Chapter XI. SUPPURATIVE INFLAMMATORY DISEASES

Soft tissues

1. Therapeutic measures in furuncles are as follows:

1. Cleansing the surrounding skin with ethyl alcohol.

2. Pressing necrotic masses out and bandaging with 70% alcohol.

3. Injection of penicillin and novocain around the affected area.

4. Administration of oral sulphonamides.

5. Local ultraviolet irradiation.

Choose the right combination of answers:

A. 1, 3, 4, 5. B. 1, 2. C. 1, 2, 4, 5. D. 3, 5. E. 1, 2, 3, 4, 5.

2. The therapies of erythaematous erysipeloid localized in the shin are as follows:

1. Moist bandaging with furacillin.

2. Antibiotics IM.

3. Desensitization (dimedrol, calcium chloride).

4. Local ultraviolet irradiation.

5. Warm bath with the potassium permanganate.

Choose the right combination of answers:

A. 1, 2, 3. B. 2, 3, 4. C. 2, 3, 5. D. 1, 2, 3, 5. E. 1, 2, 3, 4, 5.

3. Therapy of acute serous mastitis includes which of the following:

1. Incision.

2. Prevention of lactostasis.

3. Fixing the breast with scarf bandage.

4. Antibiotics.

5. Retromammary novocain block with antibiotics and proteolytic enzymes.

Choose the right combination of answers:

A. 1. B. 1, 2, 3. C. 3, 4, 5. D. 2, 3, 4, 5. E. 1, 2, 3. 4, 5.

4. The preferable direction and site of incision when opening retromammary abscess should be:

A. Radial; the upper quadrant of the breast.

B. Semi-oval; the lower edge of the breast.

C. Radial; the lower half of the breast.

D. Semi-oval; the upper edge of the breast.

E. Circular; around the nipple.

Choose the correct answer.

5. The clinical signs of axillary hydradenitis are as follows:

1. Dense painful node.

2. Follicular pustule.

3. Creamy pus.

4. Necrotic centre.

5. Dense infiltrate.

Choose the right combination of answers:

A. 1, 2, 5. B. 2, 3, 4. C. 2, 3, 5. D. 3, 4, 5. E. 1, 3, 5.

6. The local increase in temperature is not typical of the following conditions:

A. Shoulder abscess.

B. Thigh phlegmon.

C. Knee joint tuberculosis.

D. Thumb felon.

E. Suppurative bursitis of the elbow joint.

Choose the correct answer.

7. The clinical signs characteristic of carbuncle are as follows:

1. Tender infiltrate.

2. Non-tender infiltrate.

3. Skin necrosis and pus pustules.

4. Necrosis with small haemorrhagic blisters.

5. Regional lymphadenopathy.

Choose the right combination of answers:

A. 1, 3, 5. B. 2, 3, 5. C. 2, 4, 5. D. 1, 3, 4. E. 1, 4, 5.

8. The clinical stages of erysipelas are as follows:

1. Erythaematous.

2. Bullous.

3. Phlegmonous.

4. Suppurative.

5. Necrotic.

Choose the right combination of answers:

A. 1, 2, 3, 4. B. 2, 3, 4, 5. C. 1, 2, 3, 5. D. 1, 3, 4, 5. E. 1, 2, 3, 4, 5.

9. Phlegmon of soft tissues in the stage of softening requires one of the following:

A. Local application of cold.

B. Extensive incision and drainage.

C. Puncture with subsequent bacteriologic culturing.

D. Warm compression.

E. Injection of novocain and antibiotics.

Choose the correct answer.

10. The direction of surgical incision in parotitis is one of the following:

A. Horizontal.

B. Parallel to the direction of the facial nerve.

C. Parallel to he mandible.

D. Perpendicular to the facial nerve.

E. Vertical.

Choose the correct answer.

Hand infection

1. Felon in the form of cuff-link is as follows:

A. Thecal with spreading of process to the hand.

B. Subcutaneous with spread of in the epidermis.

C. Paronychia.

D. Osteal felon with spread of process to the joint.

E. Aritcular felon.

Choose the correct answer.

