The blood unit must be returned to the transfusion center to repeat compatibility

Immediate cessation of transfusion

Monitoring and administration of antihistamines

Administration of vasopressors

Adrenaline administration

Occurs regardless of the severity of the lesions and is associated with a favorable prognosis

Occurs due to excessive consumption of coagulation factors

Occurs as a result of inadequate tissue infusion

Occurs due to excessive platelet consumption

Occurs exclusively in patients with hepatic lesions

It consists in activating the fibrinolysis cascade, with inhibition of plasmin production

Primary fibrinolysis is encountered in the context of prostate surgical procedures

Occurs in patients with compensated liver cirrhosis

Congenital disorders of coagulation cascade inhibitors can cause primary fibrinolysis and are very common

Discontinuation of fibrinolytic therapy is not necessary to correct bleeding

Aging brings major changes in hemostasis processes

Patients with liver disease may have bleeding, hypercoagulability, or both at the same time.

Patients with renal impairment have a lower risk of bleeding

Older people better withstand coagulation disorders

Patients with hepatic impairment have metabolic coagulopathy due to increased protein levels

Patient history

Physical examination

Superior endoscopic evaluation

Abdominal ultrasound

Laboratory tests (aPTT, PT, bleeding time)

True polycythemia

Factor V Leiden mutation

Hemophilia A

Von Willebrand's disease

Uremia

Appears only in males

Bleeding occurs in the mucous membranes and skin

Occurs due to reduced or absent factor VIII activity, factor VIII molecules are present

The aPTT is prolonged

Platelet function is normal

Reduced factor VIII activity and reduced von Willebrand factor activity

Platelet function is normal

Occurs in both sexes

Occurs only in males

The aPTT is prolonged

Advanced liver diseases

Uremia

Anticoagulant therapy

Acquired thrombocytosis

Cardiovascular diseases

Positive FAST ultrasound

The presence of a penetrating wound

Craniocerebral trauma

Heart rate over 120 beats / minute

Systolic pressure below 90mmHg

Massive transfusion isolated from red blood cell mass may predispose to bleeding

Shock can aggravate consumption coagulopathy

Acute blood transfusion reactions can cause disseminated intravascular coagulation (CID)

When a patient is under general anesthesia, no other manifestations occur until generalized bleeding as a result of CID

The usual symptoms of an incompatible blood transfusion (agitation, back pain) also occur in patients with general anesthesia and represent the installation of CID

Bleeding that requires at least 10 units of red blood cell mass in the first 5 hours

Bleeding that requires at least 4 units per hour

Replacement of the entire blood volume of the patient in 24 hours

A bleeding with a flow rate of 20ml/min

Positive FAST ultrasound

Early control of bleeding during transport

Late surgical or angiographic hemostasis, after rebalancing

Lesion control surgery aims to stop bleeding and bacterial contamination

Early administration of hemostatic solutions at first contact

Orotracheal intubation to support respiratory functions

Inhibits coagulation, with increased risk of bleeding and an anticoagulant role

Inhibits fibrinolysis and clot dissolution, with a hemostatic role

It is recommended for patients with severe trauma and massive bleeding

It is recommended for patients with procoagulant status

It has a favorable profile in terms of side effects

Inadequate control of hemostasis during the intervention

Shock of any kind can lead to consumption bleeding

Alteration of liver function following hepatectomies

Poor drainage

Administration of tranexamic acid

Diffuse thrombosis

Diffuse hemorrhages due to coagulation factors consumption

Diffuse hemorrhages due to vascular lesions

Fibrino-platelet thrombi systemic deposition that causes diffuse tissue damage

May be precipitated by infection or shock

Release of tissue debris into the circulatory stream

Inhibition of intravascular platelet aggregation

Extensive endothelial damage that denudes the vascular wall and stimulates coagulation

Arterial hypertension which causes stasis and prevents coagulation inhibitors normally present in the circulation from reaching at the microthrombi level

Some types of interventions involving the prostate, lung or malignant tumors

Activation of the reticuloendothelial system

Traumatic brain injury

Severe liver disease

Benign prostatic hyperplasia

Arterial hypotension which causes stasis and prevents coagulation inhibitors normally present in the circulation from reaching at the microthrombi level

Low activated partial thromboplastin time (aPTT)

Low prothrombin time (PT)

