KUNSKAPSPROV FR

UTLNDSKA LKARE

TULE 45
12 september 2011

SVAR

INNEHLL:
Tema

sid

Medicin

Pediatrik

Obstetrik & Gynekologi

Psykiatri

11

Kirurgi

14

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SVAR:

MEDICIN

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A1

SVAR:

A. Andningsfrekvens, saturation, medvetandegrad, feber.

(1 pong fr tv rtta svar, 2 pong fr tre rtta svar)
B. Pleurit eller empyem. (1 pong fr ngon av dessa)
(totalt 3 pong)
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A2

SVAR:

A. Morfin, nitroglycerin. (1 rtt 1 pong, 2 rtt 2 pong)

B. CPAP. (1 pong)
(totalt 3 pong)
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A3

SVAR:

Frmaksflimmer. (1 pong)
Inferior ST-hjning. (1 pong)
(totalt 2 pong)
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A4

SVAR:

Kompressionsbehandling (med strumpa, alt. linda) (1 pong) frhindrar att det hga
trycket i vensystemet verfrs till hudens sm vener och kapillrer. (1 pong)
(totalt 2 pong)
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A5

SVAR:

A. gonbottenspegling (fynd av papilldem, bldningar och exsudat). (1 pong)

B. Maximalt 25% snkning efterstrvas (svar 15-35% godknns). (1 pong)
En mttlig snkning efterstrvas, d fr kraftig blodtryckssnkning kan leda till
cerebral ischemi p grund av fr lgt blodflde. (1 pong)
(totalt 3 pong)
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A6

SVAR:
A. Lungemboli. (1 pong) Inga andra svar ger pong.
B. D-dimer (1 pong) lgrisk enligt Wells score. Negativ d-dimer talar starkt emot
LE och DT kan d undvikas (1 pong). Annan bra motivering inkluderande
riskbedmning kan ocks godknnas.
(totalt 3 pong)

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A7

SVAR:

A. Pneumothorax. (1 pong)
B. Nedsatt eller upphvt andningsljud ver ena lunghalvan eller del av denna.
(1 pong)
(totalt 2 pong)
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A8

SVAR:

B och D.
(totalt 2 pong)
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A9

SVAR:

A. Multipelt myelom. (1 pong)

B. Benmrgsprov. (1 pong)
(totalt 2 pong)
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A10

SVAR:

A. Neutropen feber. (1 pong)

B. Blodstatus, inkl neutrofiler, blododling, bredspektrumantibiotika, mste ing
fr 2 pong.
(totalt 3 pong)
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A11

SVAR:

A. Septisk artrit. (1 pong)

B. Punktion av ledvtska med odling/gramfrgning. (1 pong)
(totalt 2 pong)
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A12

SVAR:

A. Sklerodermi. (1 pong)
B. Blodkrl, mag-tarmkanal, hud, rrelseapparat, lungor, njurar, hjrta.
(3-5 rtt ger 1 pong)
(totalt 2 pong)
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A13

SVAR:

A. Storcellsarterit (temporalisarterit). (1 pong)

B. Hgdos steroider. (1 pong)
(totalt 2 pong)
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A14

SVAR:

Resonium, insulin/glukos, beta-2 agonist, dialys.

(2 pong fr 4 rtt, 1 pong fr 2-3 rtt)
(totalt 2 pong)
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A15

SVAR:

A. Wegeners granulomatosis (ocks rtt fr vaskulit). (1 pong)

B. ANCA. (1 pong)
(totalt 2 pong)
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A16

SVAR:

A. Inflammatorisk tarmsjukdom. (1 pong)

B. Anamnesen strcker sig ver 6 veckor, vilket talar fr kronisk inflammation och
emot infektis genes. Blod i avfringen mindre vanligt vid infektis kolit.
Tidigare liknande episoder talar fr skov av inflammatorisk tarmsjukdom. Ingen
feber talar emot infektion. (1 pong)
(totalt 2 pong)
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A17

SVAR:

A. Mb Addison. (1 pong)
B. Akut provtagning fr s-cortisol och p-ACTH. (1 pong) Synachtentest r fel.
C. Cortisol intravenst (Solu-Cortef eller Hydrocortison) + iv NaCl /RingerAcetat.
(1 pong om bda r med).
(totalt 3 pong)
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SVAR:

PEDIATRIK

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B1

SVAR:

De metabola effekterna av svlt tar ver, eftersom det bildas ketoner vid nedbrytning
av fett. Barn befinner sig i tillvxt och konsumerar drfr med energi.
(2 pong)
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B2

SVAR:

Hftledsluxation.
Spastisk diplegi/CP-skada.
Som rtt svar kan ocks exempelvis muskeldystrofi duga.
(2 pong)
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B3

SVAR:

A. G utan std.
B. Bygga torn av 2-3 klossar (omoget penngrepp, klotterrita, ta hjlpligt med sked).
C. Kan sga 410 ord, kan peka p 4 kroppsdelar.
(totalt 2 pong)
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B4

SVAR:

A. IgA nefrit.
B. Njurbiopsi.
(2 pong)
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B5

SVAR:

Juvenil reumatoid artrit, bakteriell artrit, postinfektis artrit, trauma och hemofili.
Akut remiss till barnkliniken fr fortsatt utredning.
(2 pong)
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B6

SVAR:
Kernikterus samt anemi p grund av hemolys. ABO samt Rh inkompatibilitet.
(2 pong)

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B7

SVAR:

Transposition av de stora artrerna, annat ductusberoende vitium. Ultraljud hjrta.

(2 pong)
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B8

SVAR:

Infantil spasm eller BNS kramper. EEG.

(2 pong)
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B9

SVAR:

Invagination. Colonrntgen.
(2 pong)
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B10

SVAR:

Fosterstadiet insulin,
Smbarnsren tillvxthormon,
Pubertet knshormon.
(2 pong)
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B11

SVAR:

Ljumskbrck. Manuell reponering med morfin.

(2 pong)
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B12

SVAR:

Sara leukemi, Bengt ITP.

(2 pong)
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B13

SVAR:

Hyperton dehydrering. Eventuellt snabb Ringer acetat 2% av kroppsvikten p 20

minuter. 36 timmar maxlista + 10% av kroppsvikten med 5% glukos och 80 mmol
Na + 40 mmol K/l.
(2 pong)
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B14

SVAR:

Ethmoidit, iv antibiotika typ Claforan.

(2 pong)
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B15

SVAR:

Anafylaxi, kraftig allergisk reaktion p grund av getingstick. Adrenalin im ca 0,3 mg,

kortison, ev antihistamin. Ventoline eller betatvstimulerare inh.
(2 pong)
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B16

SVAR:

Leukemi samt aplastisk anemi (Fanconianemi, MDS och SLE r ocks tnkbara).
Benmrgsunderskning (med benmrgsbiopsi och fldescytometri, men behvs ej fr
full pong).
(2 pong)
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B17

SVAR:

Hemofilus influenzae, kikhosta, polio, difteri, stelkramp, pneumokocker.

Alla r avddade.
(2 pong)
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B18

SVAR:

Remiss gonakut, alternativt barnavdelning fr utredning. CT. Retinoblastom, tumr

i gat.
(2 pong)
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B19

SVAR:

Vxtvrk. Expektans.
(2 pong)
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B20

SVAR:

Krupp (falsk krupp). Upprtt kroppsstllning. P akuten ev adrenalin im och ev

kortikosteroider po.
(2 pong)
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8
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SVAR:

OBSTETRIK & GYNEKOLOGI

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C1

SVAR:

A. Tokolys, steroider, cervix/vaginalodling, urinodling. (3 pong)

B. Frlser vaginalt. (1 pong)
(totalt 4 pong)
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C2

SVAR:

A. Vulvacancer. (1 pong)
B. Biopsi. (1 pong)
(totalt 2 pong)
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C3

SVAR:

A. Placenta previa. (1 pong)

B. Infartskanyl, ambulans till frlossningsklinik. (2 pong)
(totalt 3 pong)
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C4

SVAR:

A. Sers ovarialcancer. (1 pong)

B. Uterus, adnexa och oment. (3 pong)
C. Hon fr strogensubstitution utan gestagentillgg. (1 pong)
(totalt 5 pong)
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C5

SVAR:

Prolactin/serum.
(1 pong)
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C6

SVAR:

Efter partus till Rh- kvinna som ftt Rh+ barn,

efter spontan/inducerad abort p Rh- kvinna,
efter op av extrauterin graviditet p Rh- kvinna,
efter graviditetsbldning p Rh- kvinna.
(3 pong)
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C7

SVAR:

Avvakta. Planera in patienten fr yttre vndning om fortfarande tvrlge i

graviditetsvecka 37-38.
(2 pong)
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C8

SVAR:

A. Vecka 18. (1 pong)

B. Finns ingen s lnge fostret bedms ej varande livsdugligt. (1 pong)
C. Alla bosatta i Sverige. (1 pong)
(totalt 3 pong)
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C9

SVAR:

< 37+0 veckor.

