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Faculty of Medicine

4th  year N2 group division 2016/2017

 

Surgery division

N2

at the beginning of the block 3 days of seminars. 6 (academic) hours  per day.

SEMINARS: take place at SPSK1 (Unia Lubelska)  Centrum Diagnostyki i Leczenia Nowotworów Dziedzicznych;  Klinika Ortopedii i Traumatologii – seminar room on the I floor.

 

SEMINAR DAYS:

10.10.2016 (Monday)

8:30 - 10:00 a.m.

 Venous diseases. Pulmonary embolism. – prof. Piotr Gutowski

10:15 -11:45 a.m.

Acute conditions of urology. – prof. Marcin Słojewski

12:00 -13:30 p.m.

Principles of urooncology. Erection disorders. – prof. Marcin Słojewski

 

11.10.2016 (Tuesday)

8:30 - 10:00 a.m.

Prostate disorders. Diagnostic principles in urology – dr Adam Gołąb

10:15 -11:45 a.m.

Acute abdominal trauma. Acute appendicitis. – assoc prof. Marek Kamiński

12:00 -13:30 p.m.

Gastric cancer and other gastric diseases.  Bowel obstruction. – assoc. prof. Marek Kamiński

 

12.10.2016 (Wednesday)

8:30 - 10:00 a.m.

Acute abdominal diseases - principles of diagnosis.  Abdominal hernias. – dr Anita Suwała

10:15 -11:45 a.m.

Basic guidelines in oncology. Colorectal cancer. Breast cancer. – dr Anita Suwała

12:00 -13:30 p.m.

Acute cholecystitis. Acute pancreatitis. Burns. Reconstructive surgery. – prof. Piotr Prowans

Subgroup division:

Duration of lessons: 8.15 - 11.40

The table showing names of assistants providing lessons linked to groups. The table is refreshed every month.

Legend:

Cnot= assoc. prof. Miloslaw Cnotliwy

Wier= assoc. prof Ireneusz Wiernicki

Troj= dr Beata Trojnacka

Kup= dr Halina Szumiłowicz

Petr= dr Wojtek Petriczko

Kaz= dr Arkadiusz Kazimierczak

Tur= dr Radoslaw Turowski

Now= dr Maciej Nowacki

Ryn= dr Pawel Rynio

Educational materials:

Control questions

1. Significant stenosis of the internal carotid artery (ICA) is responsible for the occurrence of stroke in:

A). 80%

B). 50%

C). 20%

D). 5%

 

2. 80 year old smoker with hypertension and detected with ultrasound 80% stenosis of right external carotid artery . Until now, he hasn't come an episode cerebrovascular and not taking any medications. Other extracranial arteries intracerebral ultrasound are without stenosis. What do you propose:

a). You qualify patient for surgical endarterectomy of right external carotid artery (CEA)

b) you assess the risk of cardiac complications to qualify for carotid stenting  (CAS)

c) disqualify any treatment of vascular surgery

d) you repeat ultrasound examination by another doctor, deploy aspirin to 100 mg and aksk for internist consultation to set the treatment of hypertension.

 

3. In the case of internal carotid artery stenosis> 70% for stroke, is mainly responsible

a) reduction in blood flow through stenosed coronary arteries

b) embolic material released from atherosclerotic plaque in the carotid bifurcation

c) pilferage of blood through the vertebral arteries and blood flow disorders in basal circulating vertebrobasilar

d) none of the above is correct

 

4. 70 year old woman with a history of, diabetes, hypertension, severe heart failure after myocardial infarction, atrial fibrillation and stroke with hemiparesis left-hand before 3 months. The ultrasound found made critical (> 95%) stenosis of the left internal carotid artery and occlusion of the right internal carotid artery. On this basis, you find that the sick has:

a) asymptomatic stroke corresponding narrowing of the ICA

b) symptomatic stroke corresponding narrowing of the ICA

c) asymptomatic not corresponding stroke ICA stenosis

d) symptomatic not corresponding stroke ICA stenosis

 