Hypofibrinogenemia

Thrombocytopenia

Positive D-dimers

Fever and/or leukocytosis

Sclero-tegumentary jaundice

Rectorrhagia

Dysphagia

Odynophagia

48 hours

24 hours

12 hours

36 hours

6 hours

One hour before the incision

2 hours before incision

4 hours before incision

30 minutes before incision

3 hours before incision

5 days

10 days

14 days

7 days

21 days

The presence of a central venous catheter

The presence of a nasogastric tube

The presence of a urinary catheter

Blood transfusion

The presence of a colostomy

Peritoneal drain

Surgical sutures

Urinary catheters

Venous catheters

Antiseptic solutions

Systemically disseminated local infection

Obesity

Contamination

Diabetes mellitus

Old age

Reducing the duration of surgical intervention

Blood glucose regulation

Increasing the duration of surgical intervention

Maintaining body temperature within normal limits

Oxygen administration

Fever

Leukocytosis

Diffuse abdominal pain

Abdominal guarding, rigidity and rebound tenderness

Hemoptysis

Pneumonia associated with hospitalization

Urinary tract infections

Ventilator-associated pneumonia

Hand infections

Breast abscess

Daily detubing availability assessment through spontaneous breathing trials

Daily sedation increase

Maintaining and improving physical fitness through early mobilization

Raise the thorax by positioning the bed at 30-45 degrees

Maintaining the circuit of the ventilator

a) Oxygen saturation level

b) Urinary catheter insertion technique

c) Duration of use for urinary catheter

d) Hemoglobin level

e) Early mobilization

a) Pathogens invasion

b) Tissue necrosis

c) Systemic signs of sepsis

d) Hemoperitoneum

e) Pneumoperitoneum

a) Spontaneous wound healing

b) Death

c) Extensive tissue loss

d) Loss of limbs

e) A slow favorable local evolution

a) The aggressive hydroelectrolytic rebalancing of the patient

b) Intravenous broad-spectrum antibiotic therapy

c) Wide surgical debridement of the necrotic tissue

d) Axillary lymph node biopsy

e) Bronchoalveolar lavage

a) Difficulty swallowing

b) Breast abscess

c) Proximal nail infection

d) Stiffness of the masseter muscle

e) Stiffness of the neck muscles

a) Smoking

b) Obesity

c) Pregnancy over age 30

d) Gestational age less than 41 weeks

e) First pregnancy

a) Generalized hypersensitivity

b) Edema and erythema

c) Palpable mass

d) Soft tissue infection

e) Staphylococcus origin

a) Short-term antibiotic therapy

b) Surgical debridement

c) Does not require surgical debridement

d) Long-term antibiotic therapy

e) Long-term antibiotic therapy and excisional debridement

a) Jaundice

b) Abdominal pain in the left hypochondrium

c) Metrorrhagia

d) Charcot’s triad

e) Fulminant fever

a) Contains the cecal appendix;

b) Contains the bladder trine;

c) Contains the sigmoid colon;

d) Contains a Meckel’s diverticulum;

e) Is located under Cooper's ligament

a) Ventral hernias are primary hernias, associated with an

anterior incision of the abdominal wall;

b) Incisional hernias develop on the site of previous incisions, and can be located anywhere in

the abdominal wall;

c) Hernias of the abdominal wall can rarely cause strangulation, most only produce incarceration;

d) Parastomal hernias develop around an anatomical orifice of the abdominal wall;

e) Hernias affect only the elderly population.

a) Acute and subacute;

b) Asymptomatic, symptomatic and acute;

c) Complete and incomplete;

d) Asymptomatic, symptomatic, subacute and acute;

e) Subacute, acute, strangulated and perforated.

a) The patient is asymptomatic, the hernia being

discovered by chance;

b) Identification is facile, the hernia is visible on inspection;

c) The patient may have paresthesias or intense antero-medial thigh pain;

d) The patient occasionally presents paresthesias, but never pain;

e) The patient must also associate an inguinal or femoral hernia.

a) Contains the cecal appendix;

b) Contains the bladder trine;

c) Contains the sigmoid colon;

d) Contains a Meckel’s diverticulum;

e) Islocated under Cooper's ligament

a) Superior epigastric vessels;

b) Inferior epigastric vessels;

c) Hollow vein;

d) The portal vein;

e) Superior mesenteric vein.

a) Sometimes require the relocation of the stoma;

b) They appear after the incision of the fascia to perform a stoma, the organs around it being

those that herniate;

c) Only the greater omentum herniates around the stoma;

d) May affect stoma function;

e) The function of the stoma is not related to the hernia itself.

a) They cause the blockage of the hernia content;

b) Lead to intestinal obstruction and ischemia

c) Incarcerated hernia may progress to possible strangulation;

d) Requires surgical intervention within 4-6 hours of incarceration to avoid complications;

e) Are not of particular clinical interest until strangulation

a) Incarcerated hernias often require emergency surgical intervention;

b) The reduced organs may suffer infarction lesions or may already be ischemic;

c) Chronic incarcerated hernia without strangulation requires emergency surgical intervention;

d) After the reduction of the hernia, it is not necessary to hospitalize the patient;

e) Reduced incarcerated hernia requires hospitalization and monitoring, as the reduced

contents can be damaged by strangulation.

a) Anatomical techniques;

b) Alloplastic techniques;

c) Component separation techniques;

d) Non-invasive techniques;

e) Continence techniques.

a) Fecal incontinence;

b) Seroma;

c) Wound infection;

d) Hernia recurrence;

e) Postoperative neuropathies

a) Women rarely have indirect inguinal hernias;

b) Women rarely have direct inguinal hernias;

c) Women never have inguinal hernias, only femoral;

d) Women never have inguinal or femoral hernias, due to the anatomy of the inguinal canal;

e) Women have a much higher incidence of femoral hernias than men

a) Can be done both by classical and laparoscopic approach;

b) Is a technique reserved only for the elderly;

c) Can be made without using a synthetic prosthesis;

d) Can only be done laparoscopically;

e) Does not involve the entry into the peritoneal cavity.

a) It is not a problematic postoperative complication;

b) May lead to defective healing;

c) May lead to an abscess requiring mesh excision;

d) It is prevented even without the administration of preoperative antibiotic therapy;

e) It necessarily leads to the excision of the surgical mesh.

a) All hernias have the potential for post- herniorraphy recurrence;

b) There is no recurrence, the surgical cure definitively solves the pathology;

c) The abdominal scarsare not a risk factor for recurrences;

d) Obesity, age, functional status are not risk factors for relapses

e) Chronic cough, smoking or vigorous physical activity are risk factors for relapses.

a) Is an anterior approach operation, performed without a mesh;

b) Is an anterior approach operation, performed with a mesh;

c) The mesh is fixed on the posterior surface of the inguinal canal;

d) Is done exclusively laparoscopically;

e) A gap is created in the mesh, at a superior level, to allow the spermatic cord to enter the

groin.

a) Represents the restriction of blood flow to or from the testicle;

b) Never appears in the cure for inguinal hernias pathology, being reserved only for the local

contusion gengerated traumas;

c) Is suggested by the presence of a swollen and sensitive testicle;

d) It is never limited;

e) For its treatment, non-steroidal anti-inflammatory drugs should be sufficient

a) Is called inguinodynia;

b) Is called athletic pubalgia;

c) Is called Gilmore’s groin or hockey groin;

d) Is usually caused by tension in the adductor muscles that is inserted on the pubis;

e) Is a hernia with a severe prognosis

a) Must permanently eliminate the risk of postoperative recurrence;

b) Must minimize the risk of postoperative recurrence;

c) Must limit potential morbidity;

d) Repair techniques include anatomical, alloplastic, and component separation techniques;

e) Repair techniques also include component separation techniques

a) interferon

b) antibiotics

c) loop diuretics

d) antivirals

e) excess potassium

a) Thyroid hypofunction by damage to the hypothalamic- pituitary axis is most commonly

