Acute abdomen and peritonitis

Question 1

Peritonitis caused by perforation of the gastric and duodenal ulcer:
A) is exclusively chemical because the content of stomach and duodenum is sterile
B) initially chemical, but bacterial peritonitis develops within hours due to overinfection
C) bacterial origin from the beginning
D) caused by anaerobic pathogens

Answer 1

B) initially chemical, but bacterial peritonitis develops within hours due to overinfection

Question 2

The most common place for gastroduodenal ulcers is:
A) the fundus of the stomach
B) the lesser curvature of the stomach in the middle third
C) the posterior wall of the antrum
D) the anterior wall of the duodenum directly below the pylorus

Answer 2

D) the anterior wall of the duodenum directly below the pylorus

Question 3

The optimal time for surgery of gastroduodenal ulcer perforation:
A) within 48 hours after the onset of complaints
B) within 24 hours after the onset of complaints
C) within 6 hours after the onset of complaints
D) scheduled in advance after the investigation is completed

Answer 3

C) within 6 hours after the onset of complaints

Question 4

Mallory-Weiss Syndrome:
A) vomiting related stomach rupture of fundus and peritonitis
B) severe inflammation on the mucosa of the fundus
C) rupture of the wall in the middle third of the lesser curvature of the stomach and peritonitis
D) serious bleeding from the rupture of the gastroesophageal mucosa during severe vomiting

Answer 4

D) serious bleeding from the rupture of the gastroesophageal mucosa during severe vomiting

Question 5

The most common cause of peritonitis related to gastric disorders:
A) perforation of peptic ulcer
B) bacterial phlegmone of gastric wall
C) perforation caused by Crohn’s disease
D) tumor-induced perforation caused by tumor disintegration

Answer 5

A) perforation of peptic ulcer

Question 6

When is the surgical treatment required for solitaire liver abscess ?
A) In case of failure of the percutan drainage
B) Only surgical intervention is an effective method for treating liver abscess
C) Never

Answer 6

A) In case of failure of the percutan drainage

Question 7

Which statement is correct?
A) The stomach of patients with peptic ulcers contains a large amount of pathogen bacteria.
B) The use of non-steroid anti-inflammatory drugs (NSAIDs) predisposes to gastric carcinoma.
C) Anterior wall ulcers of the duodenum tend to perforation, posterior wall ulcers tend to bleed.
D) Malignancy is a dangerous and frequent complication of duodenal ulcers.

Answer 7

C) Anterior wall ulcers of the duodenum tend to perforation, posterior wall ulcers tend to bleed.

Question 8

The most common acute complication of gastric lymphoma is:
A) perforation
B) cachexia
C) sepsis
D) bleeding

Answer 8

D) bleeding

Question 9

Causes of peritonitis associated with infected pancreatitis, except:
A) Hematogen spreading
B) Rupture of abscess
C) Penetration
D) Propagation through anatomically preformed route

Answer 9

A) Hematogen spreading

Question 10

Necrotising pancreatitis may be associated with peritonitis except:
A) Localised peritonitis
B) Secunder peritonitis
C) Fibrinopurulent peritonitis
D) Primary peritonitis

Answer 10

D) Primary peritonitis

Question 11

Complications of large bowel diverticulitis, except:
A) Obstruction of large bowel
B) Malignant transformation
C) Bleeding
D) Small pelvic abscess
E) Colon perforation - peritonitis

Answer 11

B) Malignant transformation

Question 12

We find necrotic small intestine during the operation of incarcerated hernia. What to do?
A) surgery is postponed and elective surgery is performed later
B) performing hernioplasty
C) removing the necrotic section and make an anastomosis between intact intestinal ends
D) the necrotic small intestine is placed in front of the abdominal wall

Answer 12

C) removing the necrotic section and make an anastomosis between intact intestinal ends

Question 13

Possible cause of perforation of appendix:
A) bacterial inflammation
B) benign tumor lesion
C) carcinoid
D) helmets
E) typhus