(1 pong)
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C10 SVAR:
A. Hostprovokationstest, bilateral parauretral upplyftning vid hosta, Bonneys test.
(1 pong)
B. Uretrocystometri, kontrollerat provokationstest. (2 pong)
C. Bckenbottengymnastik, ev operation. (2 pong)
(totalt 5 pong)
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C11 SVAR:
Kombinerade p-piller.
(1 pong)
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C12 SVAR:
A. Endometriebiopsi, ultraljud. (2 pong)
B. Corpuscancer, alternativt Hyperproliferativt endometrium. (1 pong)
C. Fetma, nulliparitet, hypertoni, diabetes, strogenproducerande tumr. (3 pong)
(totalt 6 pong)
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C13 SVAR:
Att hon br vara optimalt instlld p sin epilepsimedicin; ta folsyra.
(totalt 2 pong)
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C14 SVAR:
A. Ingenting fr nrvarande. Ny kontroll i graviditetsvecka 30-32. (1 pong)
B. Placenta previa av betydelse fr frlossningen kan ej diagnosticeras i
graviditetsvecka 18. Placenta kan dras uppt frn IMM under graviditetens tillvxt.
(1 pong)
(totalt 2 pong)
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SVAR:

PSYKIATRI

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D1

SVAR:

Antisocial personlighetsstrning. Bedrgligt beteende, aggressiv, slagsml,

ansvarsls.
Missbruk. Sker med nskeml om narkotikaklassade lkemedel.
(4 pong)
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D2

SVAR:

Bensodiazepiner.
(1 pong)
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D3

SVAR:

Lkemedel med beroendepotential till trolig missbrukare.

(2 pong)
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D4

SVAR:

Minskad gldje, aptitminskning, smnstrning, energibrist, minskad

koncentrationsfrmga.
verdriven rdsla och oro infr ett antal olika hndelser och aktiviteter. Oron r
svr att kontrollera. Rastlshet, muskelspnning, orolig smn.
(4 pong)
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D5

SVAR:

Egentlig depression. Generaliserat ngestsyndrom.

(2 pong)
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D6

SVAR:

Suicidalitet, bl.a. fr att kunna bestmma lmplig vrdniv.

Tidigare hypomana/maniska episoder. Vid susp. bipolr sjukdom mste pat. ha
stmningsstabiliserande lkemedel, frutom antidepressiv medicinering.
(4 pong)
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D7

SVAR:

SSRI
KBT
Smnmedicin fr kortare tids behandling.
(2 pong)
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D8

SVAR:

ADHD. Uppmrksamhetsstrning, impulsivitet och hyperaktivitet.

(3 pong)
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D9

SVAR:

Bipolrt syndrom. Ihllande episoder av nedstmdhet och vriga depressionskriterier.

Ihllande episoder av frhjd sinnesstmning med tydlig frndring av patientens
vanliga fungerande.
(3 pong)
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D10

SVAR:

Metylfenidat eller atomoxetin.

(1 pong)
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D11

SVAR:

Patientens tillstnd br utredas nrmare fr stllningstagande till adekvat behandling

av detta. I den akuta situationen kan patienten dock frses med mindre frpackning
av i frsta hand icke vanebildande preparat.
(2 pong)
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D12

SVAR:

Dysmorfofobi.
(1 pong)
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D13

SVAR:

Allvarlig psykisk strning.