5. The patient was out of the question 4. qualify for

a). conservative treatment

b) Operational recanalization of the left carotid artery, and then designate the term recanalization of the right carotid artery

c) you assess the risk of cardiac complications and qualify for CAS

d) qualify for CEA using shunt

 

6. The total occlusion of the internal carotid artery is an indication for:

a) carotid endarterectomy(CEA)

b) the endovascular recanalization (CAS)

c) conservative treatment

d) None of the above

 

7. three times, accelerate the speed of blood flow in the artery stenosis proves it:

a) stenosis of <50%

b) 70% stenosis

c) 99% stenosis

d) complete its closing

 

8. 76 year old smoker with well-treated hypertension, receiving Aspirin 75mg / d. Without other measures. Traveled 2 months before an episode of TIA (can not remember which side of the body was paresis, but remember that for a few minutes could not speak). An ultrasound diagnosed evident 80% stenosis of both carotid arteries. you propose

and). Re-carotid ultrasound to verify the diagnosis and prices which party is more tapered

b). You set which side is dominant patient and qualify for the CEA page opposite (eg. U-handed first CEA on the left)

c) the execution of a vendor angio-CT for final verification of the degree of vasoconstriction

d) will you order conservative treatment

 

9. Indications for CEA / CAS is not

a) Reduction of the ICA in the range of 70-99%

b) ICA symptomatic stenosis> 50% plaque hipoehogeniczną

c) asymptomatic ICA stenosis> 70% plaque hipoehogeniczną

d) Asymptomatic 65% ICA stenosis with a well-calcified plaque.

 

10. In a well-center treating vascular percentage of qualification for CAS compared to CEA should:

a) exceed 90%

b) exceed 50%

c) does not exceed 30%

d) amount to 0% (this should not be eligible at all to CAS)

 

11. The patient years 75. Currently, non-smoker. With diabetes and hypertension. Effectively treated pharmacologically. Without the burden of cardiac. An ultrasound diagnosis of stenosis of 99% ICA left ICA and 75% for the right side. you propose

a) CEA left because the risk of cardiac complications by LEE score is low

b) within a few weeks after the operation the left side designate the right hand term CEA

c) you will perform control carotid ultrasound every 6-12 months after surgery

d) all of the correct answers.

 

12. When obtaining informed consent talking with the patient in question 11 on possible treatment options, and treatment complications. The patient is more interested in submission to CAS than CEA. What do you tell him?

a) the risk of complications of brain and heart is higher in the case of CEA

b) the risk of complications of brain and heart is higher in the case of CAS

c) in the case of CEA risk of cardiac complications it is lower, but a higher risk of stroke.

d) if the risk of cardiac complications CAS is lower, but a higher risk of stroke.

 

13. steal syndrome

a) occurs more on the left side and is associated with the reversal of flow in the vertebral artery

b) can cause a temporary loss of consciousness (syncope)

c) requires a bridge carotid-subclavian if you fail to restore patency of the subclavian artery endovascular

d) all of the answers correct

 

14. Chronic ulcers are the most common

a) background Vascular

b) background immunological

c) background rheumatological

d) none of the above

 

15. In the determination of the reasons behind the ulcer is not relevant

a) to examine the pulse and evaluation of ABI

b) to establish co-morbidities and medications

c) evaluating the color, the smell of secretions from the wound

d) to take pictures ulcers

 

16. The term "staging" of clinical wound ratios are used:

a) Pedis, WAGNER, EDMONDS & FOSTER

b) ASA, GOLDMAN, LEE

c) V-POSSUM, SCORE

d) TASC, ICCP

 

17. 69 year-old longtime smoker reported with chronic ulceration of the right forefoot (5 months). Color wounds black and green, the smell of anaerobic. It occupies an area of ​​about 8cm square. Visible changes in the trophic toes. No history of diabetes. Suspecting background ischemic (ve decided no pulse below groin) are doing ABI, which is to the right of 0.56, 0.74 left.

a). You drive the patient to imaging in order to qualify for revascularization in the first place

b). You start local treatment (debridement, Octanilin, Optrunki specialist - HFT) because the wound has a good chance to heal without revascularization

c) performing the seeds to start the targeted antibiotic therapy, which should result in spontaneous healing wounds

d) qualify for primary amputation of the forefoot

 