Answer 13

A) bacterial inflammation

Question 14

When is the periappendicular infiltrate diagnose probable:
A) The complains started 3 hours ago
B) The complains started 6 weeks ago, without fever, and haven’t been treated
C) The complains started 2 days ago, did got fever, did vomit, has leukocytosis
D) When right lower abdominal resistance is palpable, the stool is Weber-positiv, apyretic
E) When in the last 5 days right lower abdominal pain, vomiting, fever is present and painful right lower abdominal resistance can be detected

Answer 14

E) When in the last 5 days right lower abdominal pain, vomiting, fever is present and painful right lower abdominal resistance can be detected

Question 15

The most common cause of big bowel ileus:
A) Ring tumor of the sigma
B) Cecal tumor
C) Diverticulitis conglomerate
D) Villous adenoma
E) Abdominal adhesions

Answer 15

A) Ring tumor of the sigma

Question 16

Which statement is true?
A) The fecal peritonitis is a banal complication of colon surgery.
B) The fecal peritonitis is an extremely dangerous complication of colon surgery.
C) The peritonitis caused by diverticulitic perforation is milder than the peritonitis caused by appendicitis.
D) After rich meal evolved foreign body colon-perforation’s treatment is the suture of the opening.

Answer 16

B) The fecal peritonitis is an extremely dangerous complication of colon surgery.

Question 17

Which statement is correct?
A) The Hartmann’s procedure is the most common elective large bowel surgery.
B) The Hartmann’s procedure advantage is, that there is no need of an anus preternaturalis to assure the emptying of stool.
C) The essence of Hartmann’s procedure is the resection of the tumorous part of the colon, with closure of the aboral blind-ended colonic stump and formation of an end colostomy with the oral colonic stump.
D) The Hartmann’s procedure is a palliative operation, and it leaves the colontumor on its place till the definitive treatment.
E) By the Hartmann’s procedure we restore the continuity of the bowel with an anastomosis.

Answer 17

C) The essence of Hartmann’s procedure is the resection of the tumorous part of the colon, with closure of the aboral blind-ended colonic stump and formation of an end colostomy with the oral colonic stump.

Question 18

Typical symptom of large bowel ileus:
A) progressively evolving abdominal distension
B) seizures with enormous pain
C) seizures like occurring fecal vomiting
D) sudden complete stop of bowel sounds
E) diffuse firm abdominal muscle guarding

Answer 18

A) progressively evolving abdominal distension

Question 19

It can cause pelveoperitonitis and life-threatening sepsis:
A) ruptured tubal pregnancy
B) ruptured ovarian chocolate cyst
C) gonorrhea
D) for more years uncontrolled IUD

Answer 19

D) for more years uncontrolled IUD

Question 20

Which entering technique should be selected by the treatment of diffuse peritonitis with unknown etiology?
A) laparoscopy with 3-4 workchanels
B) curved transverse supraumbilical incision (Chevron)
C) transverse laparotomy infraumbilical
D) right pararectal laparotomy
E) total median laparotomy

Answer 20

E) total median laparotomy

Question 21

Diagnostic methods for gastroduodenal ulcer perforation:
1) abdominal x-ray with barium based contrast material
2) native abdominal fluoroscopy
3) gastrodoudenoscopy
4) by swallowing water soluble contrast material to prove leakage

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 21

C) the 2nd and 4th answers are correct

Question 22

Which laboratory test can confirm the etiology of pancreatitis caused peritonitis?
1) serum lipase
2) stool elastase
3) serum amylase
4) blood glucose determination

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 22

B) the 1st and 3rd answers are correct

Question 23

The following investigations could verify the propagation of necrotizing pancreatitis:
1) CT
2) abdominal X-ray
3) sonography
4) ERCP

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 23

B) the 1st and 3rd answers are correct

Question 24

Relevant diagnostic modality in small intestine ileus:
1) anamnestic data
2) physical examination
3) plain abdominal radiography
4) laboratory findings