b) Primary hypothyroidism has a prevalence of over 2% in women in the UK

c) the most common cause of hypothyroidism is atrophic hypothyroidism

d) in iodine deficient areas, patients may be euthyroid or hypothyroid

e) TSH is the main investigation in primary hypothyroidism

a) Toxic multinodular goiter is most commonly found in young people

b) Subacute thyroiditis may be accompanied by VSH levels within normal limits

c) pembrolizumab may induce type I diabetes mellitus

d) pembrolizumab may induce type II diabetes mellitus

e)” apathetic thyrotoxicosis" is characteristic of the period of childhood

a) the occurrence of pregnancy can always be avoided during treatment with antithyroid drugs

b) PTU (propylthiouracil) is indicated in the last trimester of pregnancy

c) TSH receptors are strongly stimulated by HCG

d) Graves' disease is rarely involved in its pathogenesis

e) thyroidectomy is performed preferably in the second trimester of pregnancy

a) is commonly found

b) in the U.S. the incidence is 30,000 cases/year

c) medullary carcinoma comes from thyroid epithelium cells

d) Carcinomas derived from thyroid epithelium are always differentiated

e) Carcinomas derived from thyroid epithelium are only follicular

a) is a neuroendocrine tumor of C cells

b) can often be associated with MEN2

c) can often be associated with MEN1

d) prophylactic thyroidectomy for patients with mutations within MEN2 can be performed as early

as 3 years of age

e) vandetanib used since the initial stages provides a number of significant benefits

a) Anaplastic carcinomas respond to iodine radioactive

b) External radiotherapy provides long-lasting palliative therapy in anaplastic carcinoma

c) The primary treatment in papillary carcinoma is surgical

d) The primary treatment in follicular carcinoma is medical

e) levothyroxine reduces the risk of relapse in papillary and follicular carcinomas

a) Often familial behavior, local metastases, good prognosis

b) 5% frequency, more frequently in women, very poor prognosis

c) 5% frequency, poor prognosis

d) local metastases, rapid evolution

e) Slow evolution

a) Serum antibodies to the thyroid are common

b) occasionally found

c) destructive antibodies are directed against microsomes

d) destructive antibodies are directed against tiroglobulin

e) TSH anti-receptor IgG antibodies typically stimulate

a) lymphoid infiltration of the thyroid

b) atrophy

c) fibrosis

d) hyperplasia

e) a possible association with thyroid cancer

a) thyroid damage will be permanent

b) may cause hypothyroidism

c) may cause hyperthyroidism

d) antibody positivity brings with it a high chance of evolution towards transient hypothyroidism

e) antibody positivity brings with it a high chance of evolution towards permanent

hypothyroidism

a) children may have atypical forms

b) children may develop early puberty

c) differential diagnosis in young women is made with spaniomenorrhoea/amenorrhea,

menorrhagia, infertility

d) classic image of the patient includes dry hair, thickened skin, constipation, heat intolerance

e) the most common clinical forms are mild skin

a) puffy eyes

b) change in appearance

c) dry skin

d) warm peripheral skin

e) loss of eyebrows

a) serum TSH

b) AST/GOT

c) CK-serum creatine kinase levels

d) lipid profile

e) fT3

a) In patients with primary hypothyroidism, substitution therapy is temporary

b) The initiation dose in the elderly is 100 mcg/day

c) Patients with ischemic heart disease will receive initial doses of 25 mcg/day

d) sudden increase in doses leads to the development of "thyrotoxic" symptoms, with normal

fT4

e) sudden increase in doses leads to the development of "thyrotoxic" symptoms, with low fT4

a) assessment of patients is done approximately one month after the initiation of the therapy

b) tests should be repeated every 6-8 weeks

c) daily treatment can be given in several doses

d) proton pump inhibitors may cause difficulties in normalizing TSH

e) replacing T4 therapy with the combination of T4 and T3 has a definite benefit to the quality

of life of patients

a) solitary toxic adenoma

b) toxic multinodular gaiter

c) Grave’s disease

d) De Quervain’s thyroiditis

e) autoimmune thyroiditis

a) is the most common cause of hyperthyroidism

b) has autoimmune substrate

c) is associated with HLA-DR3

d) is associated with HLA-DR3

e) eye damage is characteristic of Graves disease

a) Yersinia enterocolitis

b) Yersinia pseudotuberculosis

c) Escherichia coli

d) some gram-positive bacteria

e) Yersinia pestis

a) solitary toxic adenoma

b) toxic multinodular goiter

c) Quervain’s thyroiditis

d) antepartum thyroiditis

e) amiodarone-indunced thyrotoxicosis

a) The cystic duct

b) The common bile duct

c) The common hepatic duct

d) The choledochus canal

e) The pancreatic duct

a) Most stones form in the gallbladder

b) Mixed stones are extremely rare

c) Pigment stones are of three types: black, brown and reddish

d) Pigmented stones occur exclusively in the common bile duct (CBD)

e) Mixed stones are always radiopaque because they contain a lot of calcium

a) In patients with jaundice, the presence of discolored stools suggests angiocolitis

b) The positive Murphy's sign is a sudden cessation of breathing due to pain on deep palpation in

the left hypochondrium

c) The presence of a distended gallbladder, but without sensitivity to palpation, together with

sclerotegumentary jaundice suggests acute cholecystitis

d) In the case of a malignant obstruction of CBD, the gallbladder expands passively due to

retrograde pressure and is palpable in the right hypochondrium.

e) Fever often accompanies biliary colics

a) The initial exploration of choice in patients with biliary disorders is computed tomography

b) Ultrasound has a very low specificity and sensitivity in the detection of gallstones

c) Ultrasound has a high sensitivity in the detection of biliary dilatations and can provide

information on the intra or extrahepatic site of biliary obstruction.