18. Recommended topical antiseptics for the treatment of chronic wounds are:

a) Hydrogen peroxide

b) Silver (Ag) if used long-term (more than 2 weeks)

c) Octanilina

d) iodinated in combination with Octaniliną

 

19. Which of the following statements regarding the chronic wound is not true?

a) it is always desirable and often must be performed

b) must be performed on the wound in at least three degrees W.A.R. score

b) should be performed in diabetic foot grade 3 Wagner

c) should be made of the causes of epidemiological before a planned hospitalization (in terms of insulation and limiting the spread of antibiotic-resistant strains)

 

20.Proximal episode of deep vein covers

a). Vein iliac, femoral, popliteal and tibial with the exception of superficial veins and deep vein rates

b) saphenous vein and saphenous

c) iliac vein and femoral

d) Only common iliac vein

 

21. The patient 45 years, without the burden of history and not receiving any medication reported due to swelling of the ankle and lower leg left. A few days ago ankle injury during jogging. On the advice of an orthopedic surgeon for 4 days was saving the limb. Clinically minimal swelling of the ankles and calves (1-1.5cm difference in limb circumference). In the case of this patient you recognize

a). High risk of deep vein thrombosis according to the scale Wells

b) Medium risk of deep vein thrombosis according to the scale wellas

b) Low risk of deep vein thrombosis according to the scale wellas

d) can not be determined because the scale of Wells is not used to assess the risk of venous thrombosis

22. The patient with questions 2. What diagnostics can propose to confirm / exclude DVT?

a) the level of D-Dimer in the first place

b) ultrasound compression test (CUS)

c) once the full Doppler veins of the lower limbs

d) All correct answers.

 

23. The patient with questions 21. You made the level of D-Dimer, which amounted to 300ng / ml (cut-off point 500ug / ml in your laboratory). What is your procedure

a). You exclude DVT and recommending RICE (Rest Ice compresion Elevation)

b) After all, recommending the execution of CUS

c) After all, recommending the execution of the full Doppler ultrasound

d) have performed venography

 

24. The patient 67 years, after hemicolectomy with colorectal cancer before 2 months of complicated-month stay in the ICU. For more than three weeks significant swelling on the left near the bottom. Circuit right leg about 4cm larger than the left. Little pain when walking. Heart rate present in the arteries of the foot. you recognize:

a). Medium risk of DVT by scale Wells

b). high risk of DVT by scale Wells

c). a low risk of DVT by scale Wells

d) can not be determined because the scale of Wells is not used to assess the risk of deep vein thrombosis

 

25. The patient from question 24. What diagnostics can propose to confirm / exclude DVT?

A) represents the level of D-Dimer in the first place, which will be crucial for further evaluation

b) execute ultrasound compression test (CUS), if negative except DVT

c) execute ultrasound compression test (CUS) will be negative if I ask to repeat CUS per week or full ultrasound Doppler veins

d) None of the answers is correct.

 

26. The patient from question 24. CUS recognize deep vein thrombosis in the femoral section on the left side. What is your procedure?

and). You exclude DVT and recommending RICE (Rest Ice compresion Elevation)

b) After all, you are recommending the execution of CUS a week before treatment

c) You start anticoagulant treatment

d) You drive the patient to the ward for urgent vascular thrombectomy pharmaco-mechanical thrombosis

 

27. The patient from questions 24. Should this patient suggest something else? Indicate which of the answers is correct:

a). So, to propose even among other things, diagnostics, secondary causes of deep vein thrombosis and oncology re-consultation

b). So, to propose even among other things, full of Doppler ultrasound iliac veins on an outpatient basis

c) .So, to propose even among other Compression (minimum of second degree of oppression)

d) Yes, but only enough to suggest hematologic consultation for the diagnosis of thrombophilia

 