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 24

A) the 1st, 2nd and 3rd answers are correct

Question 25

Adequate treatment of mechanical ileus:
1) conservative intestinal movement triggering
2) laxatives, enema
3) sympatholytic treatment
4) treat the obstruction with surgery if possible

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 25

D) only the 4th answer is correct

Question 26

The content of the small bowel:
1) is dilute
2) contains bacteria
3) contains more bacteria than the stomach
4) contains more bacteria than the colon

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 26

A) the 1st, 2nd and 3rd answers are correct

Question 27

Two most common complications of Meckel’s diverticulum:
1) bleeding
2) invagination
3) inflammation
4) perforation

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 27

B) the 1st and 3rd answers are correct

Question 28

What is the most common reason of liver abscesses?
1) appendicitis
2) large bowel inflammation
3) trauma
4) biliary cause

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 28

D) only the 4th answer is correct

Question 29

Typical symptom of appendicitis, except:
1) Lumbar pain
2) Right lower abdominal quadrant pain
3) Odorous eructation
4) Nausea, vomiting

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 29

B) the 1st and 3rd answers are correct

Question 30

Which treatment is not adequate for liver abscess?
1) US guided drainage
2) CT guided drainage
3) Surgical drainage
4) Marsupialization

A) the 1st, 2nd and 3rd answers are correct
B) the 1st and 3rd answers are correct
C) the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 30

D) only the 4th answer is correct

Question 31

The diagnosis is most likely appendicitis if
1) irregular menstruation is present
2) painful urination is present with pain radiating to the thigh
3) extreme leukocytosis is present
4) odorous vaginal discharge is present
5) high fever is present
6) watery diarrhea is present
7) ascites is present
8) empty rectal ampulla is present

A) none of the answers are correct
B) all of the answers are correct
C) the 3rd, 5th and 7th answers are correct
D) the 3rd and 8th answers are correct
E) the 4th, 6th and 7th answers are correct

Answer 31

A) none of the answers are correct

Question 32

The diagnosis of appendicitis is cumbersome in case of:
1) menstruation
2) elder patients
3) pregnancy
4) infancy
5) diabetes mellitus
6) cardial decompensation
7) constipation
8) renal diseases

A) the 2nd, 4th and 5th answers are correct
B) the 2nd, 3rd and 4th answers are correct
C) the 4th, 5th and 6th answers are correct
D) the 5th, 6th and 7th answers are correct
E) the 6th, 7th and 8th answers are correct

Answer 32

B) the 2nd, 3rd and 4th answers are correct

Question 33

These large bowel diseases can cause peritonitis, except:
1) irritable bowel disease
2) ulcerative colitis
3) Crohn’s disease
4) diverticulitis
5) polyposis
6) tumorous obstruction
7) carcinoid
8) villous adenoma

A) the 1st, 2nd, 3rd and 4th answers are correct
B) the 3rd, 4th, 5th and 6th answers are correct
C) the 1st, 5th, 7th and 8th answers are correct
D) the 4th, 5th, 6th and 7th answers are correct
E) the 5th, 6th, 7th and 8th answers are correct

Answer 33

C) the 1st, 5th, 7th and 8th answers are correct

Question 34

The bacterial flora of large bowel content:
1) is not rich in pathogenic bacteria
2) is very rich in dangerous pathogenic bacteria species
3) is almost only contains anaerobe bacteria
4) aerobe and anaerobe species are equally present
5) enema can completely clear the bowel from bacteria
6) mechanical bowel preparation is not needed if antibiotic prophylaxis is given (enema, laxatives etc.)

