
 D
Appendicitis
92%
 E
Colon perforation
Which of the following is the most successful method to
obtain hemostasis in the case of the bleeding from
esophageal varices which could not be stopped
 endoscopically or when urgent endoscopy is not
available?
 A
Total gastric resection
1%
 B
Infusion of antihemorrhagic agents and proton pump inhibitor
3%
 C
Sengstaken-Blakemore tube
92%
 D
Propranolol at a dose of 40 mg daily
1%
 E
Foley catheter introduced to the esophagus
Which of the following is necessary in uncomplicated
diverticulosis?
 A
Outpatient treatment with the use of a diet rich in fiber, rifaximin and antispasmodic
drugs.
79%
 B
Hospitalization which is absolutely necessary but it can go on in the internal
medicine ward, intravenous antibiotic therapy.
1%
 C
Urgent colonoscopy and making decision on the necessity and the type of
treatment on the basis of endoscopic examination results.
6%
 D
Outpatient treatment with the use of amoxicillin and metronidazol given orally.
9%
 E
Indispensable hospitalization in the surgical ward, intravenous antibiotic therapy and
observation because of the risk of diverticular perforation.
Indicate the true statement concerning the incidence of
hernias:
 A
The most common are indirect inguinal hernias; less common are direct inguinal
hernias, and the least frequent are femoral hernias; inguinal hernias occur more
frequently in females.
6%
 B
The most common are indirect inguinal hernias; less common are direct inguinal
hernias, and the least frequent are femoral hernias; inguinal hernias occur more
frequently in males.
78%
 C
 The most common are indirect inguinal hernias; less common are direct inguinal
hernias, and the least frequent are femoral hernias; inguinal hernias occur in
females and males with similar frequencies.
5%
 D
The most common are direct inguinal hernias; less common are indirect inguinal
hernias, and the least frequent are femoral hernias; inguinal hernias occur more
frequently in males.
10%
 E
The most common are femoral hernias; less common are direct inguinal hernias, and the least
frequent are indirect inguinal hernias; inguinal hernias occur more frequently in females.
The arc of Riolan is an arterioarterial anastomosis
between:
 A
Middle colic artery and the left colic artery.
53%
 B
Superior mesenteric artery and internal iliac arteries.
17%
 C
Left colic artery and the inferior mesenteric artery.
19%
 D
Inferior mesenteric artery and iliac arteries.
9%
 E
Iliac arteries and the right colic artery.
Thromboangiitis obliterans is also known as:
 A
Akayasu disease.
17%
 B
Riley and Smith syndrome.
1%
 C
Buerger syndrome.
79%
 D
Sturge-Weber syndrome.
2%
 E
Klippl-Trénaunay syndrome.
1
The most common hypothesis on the development of
varices refers their pathogenesis to:
 A
Weakened vein walls.
4%
 B
Venous valves dysfunction.
 5%
 C
Increased hydrostatic pressure in the venous system.
2%
 D
Use of anti-clotting agents.
1%
 E
A,B,C are true.
The characteristic symptoms of deep vein thrombosis
do not include:
 A
Mozes' sign
15%
 B
Ponten's sign
66%
 C
Homans' sign
9%
 D
Increased tension of the tissues beneath the crural fascia
7%
 E
Ain deep in the calf and the popliteal fossa occurring after a passive flexion of the foot
Ménétrier's disease belongs to precancerous condition
of:
 A
Stomach.
77%
 B
Duodenum.
4%
 C
Small intestine.
6%
 D
Large intestine.
4%
 E
Gallbladder.
ndicate the minimal BMI value recommended for the
qualification to surgical treatment of obesity in patients
without comorbidities:
 A
50.
2%
 B
45.
 5%
 C
40.
78%
 D
35.
11%
 E
30.
Early gastric cancer is defined as:
 A
Lesion limited only to the epithelium only.
5%
 B
Lesion limited only to the mucous membrane without metastases in the lymph
nodes.
13%
 C
Lesion limited only to the mucous membrane irrespective of the presence of
metastases in the lymph nodes.
9%
 D
Lesion limited to the mucous membrane and submucosa, regardless of the
presence of metastases in the lymph nodes.
59%
 E
Lesion limited to the mucous membrane and submucosa without the presence of metastases in
the lymph nodes.
Which of the following is an extraintestinal symptom of
Crohn disease?
 A
Optic neuritis.
8%
 B
Upus erythematous.
3%
 C
Pyoderma gangrenosum
49%
 D
Chronic venous insufficiency.
2%
 E
All the above.
Point out the real statement about Meckel's
diverticulum:
 A
Is a true diverticulum.
6%
 B
 Is the most common developmental defect of the gastrointestinal tract.
3%
 C
Consists of all layers of the intestinal wall.
7%
 D
In its structure may contain elements of the pancreatic tissue.
2%
 E
All of them.
Which of the following is the most common cause of
short bowel syndrome?
 A
Necrosis of the incarcerated intestine.
27%
 B
Volvulus.
9%
 C
Radiation exposure.
4%
 D
Intestinal atresia.
10%
 E
Mesenteric artery embolism.
Which of the following is the most common source of
metastases to the liver?
 A
Colon cancer.
92%
 B
Pancreatic cancer.
1%
 C
Gallbladder cancer.
1%
 D
Gastric cancer.
3%
 E
Lung cancer.
A 70-year-old patient comes to his family doctor
complaining of the recurrent bleeding from the lower
gastrointestinal tract. He usually has normal stools but
occasionally mucous diarrhea occurs. The patient
 suspects bleeding from the hemorrhoids. Indicate the
optimal diagnostics and treatment:
 A
Rectal examination and then referring the patient to colonoscopy in order to exclude
pathological lesions in the upper segments of the colon.
83%
 B
Rectal examination, calming the patient down because the symptoms are typical of
bleeding hemorrhoids, referral to a surgeon.
10%
 C
Referral to CT imaging, because it is the most precise examination to assess the
colon.
1%
 D
Rectal swab for parasite examination, because the symptoms may suggest
enterobiasis.
1%
 E
Referral to colonoscopy, as rectal examination may be omitted if the patient is to undergo
endoscopic examination.
Indicate the true statement concerning the keloid:
 A
It occurs at the place of intense healing of the wound, and it is a hard, elevated
reddish scar that develops at the place of the wound healing up to 6 months since
the injury and then gradually disappears over the years.
26%
 B
It develops at the place of the wound and involves also the surrounding normal
skin, it lasts longer than 6 months from the trauma; it most frequently affects the
wounds of the upper chest and shoulders.
67%
 C
It is a kind of tissue that appears at the place of the healing epidermis.
5%
 D
It is a tissue occurring at the bottom of the wound healing by secondary intention.
2%
 E
It is a traditional name of the inflammatory infiltration that occurs in the area of an infected
wound.
A 35-year-old patient came to the ED complaining of a
sever epigastric pain. The symptoms have lasted for
over a dozen hours. Laboratory tests showed increased
WBC, CRP and bilirubin concentration, decreased
calcium ion concentration, increased activity of
aminotransferases, amylase, lipase, LDH, GGTP and
 basic phosphatase. Abdominal ultrasound imaging
showed a distension of intrahepatic bile ducts and
blurred pancreatic outline. Indicate the correct
management of this patient:
 A
Suspicion of acute hepatitis and diagnostics directed at a viral infection.
4%
 B
Diagnosis of the perforation of a peptic ulcer and urgent laparotomy.
4%
 C
Diagnosis of acute pancreatitis related to cholelithiasis and the preparation of the
patient for ECPW.
88%
 D
Suspicion of an aortic rupture based on the blurred outline of the pancreas.
1%
 E
Presented data are too scarce to formulate the diagnosis.
A patient was admitted to the surgical ward with thermal
burns of second degree covering the anterior surface of
the chest and both upper limbs. Calculate the extent of