2. The types of early felon that require puncturing both for diagnosis and treatment are as follows:

A. Cutaneous.

B. Subcutaneous.

C. Tenosynovitis.

D. Paronychia.

E. Osteal.

Choose the correct answer.

3. The risk of suppurative spreading onto the forearm is high in the following felons:

1. The I finger.

2. The II finger.

3. The III finger.

4. The intravenous finger.

5. The V finger.

Choose the right combination of answers:

A. 1, 3. B. 2, 3, 4. C. 1, 5. D. 2, 5. E. 1, 2, 3, 4, 5.

4. Subungual felon requires the following surgeries:

1. Oval incision by Klapp.

2. Perforation of the nail.

3. Semi-oval incisions.

4. Resection of the nail bed.

5. Removal of the nail plate.

Choose the right combination of answers:

A. 1, 4, 5. B. 2, 3, 4. C. 2, 4, 5. D 3, 4, 5. E. 1, 3, 5.

5. The clinical signs of paronychia are as follows:

1. Swelling of the cutaneous margin.

2. «Floating» nails.

3. Secretion of pus from under the cutaneous margin.

4. Suppurative fistula.

5. Extensive contracture of finger.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 3. C. 3, 4, 5. D. 2, 4. E. 1, 3, 4.

6. The local signs of tenosynovitis are as follows:

1. Throbbing pain.

2. Swelling of the entire finger.

3. The finger is extensively straightened out.

4. Fixation of the finger.

5. Painful sensation along the tendon on palpation with a probe.

Choose the right combination of answers:

A. 1, 2. B. 1, 2, 3. C. 1, 3, 4. D. 1, 3, 4, 5. E. 1, 2, 4, 5.

7. The cross (V-form) hand phlegmon is characterized by the following clinical signs:

1. Tenderness.

2. Hand dysfunction.

3. Localization of suppurative exudate in proximal area of the palm.

4. Localization of suppurative exudate in the distal areas of the palm.

5. Extensive contracture of fingers.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 2, 4. C. 2, 3, 4. D. 1, 2, 4, 5. E. 1, 2, 3, 5.

8. The local signs of middle space phlegmon are as follows:

1. Tension of the skin being in the centre of the palm.

2. Fluctuation.

3. Tenderness.

4. Swelling of the dorsal hand surface.

5. Finger flexion.

Choose the right combination of answers:

A. 1, 2. B. 1, 4. C. 1, 3, 5. D. 1, 3, 4. E. 1, 3, 4, 5.

Osteomyelitis

1. The bones that are commonly affected in haematoge-nous osteomyelitis are as follows:

1. The femur.

2. The ischium.

3. The vertebrae.

4. The tibia.

5. The brachium.

Choose the right combination of answers:

A. 1, 4. B. 2, 3, 5. C. 1, 4, 5. D. 2, 4, 5. E. 1, 3, 4.

2. The common age of patients with haematogenous osteomyelitis is:

1. 1-10 years.

2. 11-20 years.

3. 21-30 years.

4. 31-40 years.

5. 41-50 years.

Choose the right combination of answers:

A. 1. B. 2. C. 1, 2, 3. D. 1, 2. E. 3, 4, 5.

3. Bone sequestration is typical of which of the followius types of osteomyelitis:

1. Brodie's abscess.

2. Post-traumatic osteomyelitis.

3. Ollier's osteomyelitis.

4. Garre's osteomyelitis.

5. Haematogenous osteomyelitis.

Choose the right combination of answers:

A. 1, 2, 5. B. 2, 3, 4. C. 2, 4, 5. D. 2, 5. E. 3, 5.

4. In acute haematogenous osteomyelitis, X-ray findings are evident:

A. Within 3 days.

B. Within 3 months.

C. Within 10-15 days.

D.Within 20-30 days. E. Within 30-40 days.

Choose the correct answer.