A) the 1st and 3rd answers are correct
B) the 1st and 5th answers are correct
C) the 2nd and 4th answers are correct
D) the 3rd and 6th answers are correct

Answer 34

C) the 2nd and 4th answers are correct

Question 35

Which of the following modalities are recommended for searching occult abdominal abscess in postoperative septic condition?
1) abdominal US
2) abdominal CT
3) abdominal contrast x-ray
4) irrigoscopy
5) plain abdominal x-ray
6) gastroscopy
7) colonoscopy

A) the 1st and 2nd answers are correct
B) the 3rd and 4th answers are correct
C) the 4th and 5th answers are correct
D) the 6th and 7th answers are correct

Answer 35

A) the 1st and 2nd answers are correct

Question 36

What to do in low abdominal pain and tenderness in a female patient?
1) local cooling
2) antibiotic therapy
3) gynecological examination
4) exclusion or verification of appendicitis
5) immediate removal of IUD
6) immediate surgery
7) anti-inflammatory therapy
8) therapeutic decision only after the 3, 4 and 5 point

A) the 1st, 3rd, 5th and 7th answers are correct
B) the 2nd ,4th ,6th and 7th answers are correct
C) the 3rd, 4th, 5th and 8th answers are correct
D) the 2nd, 5th, 6th and 7th answers are correct
E) the 4th, 5th, 6th and 7th answers are correct

Answer 36

C) the 3rd, 4th, 5th and 8th answers are correct

Question 37

What to do in the treatment of diffuse peritonitis?
1) microbiological sampling to be able to start targeted antibiotic therapy
2) immediate surgery to clear the cause of the peritonitis
3) abdominal flushing (lavage) after eliminating the source of the peritonits
4) fasting, liquid administration, anti-inflammatory treatment
5) local cooling, gastric tube, bowel movement triggering, enema
6) rigorous conservative treatment
7) stabilization of general condition, liquid and electrolyte supplementation, observation and surgery if the patient’s condition improves

A) the 1st and 4th answers are correct
B) 2nd and 3rd answers are correct
C) 4th and 5th answers are correct
D) 4th, 5th and 6th answers are correct
E) 5th and 7th answers are correct

Answer 37

B) 2nd and 3rd answers are correct

Question 38

Peptic ulcer perforation should be operated immediately because the mortality of anaerobe intraabdominal infections is high
A) both of them are correct, and there is a cause-effect relation between them
B) both of them are correct , but there is no cause-effect relation between them
C) the first part alone is correct, but the second part is not true
D) the first part is not true, but the second part alone is correct
E) both parts are incorrect

Answer 38

B) both of them are correct , but there is no cause-effect relation between them

Question 39

Perforated appendicitis causes serious peritonitis because the bacterial flora of the large and small bowels are equally infectious.
A) both of them are correct, and there is a cause-effect relation between them
B) both of them are correct , but there is no cause-effect relation between them
C) the first part alone is correct, but the second part is not true
D) the first part is not true, but the second part alone is correct
E) both parts are incorrect

Answer 39

C) the first part alone is correct, but the second part is not true

Question 40

IUD can cause serious pelvic sepsis and pelviperitonitis that is why it has to be removed before every abdominal surgery
A) both of them are correct, and there is a cause-effect relation between them
B) both of them are correct , but there is no cause-effect relation between them
C) the first part alone is correct, but the second part is not true
D) the first part is not true, but the second part alone is correct
E) both parts are incorrect

Answer 40

C) the first part alone is correct, but the second part is not true

Question 41

Colorectal surgery should not be done without antibiotic prophylaxis because this way only palliative intervention can be performed.
A) both of them are correct, and there is a cause-effect relation between them
B) both of them are correct , but there is no cause-effect relation between them
C) the first part alone is correct, but the second part is not true
D) the first part is not true, but the second part alone is correct
E) both parts are incorrect

Answer 41

C) the first part alone is correct, but the second part is not true

Question 42

Antibiotic prophylaxis is only given in urgent colorectal surgery to prevent antibiotic resistance
A) both of them are correct, and there is a cause-effect relation between them
B) both of them are correct , but there is no cause-effect relation between them
C) the first part alone is correct, but the second part is not true
D) the first part is not true, but the second part alone is correct
E) both parts are incorrect

Answer 42

E) both parts are incorrect