the burns according to the rule of nines and the volume
of fluids that should be given within 24 hours according
to Parkland formula:
 A
Burn surface amounts to 27% of the total body surface, the volume can’t be
calculated because the body weight is not given.
46%
 B
Burn surface amounts to 27% of the total body surface, the volume of fluids given
within first 24 hours should be 2700 mL.
5%
 C
Burn surface amounts to 36% of the total body surface, the volume can’t be
calculated because the body weight is not given.
41%
 D
Burn surface amounts to 36% of the total body surface, the volume of fluids given
within first 24 hours should be 3600 mL.
7%
 E
Burn surface amounts to 40% of the total body surface, but the Parkland formula does not refer
to the infused fluid volume.
In a patient with a head injury after a car accident, the
following are found:
 - anisocoria L>R
- opening the eyes only to a strong pain stimulus
- the patient makes incomprehensible sounds
- when establishing venous access, the patient
withdraws his hand
Indicate the GCS score and whether the patient
requires endotracheal intubation.
 A
GCS 9, the intubation is necessary
27%
 B
GCS 9, the intubation is not necessary.
14%
 C
CS 9, clinical data are not sufficient to determine indications for the intubation.
9%
 D
GCS 8, the intubation is not necessary.
10%
 E
GCS 8, the intubation is necessary.
McBurney's point is:
 A
Lace that marks the attachment of inguinal ligament to the pubic bone - the
orientation point important in hernia surgery
3%
 B
Place of the greatest pain occurring in acute cholecystitis
2%
 C
Place of the connection between the small and large intestines
1%
 D
Place at 1/3 of the distance between the anterior superior iliac spine and the
umbilicus, that corresponds to the most common location of the base of the
appendix.
94%
 E
Place where the celiac trunk branches from the abdominal aorta
A Colles’ fracture is a fracture of:
 A
Femoral neck.
4%
 B
Distal epiphysis of the ulna.
8%
 C
 First metacarpal bone.
1%
 D
Distal epiphysis of the radius in the typical location.
84%
 E
Humerus of the epicondylar type.
A 45-year-old patient, a smoker abusing alcohol, has
been admitted to the ED with severe abdominal pain.
On admission the patient presents pale, wet skin, and
complains of unbearable abdominal pain that intensifies
while he moves. On examination the abdominal
guarding and absent bowel sounds are noted. The
patient reports that the pain started acutely in the
epigastric region and then extended to the whole
abdomen. Which of the following examinations should
be performed in the first place?
 A
Abdominal ultrasound.
23%
 B
Chest X-ray and a plain frontal radiograph of the abdomen in erect posture.
63%
 C
Bdominal CT.
10%
 D
Gastroscopy.
3%
 E
None of the above.
Which of the following is an indication for the surgical
treatment of the abdominal aortic aneurysm?
 A
Diameter of the asymptomatic aneurysm exceeding 5,5 cm.
4%
 B
Diameter of the symptomatic aneurysm exceeding 2 cm.
1%
 C
Ruptured aneurysm.
1%
 D
A,C are true.
23%
 E
 A,B,C are true.
The second most common thyroid cancer is:
 A
Papillary.
12%
 B
Anaplastic.
1%
 C
Follicular.
81%
 D
Medullary.
5%
 E
Multicellular.
Carcinoid is an epithelial tumor derived from cells of the
neuroendocrine system and is most commonly located
in:
 A
Digestive tract.
75%
 B
Pancreas.
10%
 C
Thyroid.
4%
 D
Gall bladder.
2%
 E
Adrenal glands.
Which of the following is not a possible consequence of
a severe injury?
 A
Hypothermia.
7%
 B
Hypovolemic shock.
1%
 C
Coagulopathy.
9%
 D
Acute respiratory failure.
3%
 E
Alkalosis.
 Indicate a false statement about erysipelas:
 A
Is a superficial infection of the skin and connective tissue caused by streptococci.
42%
 B
Is characterized by a lack of a distinct skin injury - the infection may enter the skin
even through a minor scratch.
8%
 C
It may be complicated by the involvement of deeper tissues (a phlegmon, necrosis
of the skin and subcutaneous tissue) and sepsis.
4%
 D
Recurrent erysipelas of lower limbs may lead to skin hardening and permanent
edema of the limb.
5%
 E
There are no general symptoms of the infection.
Colorectal cancer is most commonly located in:
 A
Cecum.
4%
 B
Ascending colon.
1%
 C
Transverse colon.
1%
 D
Descending colon.
1%
 E
Sigmoid colon and rectum.
Linitis plastica denotes:
 A
Cancer extensively infiltrating the stomach wall, giving early metastases to the
lymph nodes.
77%
 B
Colon cancer, which causes obstruction of the lower gastrointestinal tract.
3%
 C
Oesophageal cancer, in the course of which the esophagus has the form of a hard,
stiff tube.
16%
 D
Advanced, unresectable pancreatic cancer.
2%
 E
Rare, primary liver cancer.
 Which of the following ranks among tension-free
surgical techniques used in inguinal hernia:
 A
Halstead procedure.
3%
 B
Lichtenstein procedure.
84%
 C
Shouldice procedure.
2%
 D
Bassini’s procedure.
3%
 E
Girard procedure.
A patient weighing 100 kg was admitted to the surgical
ward because of the 3rd degree thermal burns of the
anterior chest wall, abdomen and scrotum. Calculate
the percentage of the burned body surface according to
the rule of nines and the volume of fluids that should be
transfused in the first 24h according to the Parkland
formula:
 A
Burned body surface is 19% and the volume of fluids to be transfused within the first 24h is
7600 mL.
83%
 B
Burned body surface is 19% and the volume of fluids to be transfused within the first 24h is 760
mL.
9%
 C
Burned body surface is 10% and the volume of fluids to be transfused within the first 24h is
4000 mL.
7%
 D
Burned body surface is 10% and the volume of fluids to be transfused within the first 24h is 400
mL.
1%
 E
Burned body surface is 10% and the Parkland formula should not be used in patients with
burns of the 3rd degree.
1%
In the case of acute abdominal symptoms in a cachectic
patient in a serious condition - large intestine perforation
due to diverticulitis of the sigmoid colon - the operation
of choice is:
 A
 Sigmoid resection with end-to-side anastomosis
5%
 B
Hartmann’s procedure of the resection of the sigmoid colon.
53%
 C
Percutaneous drainage of the abdominal cavity
2%
 D
Sigmoid resection with end-to-end anastomosis.
8%
 E
Abdominoperineal resection of the rectum.
Which of the following organs is the most common site
of metastases from other organs?
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
Brain
4%
 B
Lungs
50%
 C
Liver
40%
 D
Bones
4%
 E
Skin
This question has been removed by CEM.
Hematogenic metastases are most often located in the liver. Metastasis
occurs mainly through the portal vein. However, the most common site for
metastases from other organs are the lungs. The liver is the second most
common location.
Metastases in the liver are most often caused by colorectal, gastric, pancreatic,
or lung cancer. They can appear at the same time as the primary tumor, or later
in time.
Primary tumors occur much less frequently in the liver in comparison to
metastases of other origin.
Symptoms are usually caused by the primary tumor. However, there may be
nonspecific symptoms, such as unintentional weight loss and pain in the right
upper quadrant.
Liver metastases usually show elevated levels of CEA (carcinoembryonic antigen).
Remember, the concentration of tumor markers is used to monitor
the progression of the disease! Imaging tests should be performed: CT is
particularly useful in diagnostics.
Surgical treatment consists of:
 segmentectomy,
 lobectomy, or
 enucleation of the tumor
 Surgery is only performed in cases with no more than 4 sites of metastases and
diameters <5 cm.
Widely disseminated metastases to other organs, and invasion of the liver
vasculature are contraindications to surgery.