d) Bladder lithiasis is frequently visible on plain abdominal radiography

e) The initial exploration of choice in patients with biliary disorders is magnetic resonance

cholangio- pancreatography

a) The majority patients with gallstones are symptomatic

b) The risk of gallbladder cancer in patients with gallstones is very high, justifying a

cholecystectomy in asymptomatic patients

c) Patients with acute cholecystitis have significant hyperbilirubinemia

d) Ultrasound provides little information for diagnosis

e) The differential diagnosis of acute cholecystitis includes many conditions such as acute

hepatitis, acute pancreatitis, perforated ulcer, and acute appendicitis

a) Ultrasound is very useful for establishing the definitive diagnosis

b) Ultrasound does not reveal additional information about the intrahepatic bile ducts, CBD and

pancreas

c) Initial treatment of acute cholecystitis includes stopping oral food intake, intravenous

administration of fluids, and antibiotic therapy.

d) Bacteria commonly associated with acute cholecystitis are Staphylococcus aureus, Enterococcus

Faecalis, Clostridium Difficile

e) Cholecystectomy can be performed laparoscopically, but the classic approach may be

needed due to bleeding or difficulty establishing anatomical landmarks.

a) Chronic cholecystitis is the most common form of symptomatic vesicular lithiasis

b) Nausea and vomiting may accompany the pain

c) Ultrasonography is the initial investigation of choice and can confirm the presence of

gallstones in> 95% of cases.

d) Dissolution therapy is an option in 15% of patients with gallstones who do not tolerate

surgery and those who refuse surgery.

e) Emergency laparoscopic cholecystectomy is indicated in all patients with asymptomatic

gallstones

a) Primary stones are very rare and develop de novo in the CBD

b) Secondary stones are very rare and develop de novo in the CBD

c) Smaller stones that reach the CBD can advance into the duodenum

d) Choledocholithiasis can cause biliary colic, obstruction, cholangitis, or pancreatitis

e) Jaundice associated with choledocholithiasis is a progressive jaundice in intensity

a) It is characterized by jaundice, abdominal pain in the right hypochondrium, and fever

associated with chills

b) All forms of cholangitis progress to septic shock

c) Reynold's pentad is characterized by jaundice, abdominal pain in the right

hypochondrium, and fever associated with chills, hypotension, and mental confusion.

d) In patients with cholangitis, the leukocyte count is usually low

e) Serum amylase and lipase may be increased in case of obstruction of the pancreatic duct

a) Ultrasound is the initial imaging investigation of choice in patients with choledocholithiasis

and cholangitis

b) Magnetic resonance cholangiopancreatography (MRCP), ERCP or PTC are the best

studies to define the specific site and the source of the bile duct obstruction.

c) The disadvantage of ERCP is that although it establishes the diagnosis of lithiasis, it cannot

extract stones

d) In patients with cholangitis, the number of leukocytes is usually increased

e) If the bile duct cannot be cleared of stones by laparoscopic exploration, open bile duct

exploration or postoperative ERCP and sphincterotomy may be required

a) It is a chronic condition

b) Initial management involves cholecystectomy

c) Endoscopic intraluminal lithotripsy can be used to break up large stones.

d) Blood cultures are obtained and broad-spectrum antibiotic therapy targeting Gram-

negative bacteria should be initiated.

e) Any coagulation disorders should be corrected by parenteral administration of vitamin C or

platelet mass prior to an invasive procedure.

a) Pancreatitis is commonly associated with kidney stones and alcohol consumption

b) May occur due to transient or persistent obstruction of the pancreatic duct

c) Small stones cannot cause pancreatitis

d) Biliary sludge may be a trigger for acute pancreatitis

e) Patients with acute pancreatitis are most commonly asymptomatic

a) The pain in acute pancreatitis is in the upper abdomen often radiating to the back

b) In acute pancreatitis, no signs of peritoneal signs may occur

c) Once the acute episode of pancreatitis has subsided, the gallbladder should be removed as

soon as possible to avoid recurrences of pancreatitis.

d) Antibiotic therapy is given in cases of severe acute pancreatitis

e) Emergency endoscopic sphincterotomy with stone extraction is the treatment of choice for

patients with acute biliary pancreatitis

a) It is a common cause of intestinal obstruction

b) Patients present with symptoms of acute cholecystitis

c) Plain radiographs of the abdomen show signs of small bowel obstruction and may detect

the presence of air in the bile duct.

d) CT with oral contrast is the investigation of choice for diagnosis

e) It is a mechanical bowel obstruction caused by a gallstone

a) It is the most common cancer of the biliary tract

b) Gallstones are the most common risk factor

c) Prophylactic cholecystectomy is generally recommended for any finding of gallbladder wall

calcification on imaging studies

d) The most common symptom is weight loss

e) Another risk factor for gallbladder cancer is the porcelain gallbladder

a) The most common symptom is pain in the right upper quadrant

b) The most common symptom is weight loss

c) Jaundice may be present

d) 5-year survival rate is good (> 80% at 5 years)

e) Larger tumors, abutting or growing into the liver parenchyma are treated with liver wedge

resection of the gallbladder fossa and regional lymphadenectomy

a) Severe abdominal pain

b) Chills

c) Jaundice

d) Externalization of blood through a drainage tube or postoperative wound

e) Cough

a) It is the preferred approach for the management of gallstones only in elective interventions

b) The main risks associated with the laparoscopic approach are related to injuries resulting

from blind trocar insertion or injudicious use of electrocautery

c) Intraoperative cholangiography is routinely used

d) The advantages of the laparoscopic approach are the reduction of postoperative pain and

reduction of wound and lung complications

e) If the patient has comorbidities, postoperative hospitalization is extended to 5 days.

a) Palpation of a gallstone

b) Jaundice

c) Acute biliary pancreatitis

d) Small gallbladder stones

e) Ductal dilation

a) Mobilization of the liver through the Kocher maneuver

b) Identification of the bile duct

c) Making a transverse incision in the bile duct

d) Irrigation of CBD lumen with saline

e) Making a longitudinal incision in the bile duct

a) Inferior mesenteric vein with splenic vein,

b) Splenic vein with gastrocolic vein,

c) Inferior mesenteric vein with gastrocolic vein,

d) Superior mesenteric vein with splenic vein

e) Superior mesenteric vein with gastrocolic vein

a) Cholangiocarcinoma,

b) Epithelioid hemangioendothelioma,

c) Hepatocellular carcinoma,

d) Angiosarcoma,

e) Liver metastases.