28. Indicate false statement concerning the D-Dimer

a). DVT limit for the level of D-dimer increases with age from 50 years of age

b). The level of D-dimer is always below the threshold (i.e. 100%) exclude DVT

c) When a high probability of clinical DVT perform determination of D-Dimer does not make sense

d) D-dimer levels below the limit at low or intermediate probability of trial allows to exclude DVT with considerable specificity,

 

29. When should repeat the "negative" clinical compression test (CUS) after a week? Select the incorrect answer.

a). A patient with a low probability of DVT and the level of D-Dimer below the threshold

b) A patient with intermediate probability of DVT and D-Dimer levels above the limit value

c) Patient with high probability of DVT and the level of D-Dimer below the threshold

d) A patient with a low probability of DVT and D-Dimer levels above the limit value

 

30. The patient 60 years old with a diagnosis of deep venous thrombosis in ultrasound (left lower leg vein and femoral vein left in the USG, D-Dimer baseline 1780ng / ml). In an interview with arthroscopy on his left knee after injury skiing before 7 weeks. At present, no drug. Swelling of two weeks. Accept LMWHs regularly in the correct dose. The patient has since swollen limbs persists and even intensifies at the end of the day seriously impeding walking. Concerned privately made himself today levels of D-Dimer - 760ng / ml. The probable cause of complaint persists clinical investigation are:

and). The recurrence of DVT

b). Another episode of DVT

c). Inadequate anticoagulant therapy (the patient should receive enoxaparin instead of one of the following oral anticoagulants: Warfarin, Sintrom, Riwaroxaban, Dabigatran)

d) None of compression implemented

 

31. A patient with questions 30. How long should it be used in anticoagulation

a) 3 months

b) 12 months

c) for life

d) You can not take anticoagulants in general

 

32. 25-year-old after orthopedic surgery due to injury of left shoulder against 1.5 months. He reported because of massive swelling of the left upper limb of 4 days. The USG axillary: vein thrombosis of the left subclavian. Very strong forearm pain with numbness in the fingers if you leave for a long time down the leg. From 4 days yield low molecular weight heparin in the correct dose. Despite the problems increase. What should I do?

a). The patient should be advised Compression and increase the dose heparin

b). Due to his young age, history of DVT less than three weeks and severe symptoms should refer the patient to a vascular ward for the treatment of deep vein patency.

c) The patient is not eligible for surgical treatment. It is necessary for lymphatic drainage

d). None of the answers is correct.

 

33. In the case of massive superficial vein thrombosis or high risk of expansion into the deep is recommended

a). Fondaparinux 2.5 mg after 45 days

b). Antykogulantów as DVT caused a reversible factor

c). Only low molecular weight heparins for 10 days

d) In general, do not use anticoagulants

 

34. embolism

a). It is asymptomatic in 50% of proximal DVT

b). 70% easily detect the source of ultrasound

c) mainly originated from DVT in the lower extremities located

d) all valid

 

35. pulmonary embolism- high risk of death

a) if the patient initially diagnosed in hypotension or shock

b) does not require immediate implementation of anticoagulation and reperfusion therapy

c) requires more than 10 points in MGS (Modified Geneva Score).

d) requires at least 6 points in Pěší Score

 

36. Pulmonary embolism - low risk of death

a) requires the assessment of clinical probability by MGS (Modified Geneva Score) prior to the determination of the D-dimer

b) requires the determination of D-Dimer in the case of a high probability of PE as defined in MGS before the resistance index and angioCT

c) requires confirmation resistance index and angioCT pulmonary embolism at high and intermediate probability of PE as defined in the MGS prior to the implementation of anticoagulation

d) none of the above is correct

 

37. The patient 66 years directed the persistence of swelling and pain in the left lower limb of five days when he was diagnosed in her DVT. For this reason replaced LMWH treatment dose (correctly set treatment). Interview charged diabetes. COPD, coronary heart disease. He had a stroke of paralysis left-hand two years ago and moves on crutches. He complains in addition to shortness of breath and chest pain. Pressure 120/80 heart rate of 110 / min. Saturation of 93%. How do you specify the probability of PE

a). As high in MGS (Modified Geneva Score)

b). as indirect MGS

c) as a low MGS

d) can not be determined

 