Source:
Chirurgia. Repetytorium, red. Wojciech Noszczyk, s 337-339

Kwashiorkor is a form of malnutrition caused by a lack

of:
 A
Saturated fats
2%
 B
Unsaturated fats
1%
 C
Carbohydrates
4%
 D
Proteins
92%
 E
Water
Typical clinical features of Buerger's disease do not
include:
 A
Onset of illness above 50 years of age
71%
 B
Heavy smoking
3%
 C
Occurrence of changes in all extremities
14%
 D
Presence of typical changes in angiographic examination
5%
 E
Migrating thrombophlebitis
The type IV of Takayasu disease is characterized by
inflammatory lesions located in:
 A
Arch of the aorta and its branches.
13%
 B
Whole aorta and its branches.
14%
 C
 Descending aorta and its branches.
7%
 D
Abdominal aorta and its branches.
44%
 E
Pulmonary artery.
A 57-year-old man was admitted to the hospital with
symptoms of acute pancreatitis. He has never been
diagnosed with cholecystolithiasis, but he did abuse
alcohol the nigh before. On admission Hct 46%, WBC
16,300/mm , glucose 189 mg/dL, LDH 279 U/L, AST
193 U/L, serum Ca2+ 1.95 mtmo/L, urea 1.50 mmol/L,
PaO2 67 mmHg. On the third day at the hospital: Hct
40%, WBC 13,500/mm , glucose 163 mg/dL, LDH 183
U/L, AST 170 U/L, serum Ca2+ 1.85 mmol/L, urea 1.73
mmol/L, PaO2 57 mmHg. According to the Ranson
criteria in this patient:
 A
Severe pancreatitis is unlikely on admission and on the third day of hospitalization.
8%
 B
Severe pancreatitis is unlikely on admission but it is probable on the third day of
hospitalization.
8%
 C
Severe pancreatitis is probable on admission and on the third day of hospitalization.
12%
 D
Severe pancreatitis is probable on admission but it is unlikely on the third day of
hospitalization.
13%
 E
Provided data are not sufficient to assess the risk of severe pancreatitis.
Indicate the true statement concerning gastric cancer:
 A
Females are affected twice as often as males.
3%
 B
Intestinal metaplasia does not increase the risk of the disease.
1%
 C
Early gastric cancer does not spread to lymph nodes according to its definition.
12%
 D
Treatment is mostly confined to chemo- and radiotherapy.
 9%
 E
Helicobacter pylori infection 5-fold increases the risk of the disease.
Which of the following is not the name for inguinal
hernia repair operation technique?
 A
Bassini
5%
 B
Halsted
3%
 C
Littre
76%
 D
Rutkow
7%
 E
Shouldice
A 25-year-old woman found a lump of 2 cm x 1 cm in
size in the upper lateral quadrant while self-examining
her right breast. The biopsy result was ductal
carcinoma. Considering the lymphatic drainage through
the Roth path, the lymph node metastases may be
expected in:
 A
First level of axillary lymph nodes.
29%
 B
Second level of axillary lymph nodes.
9%
 C
Third level of axillary lymph nodes.
6%
 D
First and second level of axillary lymph nodes.
18%
 E
Second and third level of axillary lymph nodes.
38
A female patient was urgently operated due
hemorrhage of parenchymal disruption in the liver and
the Pringle maneuver was performed during this
procedure. It involves compressing:
1) splenic artery
2) proper hepatic artery
 3) right gastric artery
4) splenic vein
5) proper hepatic vein
6) portal vein
7)common bile duct
The correct answer is:
 A
1, 2, 3
6%
 B
1, 4
3%
 C
2, 5, 6, 7
13%
 D
2, 5, 7
15%
 E
2, 6, 7
Indicate the false statement concerning diverticulosis of
the gastrointestinal tract:
 A
Meckel’s diverticulum is the remnant of the fetal umbilical gastrointestinal duct and
may contain ectopic foci of gastric or pancreatic tissue.
10%
 B
Acquired diverticula are created by bulging the mucus membrane through the
muscular layer of the intestine.
6%
 C
Meckel’s diverticulum is a congenital and true diverticulum of the ileum located on
the mesenteric edge of the intestine and its length can measure up to 15 cm.
64%
 D
Colon diverticula appear usually in the 4th decade of life, they are often localized in
the sigmoid colon and do not occur in the rectum.
16%
 E
Complications of diverticular disease include inflammation, abscess, perforation, bleeding and
mechanical obstruction.
Which of the following signs is not typical of acute
appendicitis?
 A
Dunphy’s sign.
16%
 B
 Blumberg sign
3%
 C
Psoas sign.
7%
 D
Ack of appetite.
3%
 E
Cullen’s sign
Indicate the false statement concerning acute
cholecystitis:
 A
It’s usually related to cholelithiasis.
4%
 B
Examination of choice is computed tomography.
76%
 C
Differential diagnostics should include right-side pneumonia and pleurisy among
others.
7%
 D
Its complications include an empyema of the gallbladder and emphysematous
cholecystitis.
2%
 E
Acute acalculous cholecystitis may be caused by several infectious agents including
Cytomegalovirus, Pneumocystis jiroveci and Isospora belli.
Secondary peritonitis does not include:
 A
Peritonitis related to chronic peritoneal dialysis.
6%
 B
Necrosis of the intestinal wall.
10%
 C
Peritonitis related to the leakage of an intestinal anastomosis.
9%
 D
Granulomatous peritonitis.
60%
 E
Fungal peritonitis.
The absolute indications for the surgical treatment of
acute pancreatitis do not include:
 A
Lack of improvement after conservative treatment.
72%
 B
 Infected pancreatic necrosis.
6%
 C
Bleeding to the abdominal cavity.
3%
 D
Gastrointestinal perforation.
3%
 E
Abdominal compartment syndrome.
Which of the following is the most common cause of
upper gastrointestinal bleeding?
 A
Hemorrhagic gastritis.
3%
 B
Esophagitis.
2%
 C
Peptic ulcer.
87%
 D
Gastric cancer.
2%
 E
Mallory-Weiss syndrome.
The abdominal compartment syndrome does not lead to
the decrease in:
 A
Intracranial pressure.
84%
 B
Blood flow into the liver and its ischemia.
1%
 C
Venous return to the heart.
5%
 D
Blood flow through the intestinal wall.
2%
 E
Tidal volume.
Identify the true statement about colorectal cancer:
 A
Its diagnosis is based on endoscopic biopsy followed by histopathological
examination.
6%
 B
It rarely spreads to the liver and is the most common cause of a bowel obstruction
1%
 C
It usually develops from polyp lesions.
2%
 D
A and C are true
83%
 E
A,B,C are true.
The antithrombotic prophylaxis does not involve:
 A
Use of low molecular weight heparin.
2%
 B
Early mobilization of the patient.
1%
 C
Use of compression stockings.
1%
 D
Administration of acetylsalicylic acid.
5%
 E
Limitation of fluid supply.
Percutaneous endoscopic gastrostomy (PEG) is not
performed in:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
A pyloric tumor obstructing the lumen of the gastrointestinal tract
42%
 B
An esophageal tumor obstructing the lumen of the digestive tract
23%
 C
A tumor at the cardia obstructing the gastrointestinal tract lumen
8%
 D
A laryngeal tumor obstructing the lumen of the gastrointestinal tract cancer
8%
 E
PEG can be performed in each of these situations
This question appeared already several times on LEK.
PEG is indicated in patients needing long-term enteral feeding.
To perform the percutaneous endoscopic gastrostomy, pass first the gastroscope
into the stomach and fill it with air. Then insert the needle with a guide through
the abdominal wall and attach the gastrostomy feeding tube to the guidewire. Pull
the gastroscope with the wire up along the esophagus.
Contraindications for PEG are:
 Ascites
 Patients after gastrectomy
 Unhealed abdominal wounds
  Coagulopathies
 And obstruction inside the esophagus -since it may prevent the gastroscope
from entering the stomach.
However, a pyloric tumor obstructing the lumen of the gastrointestinal tract is not
a contraindication against the percutaneous endoscopic gastrostomy, but in this
case, its placement is unreasonable and baseless, since the food introduced via
gastrostomy does not penetrate further into the gastrointestinal tract
remains stuck at the junction between stomach and duodenum.
This question is, unfortunately, inadequately und misleadingly formulated.
Source:
Chirurgia. Repetytorium. red. Wojciech Noszczyk, s 124

Indicate the false statement regarding the Whipple triad:

 A
Neurological disturbances due to fasting
7%
 B
The patient is usually anorexic
75%
 C
Hypoglycemia below 2.22 mmol/l (40 mg/dl) occurs
4%
 D
Symptoms subside after intravenous glucose administration.
6%
 E
It is related to a pancreatic neuroendocrine tumor.
Which of the following is the rarest reason for
mechanical gastrointestinal obstruction:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
A strangulated hernia
7%
 B
Presence of adhesions
5%
 C
A malignant tumor
13%
 D
A gallstone
33%
 E
Peritonitis
This question has been removed by CEM.
Four of these answers cause mechanical obstruction, while peritonitis may be
caused due to paralytic obstruction. - Answer E is correct.
Intestinal obstruction occurs after interruption of normal passage of bowel
contents controlled by peristaltic movements. There are several classifications of
bowel obstruction, the most common one is distinguished by etiology of
 obstruction:
 Mechanical obstruction: interruption due to a structural barrier
 Functional obstruction: impaired peristalsis in the absence of mechanical
obstruction
Mechanical intestinal obstruction usually affects the small intestine.
The most common causes of mechanical obstruction are postoperative
adhesions, followed by hernial strangulation and, more rarely, colorectal
carcinoma, while tumor is the most common cause of colorectal
obstruction. Choice D - gallstones account for only about 4 percent of mechanical
bowel obstruction, in this case, big gallstones enter the lumen of the
gastrointestinal tract by eroding the gallbladder wall into duodenum forming a
fistula.
One of the causes of paralytic ileus may be peritonitis. The main symptoms,
differentiating it from mechanical obstruction, are constant, diffuse abdominal
pain and absent sounds.
Symptoms:
 colicky abdominal pain - one of the first symptoms
 vomiting
 gas retention
 abdominal distention
Diagnostics:
 Patient history including previous surgeries and interventions
 Rectal examination
 Abdominal X-ray: characteristic multiple air-fluid levels