a) Neuroendocrine tumors,

b) Gastrointestinal tumors,

c) Breast tumors,

d) Pulmonary tumors,

e) Tumors from the genital area

a) They are caused by exposure to chemicals, drugs

b) They are not caused by infectious agents, inflammatory processes or neoplasm

c) In many cases, the etiology cannot be established

d) Patients with Coombs-positive haemolytic anaemia should be treated with corticosteroids

e) Splenectomy is indicated when corticosteroid therapy is ineffective.

a) Conservative medical treatment

b) Splenic embolization

c) Emergency splenectomy

d) Radio-imaged percutaneous drainage

e) Delayed splenectomy

a) It is an autosomal dominant condition,

b) It occurs in 10% of patients,

c) Microscopically, multiple cysts are not similar to simple cysts,

d) Although difficult to perform, surgical deroofing is the most effective method of treatment,

e) In extreme cases, liver transplantation can be used as a method of treatment

a) Have small lesions,

b) Have high blood levels of carcinoembryonic antigen

c) Have a period of more than 6 months of lack of disease progression

d) Have no extrahepatic secondary lesions,

e) Have no secondary tumor nodes.

a) Bone system,

b) Peritoneum

c) The lung,

d) Cerebral

e) Bladder.

a) Absence of nerve invasion,

b) Single tumor less than 5 cm,

c) Absence of peritoneal metastases,

d) Up to three tumors ≤3 cm

e) Absence of vascular invasion.

a) Adenoma,

b) Hepatoma,

c) Hemangioendothelioma epithelioid,

d) Liver metastases,

e) Angiosarcoma

a) It always requires surgical treatment,

b) Most patients are asymptomatic

c) It is usually discovered by chance,

d) It is often associated with ruptures and hemorrhages

e) May not increase in size.

a) 1⁄4 from the hepatic blood flow is through the portal vein,

b) The liver has a double vascularization through the hepatic artery and portal vein,

c) 1⁄4 of the hepatic blood flow is through the hepatic artery,

d) The hepatic arterial system has a unique distribution,

e) The veins in the liver drain blood directly into the inferior vena cava

a) The patient has a liver metastasis,

b) The patient appears to have focal nodular hyperplasia,

c) May be proposed for hepatic resection,

d) Radiofrequency ablation can be considered as a therapeutic option if the lesion is superficial

e) Chemoembolization is a therapeutic option.

a) Liver transplantation,

b) Liver resection,

c) Transarterial chemoembolization,

d) Chemotherapy,

e) Radiotherapy.

a) Increase in size,

b) Rupture and hemorrhage,

c) Malignant degeneration,

d) Cirrhosis of the liver,

e) Liver failure

a) Scintigraphy fails to identify possible accessory spleens

b) Splenosis results in a hypocapture of the radioisotope in ectopic positions

c) Abdominal ultrasound remains one of the best methods to quickly assess patients with

trauma for the presence of blood in the peritoneal cavity

.

d) CT scan with contrast performed intravenously and orally is most useful radiologic

investigation for determining spleen dimensions and injuries

e) Angiography is also helpful in the evaluation of spleen tumors

a) Elliptocytosis

b) Pyropylocytocytosis

c) Spherocytosis

d) Xerocytosis

e) Hydrocytosis

a) Haemolytic anaemia

b) Fever

c) Purpura

d) Liver damage

e) Neurological manifestations.

a) Platelet count < 50,000 and the presence of hemorrhage

b) If the patient has anaemia requiring transfusion

c) As a first-line indication if the hypersplenism is secondary

d) In case of neutropenia <2000 with intercurrent infections

e) In case of neutropenia <2000 without intercurrent infections.

a) In major thalassemia, splenectomy is beneficial because is reducing the need for transfusion

b) In minor thalassemia, splenectomy can reduce the need for transfusion and the problems

associated with iron overload.

c) In major thalassemia, splenectomy is beneficial in reducing physical discomfort due to

massive splenomegaly

d) Patients diagnosed with such a condition and undergoing splenectomy, are not at risk of

developing OPSI (overwhelming post-splenectomy infection)

e) There are many types of thalassemia

a) 15 and 19 years

b) 14 and 18 years

c) 20 and 24 years

d) 34 and 40 years

e) 24 and 30 years

a) thigh

b) forearm

c) calf

d) arm

e) of the hand

a) loss of at least 1500 ml of blood in the pleural space

b) loss of at least 1000 ml of blood in the pleural space

c) loss of at least 500 ml of blood in the pleural space

d) loss of at least 100 ml of blood in the pleural space

e) loss of at least 2000 ml of blood in the pleural space

a) Loss of at least 1500 ml of blood in the pleural space

b) Loss of at least 500 ml of blood in the pleural space.

c) Hypotension due to rib fractures.

d) Existence of a costal flap with aerated hemoptysis.

e) Requires emergency thoracic drainage.

a) Class I

b) Class II

c) Class III

d) Class IV

e) Class V

a) flexion

b) antero-posterior loading

c) extension

d) rotation

e) axial load

a) low-intensity heart sounds

b) jugular turgor

c) hypertension

d) high-intensity heart sounds

e) hypotension

a) fracture of the ilio-pubic branch

b) traumatic rupture of the pubic symphysis

c) spacing of the iliac wings

d) variable sacroiliac ligament ruptures

e) fracture of the ischio-pubic branch

a) antero-posterior compression of the pelvis

b) lateral compression of the pelvis

c) vertical shear

d) traumatic rupture of the pubic symphysis

e) spacing of the iliac wings with sacroiliac ligament ruptures.

a) pericardiotomy, for the treatment of cardiac tamponade

b) open heart massage (superior to chest compressions in restoring infusion, especially in

patients with hypovolemia)

c) clamping of the descending aorta at the level of the diaphragm

d) lowering blood pressure

e) intracardiac administration of drugs

a) Execute commands = 6 points

b) Withdrawal in pain = 4 points

c) Decerebration stiffness (abnormal extension) = 1 pt

d) Decerebration stiffness (abnormal extension) = 2 pt

e) Withdrawal from pain = 1 point

a) Blood loss in a person of 70 kg - 1500-2000 ml.

b) Normal blood pressure.

c) Heart rate over 100 beats / minute.

d) Blood loss of 15-30%.