5. The following are distinctive signs of Brodie's abscess:

1. Cavity with sequestrum.

2. Cavity without sequestrum.

3. Mucous exudates.

4. Purulent exudates.

5. Diffuse osteosclerosis.

Choose the right combination of answers:

A. 1, 4. B. 2, 4, 5. C. 2, 4. D. 1, 3, 5. E. 1, 4, 5.

6. The following are distinctive signs of Garre's osteomyelitis:

1. Metaphyseal cavity.

2. Bone thickening.

3. Sequestrum.

4. Albuminous exudates.

5. Osteosclerosis.

Choose the right combination of answers:

A. 1, 4. B. 1, 2, 3. C. 3, 4, 5. D. 2, 4. E. 2, 5.

7. Sequestra are formed in the following types of osteomyelitis:

1. Brodie's abscess.

2. Haematogenous osteomyelitis.

3. Garre's osteomyelitis.

4. Tumorous osteomyelitis.

5. Post-traumatic osteomyelitis.

Choose the right combination of answers:

A. 1, 2, 5. B. 2, 3, 4. C. 2, 4, 5. D. 2, 5. E. 3, 5.

8. The major signs of chronic haematogenous osteomyelitis are as follows:

1. Tendency to relapsing.

2. Muscular atrophy.

3. Suppurative fistulas

4. Sequestral box with sequestrum inside

5. Osteosclerosis

Choose the right combination of answers:

A. 1, 2, 4. 5. B. 1, 3, 4, 5. C. 1, 2, 3, 4, 5. D. 2, 4, 5.

9. The characteristics of chronic haematogenous osteomyelitis are as follows:

1. The diaphyses of long bones are more frequently affected.

2. The metaphyses and epiphyses of long bones are more frequently affected.

3. Muscular atrophy is only rare.

4. Muscular atrophy is common.

5. Lesions of neighbouring joints are uncommon.

Choose the right combination of answers:

A. 1, 3, 5. B. 2, 3, 5. C. 1, 2, 5. D. 4, 5. E. 1, 4, 5.

10. The clinical signs suggestive of advanced acute hae-matogenous osteomyelitis are as follows:

1. Skin hyperaemia.

2. Bone deformation.

3. Positive fluctuation sign.

4. Skin necrosis.

5. Suppurative fistulas.

Choose the right combination of answers: A. 1, 2, 5. B. 1, 3, 5. C. 3, 4, 5. D. 2, 3, 5. E. 1, 4, 5.

11. The aetiologies of osteomyelitis are as follows:

1. E. coli.

2. Staphylococcus spp.

3. Drumstick bacillus.

4. Corynebacterium diphtheriae.

5. Proteus mirabilis.

6. Streptococcus spp.

Choose the right combination of answers:

A. 1, 3, 5, 6. B. 1, 2, 5, 6. C. 2, 4, 5, 6. D. 1, 3, 4, 6. E. 2, 3, 5, 6.

12. The surgical procedures indicated for acute haematog-enous osteomyelitis are as follows:

1. Incision of phlegmon.

2. Incision of phlegmon with incision of the periosteum.

3. Trepanation along the affected bone.

4. Resection of the affected bone.

5. Decompression drainage of the bone canal.

Choose the right combination of answers:

A. 1, 3, 4. B. 2, 4, 5. C. 2, 3, 5. D. 1, 3, 5. E. 2, 5.

13. The most effective methods after radical sequestrecto-my are as follows:

1. Filling with plaster.

2. Myoplasty.

3. Prolonged flow washing.

4. Tamponade.

5. Plastics with collagen sponge and antiseptics.

Choose the right combination of answers:

A. 1, 2, 3. B. 2, 3, 4. C. 3, 4, 5. D. 2, 3, 5. E. 1, 3, 5.

14. The appropriate extension of the surgery in chronic osteomyelitis may be as follows:

1. Fistula excision.

2. Bone perforation.

3. Sequestrectomy.

4. Phlegmon incision.

5. Bone cavity plastics.

6. Prolonged active flowing drainage

Choose the right combination of answers:

A. 2, 3, 4, 5. B. 1, 2, 5, 6. C. 1, 3, 5, 6. D. 3, 4, 5, 6. E. 1, 3, 4, 6.

15. The most common chronic complications of chronic osteomyelitis are as follows:

1. Liver cirrhosis.

2. Renal amyloidosis.

3. Endocarditis.

4. Myocardial dystrophy.

5. Chronic anaemia.

Choose the right combination of answers:

A. 1, 2. B. 2, 3. C. 2, 5. D. 1, 4. E. 1, 5.

16. The most adequate preparations and methods of immune and antibacterial therapy of acute osteomyelitis are as follows:

1. Lincomycin hydrochloride.

2. Ampiox.

3. Antibiotics IM.

4. Prodiogiosane.

5. Bacteriophages.

Choose the right combination of answers:

A. 2, 4, 5. B. 1, 2, 4, 5. C. 1, 4, 5. D. 1, 2, 4, 5. E. 1, 2, 3, 4, 5.

Peritonitis, pleuritis

1. The factors of peritoneal inflammation are as follows:

1. Direct transition of inflammation from the organs onto the serous membrane.

2. Abdominal penetrating wound.

3. Injury of abdominal parenchymal organ.

4. Dehiscence of suture of anastomosis of hollow organs.

5. Ulcerous perforation of the intestinal wall.

Choose the right combination of answers:

A. 2, 3, 4. B. 2, 3, 4, 5. C. 1, 2, 4, 5. D. 3, 4, 5. E. 2, 3, 4, 5.

2. The specific pathogenic factors of peritonitis are as follows:

1. Spreading of the process.

2. GI paralysis.

3. Toxic dysfunction of the viscera.

4. Absorption of bacterial toxins by the peritoneum.

5. Absorption of bacterial toxins from the intestines.

Choose the right combination of answers:

A. 1, 3, 4, 5. B. 1, 2, 3, 4, 5. C. 1, 3, 4. D. 1, 3, 5. E. 2, 3, 5.

3. Diffuse peritonitis is diagnosed if the inflammation affects:

A. One area.

B. Three areas.

C. Four areas.

D. More than five areas.

Choose the correct answer.

4. The signs of generalized suppurative peritonitis are as follows:

1. Bradycardia.

2. Abdominal muscle guarding.

3. Gaseous abdominal distension.

4. Fluid accumulation in sloping areas of the abdominal cavity.

5. Continual fever.

Choose the right combination of answers:

A. 1, 3, 4. B. 2, 4, 5. C. 2, 3, 4, 5. D. 2, 4, 5.

5. The clinical stages of peritonitis are as follows:

1. Paralysis.

2. Toxicity.

3. Generalized.

4. Multiple organ failure.

5. Transude.

6. Reactive.

Choose the right combination of answers:

A. 1, 4, 6. B. 2, 4, 6. C. 2, 4, 5. D. 1, 2, 3. E. 2, 3, 4.

6. The clinical signs of toxic phase of peritonitis are as follows:

1. Abdominal distension.

2. Hypotension.

3. Tachycardia.

4. Vomiting and thirst.

5. Dyspnoea.

6. Absence of intestinal peristaltic sounds.

Choose the right combination of answers:

A. 1, 2, 4, 5. B. 2, 3, 4, 5. C. 1, 2, 5, 6. D. 2, 4, 5, 6. E. 1, 2, 3, 4, 5, 6.

7. The risk factors of generalized peritonitis that preclude urgent surgery are as follows:

1. Recent myocardial infarction.

2. Severe traumatic shock with concomitant injury.

3. Agony.

4. Post-operative peritonitis.

5. No risk factors.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 3, 4. C. 2, 3. D. 1, 3. E. 5.

8. The treatment of generalized peritonitis involves the following measures:

1. Elimination of the causative agent.

2. Abdominal cleansing and drainage.

3. Correction of fluid and electrolyte imbalance.

4. Antibacterial therapy.

5. Detoxication therapy.

Choose the right combination of answers:

A. 1, 3, 5. B. 3, 4, 5. C. 3, 4. D. 2, 3, 4. E. 1, 2, 3, 4, 5.

9. The signs of acute suppurative pleuritis are as follows:

1. Rest dyspnoea.

2. Fever.

3. Fluid in the thorax.

4. Chest pain.

5. Dislocation of mediastinum towards the affected area.

Choose the right combination of answers:

A. 1, 2, 3, 4. B. 2, 3, 4. C. 1, 2, 3, 4, 5. D. 2, 3, 5.

10. The most effective therapeutic method in acute pleural empyema is one of the following:

A. Intratracheal insufflation of antibiotics with pro-teolytic enzymes.

B. Thoracotomy with pleurectomy.

C. Siphon drainage of thorax after Balau.

D. Drainage of thorax with active aspiration.

E. Puncture of thorax with daily evacuation of pus.

Choose the correct answer.