Source:
Chirurgia. Repetytorium. red. Wojciech Noszczyk s. 438 - 444

Classic signs and symptoms of acute cholangitis that

form the Charcot’s triad include:
 A
Chelmonski’s sign, Bloomberg’s sign, jaundice.
3%
 B
Epigastric pain, nausea and vomiting without relief, fever
5%
 C
Pain in the upper right quadrant of the abdomen, jaundice and fever with chills
82%
 D
Upper right abdominal pain, signs of shock, jaundice
3%
 E
Epigastric pain, nausea and vomiting without relief, jaundice
Mallory-Weiss syndrome means:
 A
Spastic esophageal spasm.
10%
 B
Hepatic vein thrombosis
2%
 C
 Irritable bowel syndrome
1%
 D
Haemorrhage from the ruptured mucosa in the area of the cardia.
85%
 E
Thrombocythemia after splenectomy
Complete or partial removal of the spleen (splenectomy)
is recommended for:
1) splenic artery aneurysm
2) traumatic isolated splenic rupture in a 25-year-old
patient who required 2 transfusion units of red blood cell
concentrate
3) spontaneous splenic rupture as a complication of
hematological disease
4) Gaucher disease
5) Felty's syndrome
The correct answer is:
 The question doesn’t have correct answer or was annulled. In the tab
„explanation” you can read more about this.
 A
1, 2, 3
29%
 B
1, 3, 4
10%
 C
1, 4, 5
8%
 D
2, 3, 4
25%
 E
3, 4, 5
The question has been canceled by CEM.
Indications for splenectomy are mentioned in choice E.
 Spontaneous rupture of the spleen as a consequence of hematological
disease - most often due to leukemia or lymphoma
 Gaucher's disease - is a lysosomal storage disease in which, among
other symptoms, the liver and spleen become enlarged.
 Felty syndrome - The spleen is removed due to hypersplenism. Felty's
syndrome includes the triad: leukopenia, rheumatoid
arthritis, and splenomegaly.
 Other indications for splenectomy include:
o Hereditary spherocytosis
o Primary spleen tumor
o Spleen abscess
 o Parasitic cyst
o Malignant neoplasms of organs adjacent to the spleen
o Spleen pedicle torsion at risk to develop necrosis
o Splenic vein thrombosis
 And eventually in the following cases:
o Splenic trauma
o Primary hypersplenism
o Chronic essential thrombocytopenia
o Aneurysm splenic artery - only treated with a diameter of more than
2.5 cm - Item 1 - FALSE.
Splenectomy should be postponed in children until the age of 4
years (unless there are any absolute indications for surgery).
Traumatic splenic rupture is as well an indication for surgery. Usually, the spleen is
completely removed, but in some cases, like in Item 2, it may be enough to suture
the rupture or use a tissue glue controlling the hemorrhage in the spleen. - Item 2
- FALSE.
Patients scheduled for elective splenectomy must be carefully managed before the
procedure including correcting coagulation disorders and anemia as well as
preventive measures for possible infections.
The spleen is an organ, that participates amongst other things, in the production
of lymphatic and monocytic cells, storage of erythrocytes, and phagocytosis of
foreign and used blood elements. However, it is not vital. After its removal, its
functions are taken over by other lymphatic organs, as well as the liver and bone
marrow. Removing the spleen does not cause serious side effects, yet, we can
observe increased susceptibility to infection.