38. A patient with questions 37

a) has a high risk of pulmonary death

b) can not determine the risk of death

c) requires an assessment of the probability scale MGS prior to the implementation of further diagnosis and treatment

d) requires immediate reperfusion therapy

 

39. A patient with questions 37. What you propose proceedings

a) a vendor implementation D-Dimer before the resistance index and angioCT

b) perform resistance index and angioCT and you will not be commissioned performance of D-Dimer

c) a vendor chest X-ray and according to the result of the condition the further proceedings

d) none of the above

 

40. A patient with questions 37 has detected CT pulmonary embolism on the right side in a major segmental branches. Accordingly,

a) qualify patients for reperfusion therapy immediately

b) treatment of addicted determine the risk of early death by spesi score

c) give up the designation proBNP and cardiac UKG planning to conservative treatment

d) none of the above

 

41. A patient with stabliny hemodynamically, with intermediate probability of PE (in MGS) and the high risk of 30-day mortality in Pěší with elevated proBNP, but without the right ventricle overload is:

a). intermediate-low risk of death

b) Indirect high risk of death

c) low risk of death

d) a high risk of death

 

42. A patient with questions 37. Taken designation pro-BNP (significantly increased) and UKG heart (detected significant overload parasternal with high-pressure pulmonary). The patient has:

a). intermediate-low risk of death

b) Indirect high risk of death

c) low risk of death

d) a high risk of death

 

43. In this case (as described in Question 37) proposes

a) only anticoagulant treatment for three months

b) treatment facilities reperfusion therapy (open trombectomia cardiopulmonary bypass)

c) systemic fibrinolysis if there are no contraindications

d) none of the above

 

44. To determine the risk of death in the European Parliament is

a) the scale of MGS (Modified Geneva Score)

b) only the occurrence of shock / hypotension

c) the occurrence of shock / hypotension, and scale Pěší

d) Only the scale Pěší

 

45.Aneurysm is widening of vascular of

a) 20% of the nominal diameter

b) 50% of the nominal diameter

c) 100% of the nominal diameter

d) depends on the type of vessel

 

46. ​​Aneurysms can be dangerous because

a) only the risk of rupture

b) only the risk of embolism

c) the risk of embolism and cracks

d) triggering pressure on the surrounding tissues

 

47. A patient with an aneurysm of the ascending aorta and aortic arch should be directed

a) first on Vascular Surgery

b) first on cardiac surgery

c) on the first angiologia

d) First on the internet

 

48. A patient with an aneurysm of the descending aorta and thoraco-abdominal. Select the incorrect sentence

a) should be directed to consult a vascular surgeon

b) is the assumption inoperable

c) will probably be treated with endovascular techniques

d) may require treatment with a hybrid

 

49. The patient 55 years. detected during ultrasound abdominal aortic aneurysm diameter of 45mm. What will you order the proceedings, knowing that the testing was properly done (radiologist is an experienced diagnostician in vascular diseases):

a) Point the patient to the ER vascular immediately.

b) will refer the patient to consult a vascular surgeon on an outpatient basis within a period of 6-12 months

c) Point the patient to consult a vascular surgeon within 2 weeks

d) None of the above

 

50. Patient 67 years with randomly detected abdominal aortic aneurysm during the ultrasound bile ducts. The diameter of the aneurysm 65mm. The study aneurysm painless on palpation. What do you do?

a) Point the patient to the ER vascular immediately.

b) will refer the patient to consult a vascular surgeon on an outpatient basis within a period of 6-12 months

c) Point the patient to consult a vascular surgeon within 2 weeks

d) None of the above

 

51. Patient from 50 question raised after 15 months due to abdominal pain radiating to the back. RR 160/80 regular pulse. Sat 100%. The study affectionate pulsating lump just above the navel. Your investigation will look like this

a) Point the patient to the ER vascular immediately.

b) will refer the patient to consult a vascular surgeon on an outpatient basis within a period of 6-12 months

c) Point the patient to consult a vascular surgeon within 2 weeks

d) None of the above

 