11. In penetrating pulmonary trauma or lung abscess with spreading of pus and gas into thorax, the following may occur:

1. Acute pain in the side of thorax.

2. Violent cough.

3. Shallow breathing.

4. Tachycardia.

5. Squeezing of lung and dislocation of the mediastinum to the intact side.

Choose the right combination of answers:

A. 1, 2, 4, 5. B. 1, 2, 3. C. 2, 3, 5. D. 1, 2, 3, 4, 5.

12. The most important diagnostic method in suppurative pleuritis if fluid accumulation in the thorax is suspected is one of the following:

A. Chest X-ray.

B. Chest CT.

C. Chest puncture.

D. Chest ultrasonography.

Choose the correct answer.

Sepsis

1. The local signs of septic wounds are as follows:

1. Copious purulent exudate.

2. Scanty purulent exudate.

3. Marked local hyperaemia.

4. Dirty-grey wound tissues.

5. Pronounced local oedema.

Choose the right combination of answers:

A. 1, 3, 5. B. 4, 5. C. 2, 4, 5. D. 2, 4. E. 2, 5.

2. The common clinical signs of sepsis are as follows:

1. Fever.

2. Dizziness.

3. Adynamia.

4. Bradycardia.

5. Rigors.

6. Profuse perspiration.

Choose the right combination of answers:

A. 4, 5. B. 2, 4, 5. C. 2, 3, 5. D. 1, 2, 3. E. 1, 3, 5, 6.

3. The typical signs of sepsis are as follows:

1. Fever.

2. Rigors.

3. Primary focus.

4. Bacteraemia.

5. Jaundice.

Choose the right combination of answers:

A. 1, 2, 3. B. 2, 4, 5. C. 1, 4, 5. D. 3, 4, 5. E. 2, 3, 4. 5.

4. The septic fever may be of the following types:

1. Remittent.

2. Hectic.

3. Intermittent.

4. Inaccurate.

5. Continual.

Choose the right combination of answers:

A. 1, 2, 3, 5. B. 3, 4, 5. C. 1, 2, 4. D. 1, 3, 5. E. 1, 2, 3, 4, 5.

5. Suppurative absorption fever is characterized by the following signs:

1. Extensive primary purulent focus.

2. Evident in all types of the inflammation.

3. Specific causative agent.

4. Rapid exhaustion of patient.

5. Resolution with elimination of the purulent focus.

Choose the right combination of answers:

A. 1, 2, 3. B. 1, 3, 5. C. 3, 4, 5. D. 1, 3, 4. E. 1, 2, 4, 5.

6. The major signs of bacterial toxic shock are as follows:

1. Fever.

2. Bradycardia.

3. Rigors.

4. Hypotension.

5. Oliguria.

Choose the right combination of answers:

A. 1, 3, 4, 5. B. 1, 2, 3, 5. C. 2, 3, 4, 5. D. 1, 3, 4. E. 1, 2, 3, 4, 5.

7. What methods of treatment would you apply for intoxication:

1. Blood transfusion.

2. Detoxication.

3. Complete bed rest.

4. Antibacterial therapy.

5. Immunotherapy.

Choose the right combination of answers:

A. 1, 2, 3, 4. B. 2, 3, 4, 5. C. 3, 4, 5. D. 4, 5. E. 1, 2, 3, 4, 5.

8. The initial therapy of primary focus in sepsis may be as follows:

1. Surgical debridement of the wound.

2. Proteolytic enzymes.

3. Hyperbaric oxygenation.

4. Wound tamponade.

5. Wound suturing.

Choose the right combination of answers:

A. 1, 2, 3. B. 2, 3, 4. C. 3, 4, 5. D. 2, 4, 5. E. 2, 3, 5.

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