Source:
Chirurgia. red. Wojciech Noszczyk, s. 923-926

In the classification of macroscopic advanced gastric

cancer according to Bormann, Type I is defined as:
 A
A polypoid ulcerated tumor
59%
 B
An ulcerated tumor with raised margins
12%
 C
A tumor with ulceration, whose margins are hardly visible
11%
 D
Diffuse cancer (linitis plastica)
9%
 E
Bormann classification concerns early gastric cancer
A 54-year-old woman came to the ER because of
bloody stool. On physical examination: good verbal
communication, apathy, tachycardia 120/min, blood
pressure 90/60 mmHg, pale skin, abdominal walls at the
level of costal margins, the abdomen soft on palpation
 with no peritoneal signs, hyperactive bowel sounds,
fresh blood visible on per rectum examination. On lab
tests: WBC 17 000/mm , RBC 2.9x10 /mm , HGB 8.7
g/dL, PLT 60x10 /mm , APTT 40 s, INR 1.9. Additionally
there is hepatitis B infection several years earlier in the
medical history. Indicate the true statements:
1) the first step should be fluids infusion and blood
transfusion in order to manage hypovolemic shock;
2) colonoscopy should be performed because the most
probable place of the bleeding is located in the lower
gastrointestinal tract;
3) blood tests should be repeated in short time to
confirm active bleeding;
4) urgent gastroscopy is indicated;
5) gastric tube should be placed in the stomach to
evaluate its contents which would allow formulation of
the correct diagnosis and proper treatment.
The correct answer is:
 A
1,2,3.
57%
 B
2,3,5.
6%
 C
1,4.
10%
 D
All the above.
14%
 E
Only 4.
13%
Which of the following may be a cause of ileus?
 A
Diabetes.
2%
 B
Porphyria.
2%
 C
Biliary colic.
4%
 D
 Renal colic.
1%
 E
Each of the above.
Type I in the Bismuth classification of the bile duct injury
denotes an injury of:
 A
Common hepatic duct < 2 cm from the hepatic duct confluence.
28%
 B
Common hepatic duct > 2 cm from the hepatic duct confluence.
57%
 C
Common bile duct only.
9%
 D
Right or left hepatic duct.
4%
 E
At the level of the hepatic duct confluence.
The patient in discharge papers has the annotation:
"Condition after Hartmann surgery". It means that:
 A
He underwent total colectomy with the creation of the intestinal reservoir (pouch)
and protective ileostomy.
27%
 B
He has temporary, end-colostomy.
53%
 C
He has temporary, end-ileostomy.
8%
 D
Fhe has permanent, end-colostomy.
7%
 E
He underwent a submucosal resection of haemorrhoids.
Ointments containing nitroglycerine are used in
proctology. In which of the following diseases?
 A
Anal fistula.
13%
 B
Perianal abscess.
4%
 C
Haemorrhoidal disease.
31%
 D
 Pilonidal disease.
6%
 E
Anal fissure.
A young man came to the clinic. He noticed a periodic
leaking of purulent content in the upper part of the
gluteal cleft. There is a periodic pain in that area. The
examination reveals several openings in the skin in the
area, without any leakage. The most probably diagnosis
is:
 A
Perianal fistula.
14%
 B
Perianal abscess (in the phase without inflammation).
29%
 C
Anal fissure.
5%
 D
Cutaneous form of ulcerative colitis.
3%
 E
Pilonidal cyst.
The patient in poor general condition was transported to
the hospital admission room. He reports a retrosternal
pain and high fever. On the physical examination the
crackling of the skin was palpable around the neck. The
patient had been diagnosed with advanced
oesophageal cancer. The chest CT showed the
presence of air in the mediastinum, contrast leakage in
the thoracic section of the esophagus and fluid effusion
in the right pleural cavity. Indicate the optimal surgical
procedures in this case:
 A
A gastric probe, a ban on oral nutrition, antibiotic therapy.
4%
 B
Stitching the oesophagus with an access via right-sided thoracotomy.
4%
 C
Exclusion of the oesophagus through the emergence of oesophagostomy on the
neck, mediastinal drainage, occlusion of the gastric gullet, further nutrition by
nutritional gastrostomy.
 25%
 D
Oesophageal resection with gastroesophageal anastomosis in the cage chest.
21%
 E
Implantation of a self-expanding stent with optional drainage of the right pleural cavity.
A patient complains of a dull, disturbing, diffuse, deep
abdominal pain, which precise location he is unable to
determine, but the pain is the strongest at the midline.
The patient reports the pain resembles a pain that was
accompanying the first symptoms of acute appendicitis
20 years ago. Such a pain is called:
 A
Phantom pain.
7%
 B
Cluster pain.
24%
 C
Somatic pain
9%
 D
Neuralgic pain.
3%
 E
Visceral pain.
Palpable pulse can be detected on all arteries listed
below, except for:
 A
Ulnar artery
6%
 B
Iliac artery
81%
 C
Posterior tibial artery
3%
 D
Dorsal artery of the foot
0%
 E
Pulse can be tested on all the above arteries
A Richter’s hernia is defined as:
 A
Every linea alba hernia.
10%
 B
Every inguinal hernia in a woman.
 6%
 C
Hernia that contains the Meckel’s diverticulum.
11%
 D
A hernia that contains the antimesenteric wall of the intestine.
48%
 E
Hiatal hernia.
This disease usually affects young smoking men. It
manifests itself with pain in the feet and toes,
aggravating while moving. Superficial thrombophlebitis
may co-occur. Arteriography shows occlusions and
stenosis of small caliber arteries. Limb necrosis may
occur in the course of the disease. The disease is not
related to atherosclerosis. The above is a description of:
 A
Raynaud’s disease
6%
 B
Buerger’s disease.
63%
 C
Juvenile arthritis
1%
 D
Leriche syndrome.
28%
 E
Horton’s disease.
In the case of a pancreatic cyst, the surgery should be
considered:
1) if it is a pseudocyst;
2) when a cyst connection to the duct of Wirsung has
been visualized in MRI (magnetic resonance imaging)
and endoscopic retrograde cholangiopancreatography
(ERCP);
3) if there are complications (infection, bleeding);
4) when the diameter of the cyst is greater than 6 cm.
The correct answer is:
 A
Only 1.
3%
 B
1,3.
8%
 C
3,4.
55%
 D
Only 4.
2%
 E
1,2,4.
Indicate the true statement regarding the Kehr's drain:
 A
Hyroid surgery.
5%
 B
Bariatric surgery.
6%
 C
Thoracic surgery.
29%
 D
Biliary surgery.
58%
 E
Neurosurgery
Courvoisier's sign is:
 A
Painful pathological resistance over the right iliac plate
3%
 B
Palpable, painless, enlarged gallbladder
89%
 C
Small intestine looping visible through the coating
4%
 D
Enlarged palpable liver
2%
 E
Liver and spleen enlargement
Which three of the listed elements constitute the so-
called Virchov's triad (factors affecting blood clotting)?
1) slowed-down blood flow;
2) changes in blood composition (e.g., elevated
hematocrit);
3) damage to the vessel wall (i.e. endothelium);
4) increase in the blood pressure;
 5) increase in serum potassium level.
 A
1,2,3
84%
 B
3,4,5
2%
 C
2,3,4
8%
 D
1,3,5
3%
 E
2,4,5
A 56-year-old patient was subjected to total
thyroidectomy because of Grave’s disease. Immediately
after the removal of the tracheal tube the symptoms of
acute respiratory failure occurred including stridor and
dyspnea. The most probable reason for such symptoms
is:
 A
Injury of the trachea during the intubation.
11%
 B
Bilateral vocal fold paralysis with narrow glottis gap.
51%
 C
Ilateral vocal fold paralysis with wide glottis gap.
25%
 D
Postoperative bleeding at the site of the excised gland.
8%
 E
Overdose of general anesthetics.
During the surgery of the metastatic tumor of the liver,
the surgeon performed, as he explained to the students,
the Pringle maneuver. It consists in:
 A
Temporal pressure of the inferior vena cava
27%
 B
Introducing Kehr's drain into the right hepatic duct.
2%
 C
Breaking with the fingers the liver parenchyma to visualize the blood vessels and
bile ducts, which facilitates their ligation.
 8%
 D
Cutting off all the ligaments fixing the liver to ensure a free access to the rear
hepatic segments.
6%
 E
Czasowym zaciśnięciu więzadła wątrobowo-dwunastniczego w celu ograniczenia napływu krwi
do wątroby (temporal 'clamping' of the hepatic duodenal ligament to limit the inflow of blood to
the liver. Clamping is the word used in CEM database which is the right way to describe this
procedure, rather than tightening.)
The treatment of tracheo-esophageal fistulas, which are
a pathological connection between tracheal and
esophageal lumena through an epithelium-covered
canal, is very difficult and marked by numerous failures.
Indicate the methods used for the treatment of tracheo-
esophageal fistulas:
1) placing a tube into the stomach or intestine and
conducting enteral nutrition;
2) placing a permanent self-expanding esophageal
stent;
3) placing a temporary self-expanding stent in the
trachea and esophagus;
4) attempts to close the fistula canal by means of
repetitive ablation, biological glues and obliteration;
5) excision of the fistula with a segmental resection of
the trachea and a primary esophageal sewage
strengthened with a pedunculated tissue flap taken from
the neighbourhood.
The correct answer is:
 A
1,3,5.
14%
 B
1,4,5.
27%
 C
2,3,4.
12%
 D
2,4,5.
38%
 E
3,4,5.
 Damage to the middle meningeal artery causes:
 A
Subdural hematoma
8%
 B
Epidural hematoma
84%
 C
Intracerebral hematoma
3%
 D
A+B
3%
 E
All the above
In TNM classification of colon cancer the T4 denotes
the infiltration of:
 A
Mucous membrane.
2%
 B
Submucous membrane.
4%
 C
Muscle membrane.
6%
 D
Serous membrane.
9%
 E
Surrounding organs.
Indicate the true statement regarding mutations in the
BRCA1 and BRCA2 genes:
 A
In the Polish population the BRCA2 gene mutation is more common than the
BRCA1 gene mutation
16%
 B