52. Patient from 50 question goes to the ER vascular. The resistance index and angioCT made urgently excluded aneurysm rupture. Further investigation should include

a) qualified for EVAR (graft) in the case of a favorable anatomy tętnika and regardless of load internal medicine, but with maximum optimization of cardiovascular (hypotension), early discharge and set a date for surgery within 2-4tweeks

b) classification of the EVAR (graft) in the case of a favorable anatomy of aneurysm and irrespective of the load of internal medicine, but the maximum optimization of the circulatory system (pressure reduction), and perform operations within 48 hours

c) the execution of operations opened immediately regardless of anatomy tętnika and load internal medicine, but with maximum optimization of circulation possible in such a short time.

d) performance of EVAR (graft) regardless of anatomy anatomy tętnika and load internal medicine immediately 

 

53. Aortic dissection of the descending

a) should always be treated surgically

b) it is never complicated and therefore it should not be treated invasively

c) regardless of whether the aortic dissection involves the ascending section or not, always it takes precedence implanting a stent graft into the descending aorta

d) can successfully be treated conservatively if there are factors deterioration of aneurysmal

 

 

54. Female 28 years planning a second pregnancy, reports of an accidental detection of ultrasound 3cm splenic artery aneurysm. recommendation

a) Only observation. Because aneurysms t. Visceral do not crack.

b) Planned treatment before becoming pregnant (because it is possible for both endovascular treatment as and opened)

c) Treatment of treatment, but after pregnancy, because the risk of rupture exists especially during childbirth and is only dangerous for the baby

d) surgery because tętnik already exceeded 2cm in diameter

 

55.Na emergency room surgical goes patient who complains of pain and weakness in the calf right after the passage of 200 meters, which subsides with rest. From the interview you find out that you suffer from hypertension, diabetes and smokes 20 cigarettes a day. The most appropriate procedure would be:

a) diagnosis of acute ischemia of the lower limb and the performance of an imaging objective qualifications for surgery

b) identification of critical ischemia of the lower limb and the admission of the patient to a branch

c) diagnosis of chronic ischemia of the lower limb and planning of revascularization in elective with vascular clinic

d) diagnosis of chronic ischemia of the lower limb and recommend modification of risk factors with a focus on smoking cessation, diabetes compensation, guard blood pressure

e) any answer is not correct

 

56. The surgical emergency room gets a patient who complains of pain and weakness in the right calf after walking 20 meters, which subsides with rest. From the interview you find out that you suffer from hypertension, diabetes and smokes 20 cigarettes a day. The most appropriate procedure would be:

a) diagnosis of acute ischemia of the lower limb and the performance of an imaging objective qualifications for surgery

b) identification of critical ischemia of the lower limb and the admission of the patient to a branch

c) diagnosis of chronic ischemia of the lower limb and planning of revascularization in elective with vascular clinic

d) diagnosis of chronic ischemia of the lower limb and recommend modification of risk factors with a focus on smoking cessation, diabetes compensation, guard blood pressure

e) any answer is not correct

 

57. In the emergency room the patient gets the PTA external iliac artery in the previous year. Currently reported symptoms characteristic of rest pain. However, you have the impression that the patient simulates an attempt to force you to hospitalization. The most objective test to confirm / exclude the diagnosis in conditions of admissions will be:

a) measurement of ABI

b) to perform doppler ultrasound limb arteries

c) the execution of angio-CT

d) test pulse on the limbs

e) any answer is not correct

 

58. You're a doctor working in the office of the family doctor. Pursuing a patient with chronic ischemia you are aware that it is a disease associated with risk factors for other diseases. That procedure is not appropriate for patients with chronic ischemia of the lower limbs?

a) measurement of blood glucose

b) examining the value of creatinine

c) the performance of Doppler ultrasound of carotid arteries

d) a careful medical history of TIA, amaurosis fugax

e) perform spirometry

 

59. He reported to you the patient, which provides that no pain exercise the lower limbs. Which of the questions you do not ask in differentiating towards intermittent claudication?

a) if he had in the past episode of thrombosis, iliac-femoral?

b) whether it has back problems?

c) if the pain is of a stinging?

d) how quickly the pain subsides after cessation of exercise?

e) if the pain is accompanied by a sudden pallor, then bruising and redness of the calf?