Oundgngligt behov av kvalificerad psykiatrisk dygnetruntvrd.
Motstter sig vrden eller det finns grundad anledning att anta att vrden inte kan
bedrivas med samtycke.
Att patienten till fljd av sin psykiska strning kan befaras komma att allvarligt
skada sig sjlv eller ngon annan.
(4 pong)
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D14

SVAR:

Kvarstende livsleda, hopplshetsknslor, ddsnskan? Letat efter stt att ta livet av

sig inne p avdelningen? Funderat ver sjlvmordsmetoder utanfr avdelningen?
Avsikter att ta sitt liv p avdelningen eller efter utskrivning? Mjlighet att gra
verenskommelser med pat?
Finns hopp infr framtiden? Finns faktorer som avhller patienten frn frnyade
frsk (t.ex. familj eller vnner)?
(3 pong)
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D15

SVAR:

GT, ASAT, MCV, CDT.

(1-2 korrekta svar = 1 pong, 3-4 korrekta svar = 2 pong.)
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D16

SVAR:

AUDIT.
(1 pong)
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D17

SVAR:

14.
(1 pong)
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14
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SVAR:

KIRURGI

________________________________________________________________________
E1

SVAR:

Miktogram.
(1 pong)
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E2

SVAR:

Prostataglandin E1, intracavernst eller intrauretralt.

(1 pong)
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E3

SVAR:

C.
(1 pong)
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E4

SVAR:

verfyllnadsinkontinens.
(1 pong)
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E5

SVAR:

A. Hydrocele. (1 pong)
B. Varicocele. (1 pong)
(totalt 2 pong)
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E6

SVAR:

Fingret lser sig i flekterat lge.

(1 pong)
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E7

SVAR:

Frozen shoulder.
(1 pong)
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15
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E8

SVAR:

Frmre axelluxation.
(1 pong)
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E9

SVAR:

D. Perianal anestesi.
(1 pong)
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E 10

SVAR:

Pelvo spondylit Mb Bechterew.

(1 pong)
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E 11

SVAR:

A. Handens flexorsenor (som lper i senskidor). (1 pong)

B. Nekros av flexorsenor stelt, krokigt finger. (1 pong)
(totalt 2 pong)
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E 12

SVAR:

Efter att tillvxten r avslutad efter puberteten.

(1 pong)
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E 13

SVAR:

Spinal stenos.
(1 pong)
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E 14

SVAR:

Gr hl p nageln med ett gldgat gem och evakuerar hematomet.

(1 pong)
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E 15

SVAR:

N. Medianus.
(1 pong)
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16
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E 16

SVAR:

Fettembolisyndromet.
(1 pong)
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E 17

SVAR:

N. Radialis.
(1 pong)
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E 18

SVAR:

Slagsml knytnvsslag.
(1 pong)
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E 19

SVAR:

Portal hypertension.
(1 pong)
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E 20

SVAR:

Mesenterialkrls occlusion.
(1 pong)
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E 21

SVAR:

Brstsmrtor och dyspn.

(1 pong)
________________________________________________________________________
E 22

SVAR:

Ste fr trombos med embolier som fljd.

(1 pong)
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E 23

SVAR:

Hyperthyroidos.
(1 pong)
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17
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E 24

SVAR:

Djup ventrombos (DVT).

(1 pong)
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E 25

SVAR:

Normala frhllanden.
(1 pong)
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E 26

SVAR:

A. Rtt: 1 och 4
Fel: 2 och 3.
(1 pong)
B. Alternativ 3 r fel. (1 pong)
(totalt 2 pong)
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E 27

SVAR:

Ingen vidare utrymning.

(1 pong)
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E 28

SVAR:

Kronisk vens insufficiens.

(1 pong)
________________________________________________________________________
E 29

SVAR:

Primr hyperparathyroidism.
(1 pong)
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E 30

SVAR:

B.
(1 pong)
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18
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E 31

SVAR:

kar muskulra aktiviteten och gallfldet utlser smrta.

(1 pong)
________________________________________________________________________
E 32

SVAR:

Bakterieinflde via v. porta som i sin tur drnerar v. mesenterica superior.

(1 pong)
________________________________________________________________________
E 33

SVAR:

Crena ani.
(1 pong)
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E 34

SVAR:

CEA carcinoembryonalt antigen.

(1 pong)
________________________________________________________________________
E 35

SVAR:

Ulcers colit r en inflammatorisk process lokaliserad till slemhinnan gr ej

transmuralt.
(1 pong)
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E 36

SVAR:

Subcutan infektion utgende frn svettkrtlarna.

(1 pong)
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E 37

SVAR:

Mallory Weiss bldning.

(1 pong)
________________________________________________________________________