BRCA1 gene mutation predisposes to breast cancer with the same frequency as
BRCA2
15%
 C
A BRCA1 gene mutation predisposes to ovarian cancer more than a BRCA2 gene
mutation
57%
 D
Hereditary breast cancer syndrome does not increase the risk of ovarian cancer
4%
 E
Long-term use of hormonal contraceptives increases the risk of ovarian cancer
 Mark the incorrect statement about erysipelas:
 A
There are no general symptoms
83%
 B
Infection site may be a small invisible wound
4%
 C
Can lead to complications within deeper tissues (e.g. phlegmon)
4%
 D
Streptococci are the etiological factor
6%
 E
Is an infection of the skin and subcutaneous tissue
A 35-year-old motorcyclist was admitted to the
Emergency Department after a traffic accident. The
patient is unconscious. The examination revealed: rigid
abdomen, HR 140 / min, BP 60/40 mmHg, GCS 3, no
auscultation noise above the left pleural cavity. At
FAST, fluid in the peritoneal cavity. In blood gas, the
estimated Hb concentration is about 6.5 g / dL. What
should be the order of the proceedings?
 A
Whole body CT scan - laparotomy - drainage of the left pleural cavity.
17%
 B
Chest X-ray - drainage of the left pleural cavity - laparotomy.
5%
 C
Drainage of the left pleural cavity - laparotomy - CT of the whole body after
stabilization general.
40%
 D
ICU admission - massive blood transfusion - stabilized laparotomy general.
32%
 E
Laparotomy - drainage of the left pleural cavity - CT of the whole body after stabilization
general.
What is the most common parenteral cause of
mechanical obstruction of the small intestine in adults in
developed countries?
 A
Adhesions.
89%
 B
 Cancer of the small intestine.
3%
 C
Trichobezoar.
1%
 D
Intussusception.
4%
 E
Parasitic infestation.
A 36-year-old woman was admitted to the Emergency
Department (ED) after a car accident with symptoms of
hemorrhagic shock. The ultrasound examination in
FAST algorithm showed significant amount of free fluid
in the peritoneal cavity. Blood pressure: undetectable,
HR: 134 beats/min. At the ED four units of 0 Rh minus
(-) red blood concentrate were transfused. Urgent
laparotomy was performed. During the surgery another
four units of red blood concentrate and four units of
fresh frozen plasma were transfused. Which
complications can occur as a result of these
procedures?
1) thrombocytopenia;
2) coagulopathy;
3) hypocalcemia;
4) hypercalcemia;
5) hypokalemia;
6) hyperkalemia;
7) hypothermia.
The correct answer is:
 A
1,2,4,5,6,7.
14%
 B
1,2,3,5,6,7.
60%
 C
1,2,3,4,6,7.
13%
 D
1,2,3,4,5,7.
5%
  E
2,3,4,5,6,7.
The most common nosocomial infection in the surgical
department is:
 A
Surgical site infection
18%
 B
Catheter-related urinary tract infection
69%
 C
Infection at the site of the central vascular catheter
4%
 D
Infection at the peripheral vascular catheter site
7%
 E
Infection related to mechanical ventilation
A 24-year-old patient diagnosed with lasting for three
years ulcerative colitis reports persistent itching, chronic
fatigue, weakness. The most likely cause of the
reported complaints is:
 A
Inflammation of the gallbladder.
3%
 B
Chronic pancreatitis.
2%
 C
Primary sclerosing cholangitis.
87%
 D
Colon cancer.
5%
 E
Gastrointestinal stromal tumor.
Ulcerative colitis is treated surgically. The gold standard
in elective treatment is:
 A
Hartmann’s colectomy.
12%
 B
Colectomy with ileorectal anastomosis.
13%
 C
Restorative proctocolectomy.
35%
 D
 Restorative proctocolectomy with loop ileostomy.
30%
 E
Segmental colon resection.
The characteristic features of Crohn's disease are:
1. involvement of the mucosa and submucosa
2. changes may appear in any part of the digestive tract
3. perianal fistulas
4. use of conservatory surgeries
5. extensive intestinal resections are used
 A
2,3
7%
 B
2,3,4
71%
 C
1,2,3
14%
 D
2,3,5
6%
 E
Only 2
A 64-year-old patient with symptoms of an acute
abdomen (severe pain in the area of the left iliac fossa)
goes to the emergency room. On admission, the
general condition was average, the patient was
emaciated, has a history of the condition following
perforation of the sigmoid diverticulum. What kind of
surgery will be the most appropriate?
 A
Hartmann's operation
76%
 B
Proctocolectomy
1%
 C
Resection of the sigmoid colon with restoration of the continuity of the digestive
tract
15%
 D
Conservative treatment, antibiotic therapy
7%
 E
Percutaneous drainage
 Which of the following is not considered in the
differentiation of acute appendicitis?
 A
Left-sided nephrolithiasis.
78%
 B
Mesenteric lymphadenitis.
4%
 C
Meckel diverticulitis.
4%
 D
Ruptured ectopic pregnancy.
5%
 E
Crohn’s disease.
Indicate the most common direct cause of acute
peritonitis:
 A
Strangulation of the small intestine.
3%
 B
Intussusception of the small intestine into the large intestine.
5%
 C
Perforation of the gastrointestinal tract.
85%
 D
Sepsis.
4%
 E
Large intestine obstruction.
Indicate risk factors for pulmonary embolism:
1. age
2. obesity
3. pregnancy
4. active neoplastic process
5. varicose veins of the lower extremities
6. lower limb and pelvic surgery
7. surgery on the upper limb
8. vitamin K deficiency
 A
1,2,3,4
5%
 B
2,3,4,5,8
 2%
 C
2,3,4,5,7,8
4%
 D
1,2,3,4,5,6
68%
 E
All of the above
22%
Hunter's arch is the connection of: (we couldn't find a
proper translation for this in English. In Polish the term
is "łuk Huntera", it's an anatomical eponym. Do NOT
confuse with Bow Hunters Syndrome)
 A
The internal iliac artery and the inferior mesenteric artery
58%
 B
The internal iliac artery and the superior mesenteric artery
19%
 C
Left colic artery with right colic artery
13%
 D
Left colic artery with internal iliac artery
8%
 E
Upper mesenteric artery with left colic artery
Indicate the false statement concerning hemorrhoids:
 A
Common causes of hemorrhoids are constipation as well as excessive pressure
when passing stools.
2%
 B
Very often hemorrhoids appear during pregnancy, probably due to hormones
affecting the loosening of connecting tissue, constipation and baby head pressure
on the pelvic soft tissues.
3%
 C
Hemorrhoids may prolapse during defecation, but they spontaneously return to the
anal canal - this is the example of the third stage of hemorrhoidal disease.
71%
 D
The main hemorrhoid symptoms are bleeding and prolapse, acute complications
that require surgical treatment are thrombosis or hemorrhage.
3%
 E
All the statements are true.
The causes of hyperamylasemia include:
1) acute pancreatitis;
 2) peptic ulcer perforation;
3) distal radius fracture;
4) ectopic pregnancy miscarriage;
5) renal failure;
6) cystitis;
7) acute appendicitis;
8) right foot toe paronychia.
The correct answer is:
 A
1,2,4,5,6.
20%
 B
2,4,5,6,7.
5%
 C
1,2,4,5,7.
72%
 D
1,3,4,7,8.
3%
 E
3,5,6,7,8.
Which of the following concerning adrenal glands is
true?
1) incidentaloma always requires surgery;
2) ultrasound is the test of choice in the imaging
diagnostics of adrenal glands;
3) laparoscopy should not be used in the surgical
treatment of adrenal tumors;
4) pheochromocytoma develops from cells of the
adrenal cortex;
5) Conn syndrome most often is associated with benign
adenoma of the glomerular layer of the adrenal gland.
The correct answer is:
 A
1,3.
3%
 B
2,3.
6%
 C
2,4,5.
 21%
 D
Only 1
4%
 E
Tylko 5
Indicate the false statement concerning spleen surgery:
 A
The indication for splenectomy is: spleen trauma, hemolytic anemia, proliferative
diseases, hypersplenism.
6%
 B
During radical gastrectomy or peripheral pancreatic resection, splenectomy is
additionally performed.
30%
 C
Splenectomy can be performed using both laparoscopy and classical technique.
4%
 D
After splenectomy vaccination against Haemophilus influenzae type B,
meningococcal group C and seasonal influenza vaccinations are recommended.
8%
 E
The risk of fulminant sepsis after splenectomy is the greatest when the surgery is performed for
hematological indications in the elderly.
A 42-year-old man is suffering from weight loss - 15 kg
in 3 months, diarrhea, increased amount of urine,
recurrent urinary tract infections and recurrent oral
mucositis - was admitted to the hospital. The abdomen
ultrasound examination visualized pancreatic head
tumor. The tumor biopsy was performed during
endoscopic ultrasonography. The most probable biopsy
result is:
 A
Pancreatic neuroendocrine tumor - VIP-oma.
7%
 B
Pancreatic neuroendocrine tumor - glucagonoma.
57%
 C
Metastasis of colorectal adenocarcinoma.
4%
 D
Pancreatic neuroendocrine tumor - insulinoma.
26%
 E
Pancreatic neuroendocrine tumor - gastrinoma.
 A Sengstaken-Blakemore tube is used to:
 A
Measure of pulmonary wedge pressure.
3%
 B
Remove varices in the lower limbs.
1%
 C
Perform colonoscopy.
1%
 D
Temporally stop the bleeding from esophageal varices.
93%
 E
Remove gallstones during ERCP.
The gateway to the femoral hernia is the femoral ring
which includes the following structures, except for:
 A
Nguinal ligament.
7%
 B
Femoral vein.
5%
 C
Lacunar ligament.
11%
 D
Aponeurosis of the external oblique muscle.
65%
 E
Branches of the pubic bone and the crest ligament that covers them.
A 27-year-old woman, with no chronic diseases was
admitted to the Emergency Department due to fainting
and severe abdominal pain lasting for 30 minutes.
Blood pressure 80/60 mmHg, HR: 105 beats/min. Blood
test: Hb: 12.5 g/dL, Hct: 41.5%, PLT: 251 000/mm , Na:
135 mmol/L, K: 4.5 mmol/L, amylase: 463 U/L, total
bilirubin: 0.7 mg/dL, β-hCG: 1.15 mIU/mL. The
ultrasound examination in FAST algorithm showed trace
of fluid around the spleen and in the pouch of Douglas.
Indicate the most likely cause of the patient’s abdominal
