There may be a pneumoperitoneum in perforation of all the following locations, except one, which one?:
Stomach.
Ileum
Sigmoid colon.
Appendix.
Third duodenum.
The most common fatal complication of chronic peptic ulcer of the stomach is:
Adenocarcinoma
Acute gastritis
Perforation and peritonitis
Pancreatitis
Pyloric outlet obstruction
Which of the following, the three most common complications after surgery for peritonitis? : 1. Small bowel fistula. 2. Abscess cul-de-sac. 3. Postoperative occlusion. 4. Gastrointestinal bleeding. 5. Parietal suppuration
1-5-4
1- 4-3
1-2-4
2-3-5
1-2-5
Among the clinical forms of peritonitis following, which gives a pneumoperitoneum?:
Appendiceal peritonitis.
Peritonitis by perforation of a duodenal ulcer.
Peritonitis in acute cholecystitis.
Peritonitis in pelvic inflammatory disease.
Pneumococcal peritonitis
Which of the following laboratory results would be expected in a client with peritonitis?:
Partial thromboplastin time above 100 seconds
Hemoglobin level below 10 mg/dL
Potassium level above 5.5 mEq/L
White blood cell counts above 15,000
Complications of Peritonitis:
Bowel obstruction- from inflammation, Sepsis- from bacterial invasion, Shock- from sepsis and hypovolemia
Controlling the contamination, Removal of foreign material, Removal of foreign material, Draining collected fluid
Caused by contamination from bacteria or chemicals
Elevated WBC > 20,000; Low H/H; Altered Electrolytes- K, Na, Cl-; Abdominal X-ray and US; Abdominal CT; Peritoneal aspiration and culture.
. General treatment policy of acute peritonitis is:
Conservative
Surgical.
Initial treatment is conservative + surgery for some indications.
Surgical in young patients, conservative in elderly patients
All of the following have been associated with H. pylori infection except:
Squamous cell of the esophagus
Adenocarcinoma of the stomach.
Duodenal ulcer.
Chronic active gastritis.
Gastric lymphoma, MALT type (MALToma).
Among the following bacteria, one of which is frequently associated with gastritis. Which is it?:
Campylobacter jejuni.
Campylobacter coli.
Campylobacter pylori.
Sputorum Campylobacter.
Campylobacter fetus ssp. fetus.
With regard to benign gastric ulceration, the most common location of disease is which of the following?:
Along the greater curvature
Immediately distal to the esophagogastric junction along the lesser curvature
In the area of the incisura angularis along the lesser curvature
Within the gastric antrum
What of the following factors, which is usually considered as predominant in the mechanism of onset of ulcers stomach?:
Acid hypersecretion of vagal
Acid hypersecretion due to excessive secretion of gastrin
An increase in the number of parietal cells (oxyntic) in the fundic mucosa
Gastric atrophy
A decrease in the resistance of the mucosal barrier and / or fragility of the wall
62. Among the etiological factors include, what are the two which appear currently the most important in terms of gastric ulcer?: 1. Heredity 2. Tobacco 3. Stress 4. NSAIDs or aspirin 5. Helicobacter pylori infection
1 +2
2 +3
1 +4
1 +5
4 +5
Spread person to person by fecal-oral route:
Treatment of H. pylori
Transmission of H. pylori
Gram Stain of H. pylori
Diagnosis of H. pylori
Urease, flagella, adhesins, mucinase, vauolating toxin, neutrophil activation protein, LPS, superoxide dismutase and catalase, and PAI:
Virulence factors of H. pylori
Mucinase
Urease
Vacuolating toxin
Invasive with endoscopy or noninvasive with urease breath test or ammonia breath test and detection of H. pylori antibodies in saliva:
Flagella of H. pylori
Diagnosis of H. pylori
Adhesins of H. pylori
Reservoir of H. pylori
Only humans:
Gram Stain of H. pylori
Diagnosis of H. pylori
Treatment of H. pylori
Reservoir of H. pylori
What kind of bacteria is H. Pylori?:
A. Urease
B. Gram-negative curved rod
C. Colonize
D. There must be regions of homology
What are the key virulence factors of H. pylori? Why?:
Chemotaxis
Stomach and duodenal ulcers
Chemotaxis and motility. So it can get into the mucin later away from acidic conditions
There was no animal model for the isolated bacteria to be reinoculated into. Barry Marshall inoculated himself.