 

60. Which of the following statements is not true?

a) Leriche's disease is a form of chronic limb ischemia

b) The scale of Rutherford is the scale of assessment of chronic limb ischemia

c) the scale of Fontein is the scale of assessment of chronic limb ischemia

d) intermittent claudication is a symptom always present in the early stages of chronic limb ischemia

e) all answers are correct

 

61. It goes to you the patient with intermittent claudication of 400 meters. In the interview, smokes 30 cigarettes a day, diabetes after the determination of HbA1c receive the result of over 10%, blood pressure measurements recorded in the book of the patient oscillates row 170/105. What will you order not to prolong claudication?

a) exercises march 3 times a week for three months

b) smoking cessation

c) start antihypertensive therapy based on ramipril

d) you focus on glycemic control

e) all answers are correct

 

62. He went to you a patient who complains of intermittent right buttock. You explored the pulse in the groin, under the knee and ankle. Everywhere you sensed pulse. We conclude that:

a) it is not possible buttock claudication with a palpable pulse as described above. You are looking for a different diagnosis

b) you are aware that in this state may correspond occluded internal iliac artery, start diagnostic imaging to confirm the suppositions

c) check the pulse on the other side, in the absence of groin recognize Leriche syndrome.

d) you think, but that is closed external iliac artery and what you can feel as a heartbeat pulse is given by the elasticity of atherosclerotic plaque

e) no correct answer

 

63. You made ABI stating the result of 0.4. On the basis of this result, you qualify for the patient according to the scale Fontein as:

a) I

b) IIa

c) IIb

d) III

e) all of the answers are wrong

 

64. It goes to you the patient with pain in  feet for more than three weeks. He suffers from diabetes and kidney failure. You made ABI, which amounted to 1.0.

a) concludes that if the ABI is correct that you exclude the cause of vascular. You focus on the diagnosis of gout and arthritis.

b) you are aware that patients with diabetes dishes can not be compressed by the cuff pressure gauge, and therefore the result is likely overstated and therefore outsource imaging

c) you aware that patients with renal vessels can not be compressed by the cuff pressure gauge, and therefore the result is likely overstated and therefore outsource imaging

d) b + c

e) no answer is correct

 

65. It goes to the emergency room surgical patients with acute ischemia of the lower limb. What is not normal behavior within the study of subjective?

a) a request or suffering from aortic aneurysm

b) request or suffer from atrial fibrillation

c) Ask if he had performed the procedure in the arteries of the lower limb

d) request or suffering from popliteal artery aneurysm

e) all answers are correct

 

66. Which of these features is not characteristic of acute ischemia of the lower limb?

a) no pulse

b) paleness

c) overflow superficial veins

d) cooling the limb

e) callousness combined with rest pain

 

67. It goes to the emergency room surgical patient with suspected acute ischemia of the lower limb left. Interview with the patient is impossible to collect because of the significant dementia, although the patient shows that it hurts calf and foot. As part of the diagnosis made by you you establish that the patient has a cooler, a pale limb, after the application head doppler can hear the sound of venous ankle .Prosisz patient to bent dorsal foot as he fails. Can you feel the pulse in the groin, but you are unable to feel the knee. The correct procedure is:

a) send the patient to X-ray the foot to exclude trauma

b) reject the diagnosis of acute ischemic recognize critical ischemia

c) recognize acute ischemia IIB SVS, you are aware of the patient should operate on as soon as possible

d) recognize acute ischemia IIA SVs, you are aware of the patient does not need to operate immediately

e) recognize acute ischemia III SVS, you are aware that in this situation you can not take the attempt of revascularization

 

68. In which of the patients apply targeted thrombolysis in acute ischemia of the lower limb?

a) a patient with acute ischemic renal failure and IIB

b) in a patient with acute ischemia IIA hypertension and

c) in a patient with acute ischemia III

d) in a patient with acute ischemia IIA headache glioma after surgery two weeks ago

e) no correct answer