pain:
 A
 Ectopic pregnancy miscarriage.
26%
 B
Acute pancreatitis.
52%
 C
Ureteric colic.
2%
 D
Mesenteric artery ischemia.
3%
 E
Both A and B are correct.
Indicate the true statements concerning Lynch
syndrome (hereditary nonpolyposis colorectal cancer):
1) it is an autosomal dominantly inherited disease; 2)
one of its variants is Gardner’s syndrome; 3) diagnosis
is based on the Amsterdam criteria; 4) age of onset is
usually between 20-30 years of life; 5) adrenal cancer is
more common. The correct answer is:
 A
1,3.
68%
 B
2,3.
9%
 C
2,4,5.
8%
 D
Only 1.
13%
 E
Only 3.
Damage to the middle meningeal artery most often
leads to the following:
 A
Stroke
2%
 B
Subarachnoid hematoma
4%
 C
Subdural hematoma
8%
 D
Epidural hematoma
 81%
 E
Intracerebral hematoma
Indicate the false statement concerning familial
adenomatous polyposis (FAP):
 A
It is autosomal dominantly inherited condition, the mutation concerns the APC
gene.
8%
 B
The only surgery is proctocolectomy with end ileostomy.
71%
 C
Colectomy with ileorectal anastomosis is performed in some patients.
4%
 D
There is an increased incidence of papillary thyroid cancer.
10%
 E
Desmoid tumors form in the abdominal cavity.
The indications for total parenteral nutrition include:
1) prolonged intestinal obstruction;
2) sepsis with the infection source in the abdomen;
3) fistula of the proximal small intestine with high
secretion;
4) necessity to meet increased metabolic needs after
severe trauma;
5) pseudobulbar palsy;
6) coma due to subarachnoid hemorrhage;
7) isolated frostbite of toes.
The correct answer is:
 A
1,2,3,4.
67%
 B
1,2,5,6,7.
15%
 C
1,3,4.
11%
 D
1,2,5,7.
1%
 E
 1,3,4,5.
Which of the following concerning pancreatic cancer is
true?
1) laparoscopy is contraindicated in surgical treatment;
2) jaundice may be one of the first symptoms and may
indicate compression of the bile ducts;
3) head of the pancreas is the most common location;
4) curability is estimated at 50%;
5) women fall ill more often.
The correct answer is:
 A
1,3.
5%
 B
2,3.
88%
 C
2,4,5.
4%
 D
Tylko 1.
1%
 E
Tylko 3.
Which of the following is the early complication after
vascular surgery which can be diagnosed with
ultrasound imaging?
 A
True aneurysm.
7%
 B
False aneurysm.
12%
 C
Perigraft abscess.
12%
 D
Retroperitoneal hematoma.
66%
 E
Seroma.
The most common cause of intestinal fistulas is:
 A
Radiation-induced damage.
2%
 B
Peritoneal adhesions.
24%
 C
Crohn’s disease.
17%
 D
Malignant neoplasm.
2%
 E
Surgical complication.
The procedure consisting in cutting the esophageal
muscles including the lower esophageal sphincter is
performed in the patients with:
 A
Zenker’s diverticulum.
5%
 B
Upper esophageal sphincter spasm.
3%
 C
Achalasia.
14%
 D
Diffuse spasm of the esophagus.
3%
 E
C and D are correct.
During the operation consisting in the resection of the
right liver lobe, because of the wrong cut the hepatic
flexure of the colon was injured which led to its
perforation and the intestinal contents entered the
peritoneal cavity. What is the correct classification of
such a wound?
 A
Clean-contaminated.
12%
 B
Dirty.
6%
 C
Contaminated.
78%
 D
Clean.
2%
 E
Secondary.
 A 35-year-old patient was admitted to the surgical ward
with the diagnosis of acute pancreatitis in the course of
alcohol use disorder. The patient complains of
epigastric pain and vomiting. In the imaging studies
cholelithiasis has been excluded, and acute edematous
pancreatitis has been confirmed without any
pathological cysts in the pancreatic area. There are no
signs of cholangitis and inflammatory markers are low.
Indicate the correct management:
 A
Urgent laparotomy and a drainage of the peritoneal cavity.
4%
 B
Discharge after 24 hour observation.
2%
 C
Conservative treatment until the normalization of laboratory test results and the
relief of symptoms.
89%
 D
Laparoscopic cholecystectomy.
2%
 E
ERCP or MRCP.
The commonest complication after thyroidectomy is:
 A
Postoperative bleeding.
2%
 B
Hypoparathyroidism.
90%
 C
Damage to the recurrent laryngeal nerve.
6%
 D
Surgical site infection.
1%
 E
Recurrent goiter.
The anterior wall of the inguinal canal is formed by:
 A
Aponeurosis of the abdominal external oblique muscle.
64%
 B
Abdominal external oblique muscle.
5%
 C
 Transverse abdominal muscle.
6%
 D
Abdominal external oblique muscle with the transverse abdominal muscle.
19%
 E
Transverse fascia.
7
The possible complications of anesthesia and surgery
include: 1) nausea and vomiting; 2) hiccup; 3)
pneumonia; 4) respiratory failure; 5) delirium; 6) urinary
retention; 7) pulmonary embolism; 8) wound infection.
The correct answer is:
 A
All the above.
91%
 B
,3,4,5,7,8.
5%
 C
1,5,6,8.
2%
 D
1,3,7,8.
2%
 E
2,5,6,7.
Indicate the true statement concerning Meckel’s
diverticulum:
 A
It is a true diverticulum.
4%
 B
It is the most common congenital defect of the gastrointestinal system.
3%
 C
It consists of all the layers of the intestinal wall.
8%
 D
It may include elements of pancreatic tissue.
1%
 E
All the above.
Indicate factors promoting thromboembolic
complications: 1) age; 2) obesity; 3) long duration of
surgery; 4) pelvic and hip surgery; 5) upper extremity
surgery; 6) vitamin K deficiency; 7) pregnancy; 8) use of
 oral hormonal contraceptives; 9) varicose veins of the
lower extremities; 10) neoplastic disease. The correct
answer is:
 A
2,3,4,5,7,8,9.
4%
 B
1,2,4,6,7,8,9,10.
14%
 C
1,2,3,4,7,8,9,10.
77%
 D
1,2,6,7,8,9,10
2%
 E
2,3,4,5,8,9,10.
A 40-year-old man, 80 kg of weight, was admitted to the
ER with third-degree burns on the left upper limb, left
lower limb and perineum. What amount of fluids should
be administered during the 24 hours?
 A
Approx. 2 litres.
2%
 B
Approx. 9 litres.
86%
 C
Approx. 15 litres
9%
 D
Patient needs only oral rehydration.
1%
 E
Described degree and extent of the burns do not require the use of intensive fluid therapy.
What is the most common location of arterial embolism?
 A
Division of the brachial artery into the radial and ulnar arteries.
2%
 B
Division of the aorta into the common iliac arteries.
4%
 C
Division of the common carotid artery.
4%
 D
Division of the femoral artery into the deep artery of the thigh and the superficial
femoral artery
 83%
 E
Division of the popliteal artery into the arterial tibial artery and the tibial-fibular trunk.
An adult man who has fallen from the third floor is
unconscious: he does not open eyes in response to
pain, does not produce any sound, tenses up extensor
muscles of the limbs, he extends and rotates internally
his arms - he holds his limbs in an extended position.
What should his GCS score be?
 A
1.
2%
 B
2.
4%
 C
3.
13%
 D
4.
74%
 E
5.
Indicate the false statement concerning thyroid cancer:
 A
Papillary cancers rarely occur in patients older than 40 and rarely give distant
metastases.
14%
 B
Follicular cancer most frequently occur in patients aged 30-50 and spreads mainly
through blood vessels.
5%
 C
Anaplastic cancer does not infiltrate surrounding tissues and rarely metastases to
the lungs.
76%
 D
Medullary cancer secretes calcitonin.
2%
 E
Medullary cancer can occur as a part of MEN II syndrome.
Indicate the false statement concerning erysipelas:
 A
It is an infectious disease caused by staphylococci.
81%
 B
Infection may spread by the lymphatic system (so-called erysipelas migrans).
4%
 C
Onset is acute and the symptoms rapidly develop.
3%
 D
High doses of benzylpenicillin are a treatment of choice
6%
 E
Lesions are usually located on lower limbs or the face, skin necrosis and gangrene occur in
some cases.
Acute pancreatitis: 1) has a benign course in about 80%
of cases; 2) is frequently characterized with symptoms
of generalized peritonitis; 3) usually recurs in patients
drinking alcohol regularly; 4) usually causes multiple
organ dysfunction syndrome; 5) is treated
conservatively in the majority of cases. The correct
answer is:
 A
1,2,3.
7%
 B
1,3,5.
76%
 C
2,3,4.
5%
 D
2,4,5.
4%
 E
3,4,5.
A frequent complication after abdominal surgery is
urinary retention. The symptoms include pain within the
hypogastric region and excessive filling of the bladder
along with inability to initiate micturition. The appropriate
treatment procedures of postoperative urinary retention
should start with:
 A
Rapid intravenous infusion of 1000 ml normal saline (0.9% NaCl) and then 40 mg
oral furosemide.
6%
 B
Urinary tract catheterization for 2-3 days.
86%
 C
Nephrostomy.
 2%
 D
Oral tamsulosin (rec. α1 antagonist) until normal diuresis.
5%
 E
Haemodialysis, since post-operative urinary retention is always due to acute kidney failure.
Missing question: Question number 79 - LEK in session Spring 2021 A 68-year-old woman
came in the evening to the ER because of colic abdominal pain, fecal vomiting, intermittent
diarrhea and constipation for 7 days, and the presence of fresh blood in the stool. She reports
she had lost 12 kg for the last 3 months without any specific diet. On physical examination the
abdomen is distended, without muscle guarding, with audible resonant peristaltic sounds. On
per rectum examination - the rectal ampulla is empty. Indicate the correct management: A.
admission to the internal medicine ward for the hospital observation. B. abdominal ultrasound
imaging and the observation in the out-patient settings. C. urgent out-patient colonoscopy. D.
admission to the general surgery ward and qualification to the surgical treatment of the ileus. E.
discharging the patient to home and referral for the control visit in the surgery outpatient clinic
on the next day. ANSWER: D