e) Normal capillary filling time

a) Hypotension.

b) Hypertension.

c) Bradycardia.

d) Tachycardia.

e) Cold extremities.

a) Hypotension.

b) Bradycardia.

c) Tachycardia.

d) Cold extremities.

e) Cyanotic skin.

a) L2.

b) L3.

c) L4.

d) L5.

e) S1.

a) Hematuria.

b) Scrotal hematoma.

c) Malposition of the prostate to rectal touch.

d) Edema of the foreskin.

e) Absence of prostate on rectal palpation.

a) Hemorrhagic/hypovolemic

b) Cardiogenic

c) Abdominal

d) Neurogenic

e) Obstructive

a) Paraplegia

b) Tetraplegia

c) Brown-Sequard syndrome

d) Anterior medullary syndrome

e) Central medullary syndrome.

a) Pneumothorax in tension

b) Cardiac tamponade

c) Massive hemothorax

d) Multiple rib fractures

e) The costal flap

a) It may be associated with contusion of the underlying lung parenchyma

b) It is clinically highlighted by the Kussmaul sign and the paradoxical pulse

c) It is always associated with pneumothorax

d) Occurs when 2 or more adjacent ribs are fractured in several places

e) It is clinically highlighted by the paradoxical movement of the chest wall with the

respiratory rhythm

a) Intense lumbar pain

b) Size of the herniated disc visualised on MRI

c) Pain irradiated in inferior limbs

d) Progressive neurological loss due to herniated disc

e) Young age of the patient.

a) Multiple myeloma

b) Osteosarcoma

c) Chondrosarcoma

d) Ewing sarcoma

e) Giant cell tumour.

a) Fracture of the 2nd and 3rd metacarpal bone

b) Fracture of the distal epiphysis of the radius

c) Fracture of the 5th metacarpal bone

d) Fracture of the 1st metacarpal bone

e) Fracture of ulna.

a) Osteosynthesis with an external fixator

b) Cast immobilisation

c) Internal fixation with plate and screws

d) Osteosynthesis with cortical screws

e) Osteosynthesis with locked centromedullary nail.

a) Diaphysis of long bones

b) Metaphysis of long bones

c) Epiphysis of long bones

d) Synovial membrane

e) Periosteum

a) Healing prognosis

b) Type

c) Localization

d) Displacement

e) Angulation.

a) Open, unstable fractures

b) Infected fractures

c) Stable pelvic ring fractures

d) Severely comminuted or unstable fractures when internal fixation is not possible

e) Fractures with bone loss when the length of the bone must be preserved and a bone graft

has to be added

a) Tip of angle deformity points opposite to the median line of the body

b) Tip of angle deformity points towards to the median line of the body

c) Displacement of the distal part is towards the median line of the body

d) Displacement of the distal part is lateral of the long axis of the affected area

e) Displacement of the distal part is medial of the long axis of the affected area.

a) Hypesthesia of the medial part of the arm and 5th finger

b) Weak finger extension

c) Weak triceps extension

d) Weak wrist flexion

e) Decreased tricipital reflex.

a) Pain over articular line, especially in effort

b) Eccentrical epiphyseal radiological image with metaphyseal extension

c) Pain near the joint

d) Pain along the diaphysis

e) Localization in the epiphysis that form the knee joint

a) Head of the humerus

b) Head of the femur

c) Head of peroneum

d) Talus

e) Calcaneum

a) May influence the viability of the affected limb

b) Have bacterial contamination

c) May lead to infections of the wounds and osteomyelitis

d) Are accompanied by shock

e) Have a better outcome than closed fractures in general.

a) Osteoporosis

b) Submaximal stress on the same bone

c) Malignant bone tumors

d) Benign bone tumors

e) Bone metastasis.

a) Spiral fracture

b) Oblique fracture

c) Butterfly fragment fracture

d) Fracture with more than two fragments

e) Segmentary fracture.

a) Occurs in children

b) Is a complete fracture

c) Affects only one side of the cortex

d) Is an incomplete fracture

e) Is a segmentary fracture.

a) Subchondral osseous cysts

b) Subchondral bone sclerosis

c) Microfractures

d) Osteophytes

e) Decreased articular space.

a) Reveals achilian tendon rupture

b) Shows plantar flexion af the ankle when the tendon is ruptured

c) Shows dorsal flexion of the ankle when the tendon is ruptured

d) Is performed with the patient in prone position with the foot at the side of the examination

table

e) Shows the integrity of the gastrocnemius-solear muscles complex.

a) Anterior drawer test

b) Medio-lateral instability of the knee

c) Valgus displacement for medial colateral ligament tear

d) Varus displacement for lateral colateral ligament tear

e) Full knee extension

a) Cast immobilisation

b) Autologous patellar tendon graft

c) Early knee mobilisation

d) Orthosis immobilisation

e) Autologous semitendinosus and gracilis muscle graft.