What does urease do?:
No, some are Cag+, some Cag-
By binding directly to MHCII to induce cytokine production
Colonize
Hydrolyzes urea to form ammonia (basic)
Helicobacter pylori causes :
Gastritis.
Duodenal ulcers.
Stomach ulcers.
Increased risk for stomach cancer.
All of the choices are correct.
A clinical examination of a patient with uncomplicated peptic ulcers:
It is common to see a splashing palpation of the epigastrium.
Is triggered plexalgie happy one
We often hear a systolic murmur.
There is a sore point for Mayo Robson.
It generally does not detect any abnormality
Epigastric pain without radiation, post-prandial late, cramping, punctuated in the day, speaks first:
An ulcer pain
A gastritis
A gastroesophageal reflux
A hemorrhagic pancreatitis
A colic
Which of the following isn't a complication of peptic ulcer disease?:
Perforation
GI bleeding
Pyloric obstruction
Pain
Helicobacter pylori:
Bacillus gram - Spiral
Pathology associated with ulcerative
Sensitive to metronidazole and erythromycin
Is isolated from gastroduodenal biopsies
Is isolated from the stool of the patient
A patient has a higher risk of peptic ulcer disease (PUD) if they are a chronic user of:
Certain antibiotics.
Laxatives and stool softeners
Magnesium-aluminum antacids.
Nonsteroidal antiinflammatory drugs.
Antibiotics, proton pump inhibitor, and bismuth.:
Treatment of H. pylori
Flagella of H. pylori
Reservoir of H. pylori
Gram Stain of H. pylori
Bile:
Salts contribute to the solubility of cholesterol in the bile.
Contains bilirubin mainly in the unconjugated form.
Contributes more than pancreatic secretion to the neutralisation of acid from the stomach.
Becomes more alkaline following concentration in the gall bladder.
Is produced at a rate of approximately 2000 ml/day.
Inflammation of the gall bladder. Usually associated with cholelithiasis.:
Cholecystitis
Collaborative Care of Cholelithiasis
Cholelithiasis
Complications of cholelithiasis
Gallbladder duct inflammation, Caused by the migration of gallbladder stones:
Cholecystitis
Cholecystitis imaging
Cholecystitis labs
Cholecystitis PE
Caused by obstruction of common bile duct, Jaundice, pain and possible liver damage.:
Biliary colic
Bile reflux
Empyema
Cholecystitis
Gallstones develop when the balance that keeps cholesterol, bile salts, and calcium is altered so that precipitation of these substances occurs. Infection and disturbances in the metabolism of cholesterol may cause this.:
Diagnostic Studies for cholelithiasis
Post-Op Care for a Laparoscopic Cholecystectomy
How do gallstones develop
Other causes of cholecystitis
Which of the following statement is/are true concerning the solubilization of cholesterol in bile?:
Cholesterol is highly soluble in both serum and bile
Mixed micelles are the primary transport mechanism for biliary cholesterol
Most cholesterol found in bile is the result of excretion from serum
Biliary vesicles are composed primarily of biliary phospholipids
Fever, Tachycardia, RUQ or epigastric tenderness, Guarding or rebound, Murphy sign, Palp gallbladder or RUQ fullness ~40%, Jaundice ~15% of patients.:
Cholecystitis PE
Cholecystitis imaging
Cholecystitis labs
Cholecystitis presentation
Among the following propositions concerning the liver colic crisis, one is inaccurate. Which?:
Pain may occur in the left hypochondrium.
Pain can be relieved by the deep pressure of the epigastric cavity.
Irradiation of pain in the right shoulder is common.
Pain is related to the sudden straining of the bile ducts.
Epigastric pain of sudden onset without a peritoneal defense should evoke first of all a hepatic colic.