In acute pancreatitis, the indications for initiating

antibiotic therapy include:
1) any case of acute pancreatitis related to
choledocholithiasis;
2) any case of alcohol-related acute pancreatitis;
3) confirmed presence of infected necrosis in the course
of acute pancreatitis;
4) pancreatic pseudocysts as a complication in acute
pancreatitis.
The correct answer is:
 A
1, 3, 4.
15%
 B 2,3,4
3%
 C
2, 4.
5%
 D
Only 3.
71%
 E
Only 4.
After falling from the height of 5 m, the patient:
- opens eyes after pain stimulus;
- is confused and disoriented, cannot tell where he is or
what happened;
- does not obey commands to make a movement but
 can localize painful stimulus;
In the GCS, the patient will score:
 A
15 points.
2%
 B
13 points.
3%
 C
12 points.
12%
 D
11 points.
60%
 E
10 points.
The indication for splenectomy can be:
 A
Hereditary spherocytosis.
2%
 B
Idiopathic thrombocytopenia.
0%
 C
Thalassemia.
0%
 D
Sickle cell anaemia.
2%
 E
All of the above.
An 83-year-old male who was treated for arrhythmia
and arterial hypertension was admitted to emergency
dept. due to severe abdominal pain. The pain appeared
suddenly, about an hour before admission, was at first
located within the epigastric region and was paroxysmal
in nature. However, at the time of examination, the pain
is continuous and concerns the entire abdomen area.
The abdomen is bloated, and positive peritoneal
symptoms are present in all abdominal quadrants. The
patient has nausea and vomits with the stomach
content. Peristalsis cannot be heard. Physical
examination shows large inguinal hernia on the right
side, and per rectum examination, brown stool in the
 rectal ampulla. HR: 96/min, BP: 103/57 mmHg, RR:
18/min, WBC: 33000/mm3, Hgb: 11.2 g/dl, Hct: 31%,
Amylase: 140 U/l, D-dimers 15000 µg/l, Tnl: <0.001
ng/ml. ECG: without abnormalities. Indicate what is the
cause of the patient’s complaints:
 A
Gastric ulcer perforation.
16%
 B
Acute intestinal ischaemia.
64%
 C
Myocardial infarction.
4%
 D
Obstruction caused by colon tumour.
6%
 E
Acute pancreatitis.
A 53-year-old male checked into emergency dept. due
to painfulness within the right hypochondriac region.
The pain, which appeared the day before, is paroxysmal
and accompanied by nausea and vomiting. At present,
the patient has fever with chills, 39.2 degrees Celsius.
He also reports dark-coloured urine. On physical
examination, Chelmonski symptom is positive, and
yellowing of the eye sclera can be observed. Per
rectum, the stool in the rectal ampulla is discoloured.
Laboratory findings: Hgb 12.5 g/dl, Hct 36%, CRP 120
mgl/l, bilirubin 80 µmol/l (4.68 mg/dl). Ultrasound
examination shows a common bile duct of 11 mm in
diameter and a thin-wall gallbladder with numerous
deposits. Indicate the right diagnosis and procedure:
 A
Acute cholecystitis - laparoscopic cholecystectomy and antibiotic therapy.
16%
 B
Cholangitis - oral conservative treatment with antibiotics.
5%
 C
Cholangitis - endoscopic retrograde cholangiopancreatography and antibiotic
therapy.
 71%
 D
Acute cholecystitis - oral conservative treatment with antibiotics.
4%
 E
Diagnosis cannot be made based on the information provided; all diagnoses are equally
probable.
Indicate the false statement regarding venous ulcers of
lower extremities:
 A
The risk factors for venous ulcerations include previous deep vein thrombosis,
thrombophilia and varicose veins.
2%
 B
Venous ulcers occur on the lower legs, typically around the lateral or medial ankle
area.
4%
 C
Venous ulcers are characterised by severe pain which can be relieved by
unweighting the leg.
55%
 D
The skin surrounding venous ulcers is usually atrophic, can be discoloured, and the
limb is often swollen.
4%
 E
All the above statements are true.
The complications of diverticular disease include:
 A
Sigmoid cancer.
11%
 B
Sigmoidovesical fistula.
78%
 C
Ulcerative colitis.
4%
 D
Left-sided renal colic.
6%
 E
Left ovarian cyst.
Indicate true statements regarding an abscess:
1) an essential treatment is its evacuation;
2) surgery is contraindicated; antibiotic therapy is more
beneficial;
3) the complication of perirectal abscess can be an
perianal fistula;
 4) the complication of perirectal abscess can be an anal
fissure;
5) perianal abscess is more commonly found among
males.
The correct answer is:
 A
1, 2, 4.
5%
 B
1, 3, 5.
70%
 C
2, 3, 5.
4%
 D
2, 3, 4.
3%
 E
1, 3, 4.
Question 82 should be: Question number 82 - LEK in session Spring 2021 Meckel's
diverticulum consists of: A. all layers of the intestinal wall. B. mucous membrane only. C.
muscular layer only. D. serous membrane only. E. serous membrane and muscular layer.
Option a is correct

 mczarn0417
Question 83 should be: Question number 83 - LEK in session Spring 2021 In the classification
of upper gastrointestinal hemorrhage according to Forrest grade I denotes: A. recent
hemorrhage. B. active hemorrhage. C. old hemorrhage. D. no sign of hemorrhage. E. Forrest
classification does not refer to gastrointestinal hemorrhage.23.7.2021-14:27:25

 mczarn0417
Answer: B23.7.2021-14:28:54
A surgeon, after consultation, stated that the patient had
Courvoisier syndrome. It means:
 A
There is no dullness over the liver during percussion (probable perforation of the
digestive tract).
9%
 B
Znacznie rozdętą esicę - podejrzenie skrętu.
1%
 C
Obronę mięśniową w lewym śród- i podbrzuszu (prawdopodobne zapalenie
uchyłków esicy).
18%
 D
Rozdęty, niebolesny pęcherzyk z towarzyszącą żółtaczką.
71%
 E
 Opór w miednicy w czasie badania per rectum (poza światłem odbytnicy).
 Kozerawskik
Test questions are in polish22.3.2021-11:14:24

 Siljepedersen
a. There is no dullness over the liver during percussion (probable perforation of the digestive
tract) b. Significantly distended sigmoid . a twist suspicion c. Muscle defense in the left sigmoid
– and lower abdomen (probable sigmoid diverticulitis) d. Distended, painless gallbladder with
jaundice e. Resistance in the pelvis during rectal examination (outside the rectal lumen) (by
google translate)17.4.2021-17:41:43