a) Arthroplasty

b) Arthrodesis

c) Osteosynthesis

d) Realignment osteotomy

e) Steroid or viscosupplementation agents intraarticular injections

a) venous blood collection

b) arterial blood collection

c) sperm analysis

d) urine culture with antibiogram

e) summary urine test

a) E. coli

b) Klebsiella Pneumoniae

c) Pseudomonas aeruginosa

d) Serratia marcescens

e) Acinetobacter

a) the ureteral orifices

b) the junction between proximal ureter and renal pelvis

c) the bladder

d) the membranous urethra

e) the prostate

a) 20-25 mL / sec

b) 50-75 mL / sec

c) 75-90 mL / sec

d) 100-125 mL / sec

e) 10 mL / sec

a) involuntary loss of urine

b) urinary retention

c) urinary tract infection

d) positive urine culture with E. coli

e) hematuria

a) decrease or lack of urination sensation, without detrusor hyperreflexia

b) high bladder capacity

c) reduced bladder capacity

d) has nothing characteristic

e) accentuation of the urination sensation

a) sigmoid diverticulitis

b) cancers

c) Chron's disease

d) penetrating abdominal trauma

e) benign prostatic hypertrophy

a) CRCC most often metastasizes to the lung, bone, and brain

b) the treatment for localized CRCC is radical or partial nephrectomy

c) hematuria seems to be the most common clinical sign

d) in 50% of cases CRCC may be bilateral

e) there are 4 tumor markers specific for CRCC

a) Finasteride

b) Dutasteride

c) Tamsulosin

d) Doxazosin

e) Terazosin

a) it is a life-threatening infection

b) uncontrolled diabetes is the most common risk factor

c) the diagnosis is frequently established by CT

d) nephrectomy is strictly forbidden

e) the administration of anti-inflammatory medication is of the first intention

a) myelodysplasia

b) hypospadias

c) HIV

d) Hepatitis C

e) Hepatitis B

a) leukoplakia

b) Bowen's disease

c) Queyraterythroplasia

d) giant acuminate warts

e) paraphimosis

a) tubular acidosis

b) hyperparathyroidism

c) dehydration

d) moderate physical exercises

e) alcohol consumption

a) telescope

b) forceps of foreign bodies

c) an intermediate piece

d) a sheath containing inlet and outlet channels for irrigation

e) urine collection bag

a) is the fifth most common cancer in the American population

b) the prevalence among smokers is 5 times higher

c) transitional cell carcinoma represents 85-90% of all bladder tumors

d) is not treated surgically

e) macroscopic hematuria is a rare sign

a) Two corpora cavernosa and two corpora spongiosa

b) Two corpora cavernosa

c) One corpus spongiosum

d) Buck’s fascia

e) One corpus cavernosum and two corpora spongiosa

a) Can have high-flow

b) Can be without flow

c) Can have low flow

d) Is a pathology defined by the absence of erection

e) Is a pathology defined by the presence of a prolonged erection

a) Represents the presence of a scar of the tunica vaginalis of the testis

b) Represents the presence of a scar of the tunica albuginea of the corpora cavernosa

c) Is commonly found on the ventral face of the penis

d) Is commonly found on the dorsal face of the penis

e) Can be efficiently treated with oral medication

a) Is divided into posterior, middle and anterior urethra

b) Has a segment called membranous urethra

c) Has a segment called bulbar urethra

d) Has a segment called spongious urethra

e) Is all lined with transitional cell epithelium

a) The urethral meatus is located in the dorsal face of the penis

b) The urethral meatus may be perineal

c) The urethral meatus may be penoscrotal

d) The urethral meatus may not be glandular

e) The urethral meatus may not be coronal

a) Subcutaneous collection of pus

b) Acute bacterial infection of the dermis and subcutaneous tissue

c) Quickly spreading group polymicrobial infection of fascial planes

d) Tissue necrosis because of poor vascular supply or severe infection

e) Contagious skin infection most commonly found in children; most commonly caused by

Staphylococcus aureus

a) the trunk

b) anterior tibias

c) other extremities

d) posterior tibias

e) cephalic extremity

a) Pearly papule with fine vascular markings

b) Painless, erythematous plaque with scaling

c) Erythematous papule with rough, scaly surface

d) Painless, pigmented lesion, superficial spreading

e) Lesion with irregular borders, multiple colors, rapidly growing

a) superficial spreading

b) lentigo maligna

c) nodular

d) acral lentiginous

e) acromic

a) 0,5 cm

b) 1 cm

c) 2 cm

d) 0,6 cm

e) 3 cm

a) Abscess

b) compartment syndrome

c) sepsis

d) permanent scars

e) necrotizing fasciitis

a) yellow crusted lesions

b) erythematous vesicles or blisters

c) facial pruritus

d) papules, pustules or erythematous nodules

e) scars

a) Topical retinoids

b) Antibiotics oral or topical

c) Cryotherapy or topical salicylic acid

d) Topical benzoyl peroxide

e) Oral isotretinoin in severe cases

a) erythema, swollen and warmth in involved area

b) myalgias

c) ulcers and bulle

d) fever, chills

e) extensive necrosis of the soft tissue

a) encephalitis

b) pneumonitis

c) hepatitis

d) Transmission from infected mother to newborn can cause disseminated disease with severe

neurologic involvement.

e) frequent reccurences

a) well-defined lesions of thickened epithelium

b) shiny papules with central umbilication

c) may appear flat or raised

d) painful, small vesicles

e) occasional tenderness to palpation

a) macules, plaques or vesicles on extremities

b) target lesions

c) myalgias, pruritus

d) positive Nikolsky sign

e) malaise

a) decreased WBC

b) decreased hemoglobin

c) decreased hematocrit

d) increased alanine aminotransferase (ALT)

e) decreased aspartate aminotransferase (AST)

a) pruritus

b) erythematous plaques with yellow, greasy scales

c) erythematous plaques with silvery scales

d) erythematous plaques and xerosis

e) oval erythematous papules covered with white scale

a) moisturizing creams

b) topical corticosteroids

c) oral corticosteroids in severe cases

d) antihistamines

e) antifungals

a) sharply demarcated erythematous plaques with silvery scales

b) the lesions affect the extensor surfaces

c) positive Auspitz sign

d) pitted nails

e) absence of pruritus

a) emollients

b) topical corticosteroids

c) phototherapy

d) methotrexate, cyclosporine in severe cases

Edwin

a) positive family history

b) Infections

c) collagen vascular diseases

d) inflammatory bowel disease

e) Drugs

a) painful, fragile blisters on the skin and mucosa

b) erosions are common

c) positive Nikolsky sign

d) positive Auspitz sign

e) widespread blistering/bullae, pruritus

a) corticosteroids

b) low-dose chloroquine or hydroxychloroquine

c) azathioprine

d) periodic phlebotomy

e) cyclophosphamide

a) may occur due to acquired membrane defects

b) include anemia due to pyruvate kinase deficiency

c) malaria cannot cause hemolysis, anemia is due to low erythrocyte production

d) In cold AIHA, antibodies are usually IgG

e) AIHAs are idiopathic in 90% of cases

a) iron supplements are administered with a cup of tea to optimize absorption

b) administration of iron supplements can take up to 6 months

c) it is recommended to take 200 mg of oral iron 3 times a day, knowing that hepcidin is decreasing

after the first dose

d) clinically, in iron deficiency anemia, neurological syndrome may occur

e) ferritin is the iron transport protein in the body

a) koilonychia is observed only in cases with a very long term iron deficiency

b) serum ferritin is elevated

c) TIBC is low

d) macrocytosis occurs

e) orange juice may decrease iron absorption

a) in cold AIHA, the antibodies are usually IgG

b) can be classified into anemia of immune, non-immune or other causes

c) the antibodies involved in warm AIHA are predominantly IgG, and the Coombs test is positive

only for IgG, IgM and complement

d) only alloantibodies are the main causes of immune destruction of erythrocytes

e) direct Coombs test detects free anti-erythrocyte autoantibodies, not fixed on red blood cell

surface

a) an increased plasma volume will lead to a falsely increased hemoglobin;

b) lower limb ulcers may occur in association with iron deficiency anemia

c) worldwide, the most common cause of anemia is vitamin B12 deficiency

d) the majority of iron in the body is in the insoluble ferric (Fe3+) form.