May be vague: Epigastric fullness or mild gastric distress after large or fatty meal:
Cholecystitis
Empyema
Early manifestations of gallstones
Cholecystitis presentation
Increasing abdominal tenderness or rigid, board like abdomen:
Signs of rupture of the gallbaldder with peritonitis
Factors of Cholelithiasis
Bile reflux
Gallstone ileus
The surgical treatment of a choledochial lithiasis that has migrated from the gallbladder outside acute episodes of acute infection (angiocholitis, acute cholecystitis) can only be performed on one of the following procedures:
Cholecystectomy.
Choledochotomy with ablation of calculation and closure of the common bile duct.
Cholecystostomy.
Cholecystectomy + choledochotomy with ablation of stone and closure of the common bile duct on Kehr drain.
Choledocho-duodenal anastomosis alone.
Biliary colic:
Provoke a pain of left hypochondrium.
Accompany of respiratory inhibition.
Accompany of fever.
Accompany of jaundice.
Reveal of CBD stone.
. A patient presenting with acute abdomen is being examined. On palpation of Right hypochondrial region, there is pain on deep inspiration and the patient catches breath. The diagnosis is probably:
Acute Appendicitis.
Acute cholecystitis.
Rupture Spleen.
Cancer Caecum.
With respect to gallstones:
Most people with gallstones are asymptomatic.
CT is the imaging modality of choice in diagnosing gallstones.
Approximately 90% of gallstones are visible on plain abdominal x-ray.
Gallstone ileus occurs when a gallstone travels through the bile duct into the small bowel and causes an obstruction.
Mirizzi's syndrome is caused by a stone in the common bile duct.
Pain of hepatic colic in its typical form:
Seat in right hypochondrium or epigastrium.
Has a brutal start.
Inhibits deep inspiration.
Is often associated with nausea or vomiting.
All of the above
Cholangiogram:
Formation of stones in the gallbladder or biliary duct system
Radiologic (x-ray) procedure, Direct visualization of the duct with an endoscope, Iodine-containing dye is injected IV into the blood
C. X-ray examination of the gallbladder: dx of cholecystitis, cholelithiasis, and tumors
Fat-free diet at least 12 hrs before. Ingest a contrast material containing iodine. Fatty meal or cholecystokinin afterward to stimulate gallbladder contraction expel bile and contrast media in the bile duct additional x-ray 1 hr later
Nausea, vomiting
Gangrene and perforation with peritonitis, Chronic cholecystitis, Empyema, Fistula formation, Gallstone ileus
The image of "porcelain vesicle" diagnosed on the abdomen cliché without preparation corresponds to:
A diffuse micro-lithiasis.
Parietal calcification of the vesicle.
The presence of multiple benign tumors of the vesicular wall.
A vesicular cancer.
A bilio digestive fistula.
Ultrasound carries the diagnosis of extrahepatic obstruction causing jaundice if:
Extrahepatic bile ducts are normal.
There are calculations in the vesicle.
The liver is hyperbrilliant but homogeneous.
Intrahepatic bile ducts are dilated.
There is an ascites.
Obstruction of small intestine by a large gallstone:
Gallstone ileus
Bile reflux
Cholangitis
Cholestyramine (Questran)
Most common site of fracture of the clavicle is:
Medial end.
Lateral end.
Midpoint of the clavicle.
Junction of the medial two-thirds and the lateral third.
Junction of the lateral two-thirds and the medial third.
Concerning fracture of the shaft of the clavicle, it is untrue that it:
Is usually due to direct trauma
Commonly involves the middle third
Is often associated with overriding of fragments
Causes dropping and deformity of shoulder
Is usually treated by figure-of-eight bandage
Ladder step deformity characteristic of fracture clavicle is:
Medial fragment is displaced downward below lateral fragment.
Lateral fragment is displaced foreword while medial is displaced backward.
Dislocation of sternoclavicular joint gives ladder step deformity.
Dislocation of acromio-clavicular joint.
Lateral fragment is displaced downward & foreword by weight of the upper limb while medial fragment is displaced upward & backward by spasm of the sternomastoid muscle.
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