e) one of the causes of microcytic hypochromic anemia is the defect in globin production

(sideroblastic anemia)

a) daily, only 10% of the iron from the diet is absorbed.

b) iron is absorbed in the terminal ileum cells

c) a protein called hepcidin is essential for regulating intestinal iron absorption

d) absorption is low in iron overload, except for hereditary haemochromatosis, where it is

increased

e) most of the iron bound to transferrin comes from iron absorbed in the intestine

a) about two-thirds of the total body iron is in the circulation as haemoglobin

b) ferritin is an acute phase protein

c) absorption of non-heminic iron occurs in the duodenum

d) hemosiderin is a water-soluble complex formed by the association of iron with a protein,

being present in small amounts in plasma

e) each transferrin molecule binds two ferric iron atoms and is normally completely saturated

a) in pregnant women

b) blood loss from the gastrointestinal tract resulting from parasites

c) when iron intake is insufficient for growth requirements

d) postmenopause

e) in patients with chronic diseases

a) There is accumulation of iron in the mitochondria of megakaryoblasts, secondary to abnormal

heme synthesis

b) transmission is X linked or autosomal recessive

c) most adult-acquired sideroblastic anemias are a form of myelodysplastic syndromes

d) the most effective therapeutic attitude is corticotherapy

e) inefficient heme synthesis is responsible for macrocytic, normochromic cells

a) there is a decrease in the lifespan of the erythrocytes

b) serum iron and total iron binding capacity (CTLF) are low

c) the level of hepcidin decreases and the circulating iron is depleted

d) serum ferritin is normal or low secondary to the inflammatory process

e) recombinant erythropoietin therapy is used occasionally in patients with rheumatoid

arthritis

a) there is no methylation of deoxyuridine monophosphate to deoxythimidine monophosphate

b) erythroblasts have delayed maturation cytoplasm

c) megaloblastic changes may occur in RNA synthesis defects, such as in congenital enzyme

deficiencies

d) megaloblastic changes may occur in myelodysplasia due to dyserythropoiesis

e) nuclear maturation of erythroblasts is delayed

a) low LDH

b) hypersegmented polymorphonuclear neutrophils

c) thrombocytosis

d) thrombocytopenia

e) the bone marrow examination reveals normoblasts

a) secondary haemochromatosis that occurs in sideroblastic anemia

b) hereditary haemochromatosis where a mutation in the HFE gene or other iron-controlling

proteins causes increased iron absorbtion

c) hereditary haemochromatosis due to iron overload in conditions treated by regular blood

transfusions

d) non-transfusional iron overload, where effective erythropoiesis results in controlled absorption of

iron in the stomach via erythroferrone

e) non-transfusion iron overload, ineffective erythropoiesis drives uncontrolled iron

absorption from the gut via erythroferrone

a) serum folate reflects recent folate status and intake

b) the amount of folate in red blood cells is a measure of tissue folate over the lifetime of red

blood cells

c) a level below 3 µg/L (7 nmol/L) indicates folate deficiency

d) a level below 1500 µg / L (340 nmol/L) of tissue folate is representative of folate deficiency,

e) serum folate measurement is usually not sufficient to to diagnose folate deficiency

a) folic acid is not present in nature in the form of polyglutamate, but appears as

monoglutamate

b) folates are present in food as polyglutamates in the reduced dihydrofolate or tetrahydrofolate

forms

c) polyglutamates are broken down to monoglutamates in the lower gastrointestinal tract

d) methylation of homocysteine to methionine requires both methylcobalamin and methyl THF as

coenzymes

e) intracellular polyglutamates are the inactive forms of folate

a) vitamin B12 was first crystallized as cyanocobalamin

b) measurement of methylmalonic acid is used as a routine test for vitamin B12 deficiency

c) vitamin B12 is absorbed in the stomach

d) deoxyadenosylcobalamin is a coenzyme for the conversion succinyl CoA to cobalamin

e) vitamin B12 has a central corrin ring and a nucleotide set at right angles

a) occasionally are seen in patients who are not clinically anaemic

b) patients present with asymmetrical paraesthesiae in the fingers and toes

c) patients present late loss of vibration sense and proprioception, and progressive weakness and

ataxia

d) typical neurological changes are those of a polyneuropathy that progressively involves the

peripheral nerves, the posterior and eventually the lateral columns of the spinal cord

e) paraplegia cannot occur

a) intrinsic factor deficiency

b) congenital transcobalamin II deficiency

c) gastrectomy

d) bacterial overgrowth in the small bowel

e) secondary to exaggerated erythrocyte destruction

a) occurs in patients receiving aspirin

b) folate deficiency develops over the course of about 4 months to the patients in intensive care

units

c) occurs in malignant disease with increased cell turnover

d) on a deficient diet, folate deficiency develops over the course of about 4 months,

e) occurs in patients receiving Methotrexate

a) oral treatment with vitamin B12 can be used

b) hydroxycobalamin 1000 µg can be given intramuscularly over the course of 4-5 months

c) clinical improvement may occur within 48 hours and a reticulocytosis can be seen to 2–3 days

after starting therapy

d) polyneuropathy may improve in 6-12 months, but long- term spinal cord injury is irreversible

e) hyponatremia may occur and, if it is severe, potassium supplements should be administered