2012 Flashcards
1. Routine examination of a child with a history of bronchial asthma reveals AP of 140/90 mmHg.Themostlikelycause of the hypertension is: A. Coarctation of the aorta B. Theophylline overdose C. Chronic lung disease D. Renal disease E. Obesity
D. Renal disease
Head of a department and a tradeunion group have appealed to the head of a hospital about dismissal of the senior nurse who has 17 year record of service. The facts of charge were confirmed and recognized by the nurse herself. This nurse lives with a daughter (who is divorced and unemployed) and a 9-monthold grandson. Make an administrative decision:
A. To continue the worker in office with a warning of dismissal in case of repeated violation of labor discipline
B. To discharge the worker, i.e. to satisfy demands of the collective
C. To issue the sick list
D. To shift the solution of this problem on other officials or public organizations
To continue the worker in office with a warning of dismissal in case of repeated violation of labor discipline
Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?
A. Iatrogenic injury of the trachea
B. Deep neck phlegmon
C. Perforation of the cervical part of the easophagus
D. Perforation of the thoracic part of the easophagus
E. Cervical lymphadenitis
E. Cervical lymphadenitis
For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of: A. Skin B. Thyroid gland C. Reproduction system organs D. Breast E. Lungs
B. Thyroid gland
During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?
A. Shunting
B. Depositing of blood in venous channel C. Developing of cardiac insufficiency
D. Presence of hypervolemia
E. Increase of bleeding speed
C. Developing of cardiac insufficiency
A neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd day of life, then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275µmol/L, direct bilirubin level -5µmol/L, Hb-150 g/l. Mother’s blood group -0(I), Rh+,child’s blood group -A(II), Rh+. What is the most probable diagnosis?
A. Hepatitis
B. Jaundice due to conjugation disorder
C. Hemolytic disease of the neonate (АВ0 incompatibility), icteric type
D. Physiological jaundice
E. Hemolytic disease of the neonate (Rh incompatibility)
C. Hemolytic disease of the neonate (АВ0 incompatibility), icteric type
An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 yearsold, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?
A. 1 cm left from the left medioclavicular line
B. 1 cm right from the left medioclavicular line
C. Along the left medioclavicular line
D. 1 cmleft from he left parasternal line E. 1 cmright from the left parasternal line
A. 1 cm left from the left medioclavicular line
A neonate is 5 days old. What vaccination dose of BCG vaccine (in mg) is necessary for vaccination of this child?
A. 0,2 mg B. 0,025 mg C. 0,075 mg D. 0,1 mg E. 0,05 mg
E. 0,05 mg
A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temp of 38, 9oC, along with right upper quadrant tenderness. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas B. Benign biliary stricture C. Malignant biliary stricture D. Choledocholithiasis E. Choledochal cyst
D. Choledocholithiasis
4 days ago a 32-year-old patient caught a cold: he presented with sore throat, fatigue. The next morning he felt worse, developed dry cough, body temperature rose up to 38,2oC,there appeared muco-purulent expectoration. Percussion revealed vesicular resonance over lungs, vesicular breathing weakened below the angle of the right scapula, fine sonorous and sibilant wheezes. What is the most likely diagnosis? A. Bronchial asthma B. Focal right-sided pneumonia C. Acute bronchitis D. Pulmonary carcinoma E. Pulmonary gangrene
B. Focal right-sided pneumonia
A 45-year-old woman, mother of four children, comes to the emergency room complaining of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back, accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely diagnosis is: A. Acute pancreatitis B. Perforated peptic ulcer disease C. Myocardial infarction D. Sigmoid diverticulitis E. Acute cholecystitis
E. Acute cholecystitis
During an operation for presumed appendicitis the appendix was found to be normal; however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayish-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:
A. Ulcerative colitis B. Perforated Meckel’s diverticulum C. Crohn’s disease of the terminal ileum D. Ileocecal tuberculosis E. Acute ileitis
A girl is 12-year-old. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8oC. Pasternatsky symptom is negative. Urine analysis: protein -0,033 g/L, WBC-20-25in f/vis, RBC-1-2 in f/vis. What diagnosis is the most probable? A. Acute pyelonephritis B. Dysmetabolic nephropathy C. Acute glomerulonephritis D. Acute cystitis E. Urolithiasis
D. Acute cystitis
A woman, primagravida, consults a gynecologist on 05.03.2012. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2012. When should she be given maternity leave? A. 11 July B. 25 July C. 22 August D. 8 August E. 5 September
D. 8 August
A 40-year-old female patient has been hospitalized for attacks of asphyxia, cough with phlegm. She has a 4-year history of the disease. The first attack of asphyxia occurred during her stay in the countryside. Further attacks occurred while cleaning the room. After 3 days of inpatient treatment the patient’s condition has significantly improved. What is the most likely etiological factor? A. Infectious B. Pollen C. Household allergens D. Chemicals E. Psychogenic
C. Household allergens
A 3-year-old child has been admitted to a hospital because of ostealgia and body temperature rise up to 39oC. Objectively: the patient is in grave condition, unable to stand for ostealgia, there is apparent intoxication, lymph nodesare enlarged up to 1,5 cm. Liver can be palpated 3 cm below the costal margin, spleen -2 cm below the costal margin. In blood: RBCs-3,0·1012/l,Hb-87g/l,colour index -0,9, thrombocytes -190 · 109/l, WBCs -3,2 · 109/l, eosinophils -1, stab neutrophils -1, segmented neutrophils 0, lymphocytes -87, monocytes -2, ESR-36 mm/h. What examination should be conducted in order to specify the diagnosis? A. Sternal puncture B. Ultrasound C. Lymph node puncture D. Lymph node biopsy E. Computer tomography
A. Sternal puncture
A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis? A. Neurodermatitis B. Dermatitis simplex C. Eczema D. Erysipelas E. Allergic dermatitis
E. Allergic dermatitis
A 16-year-old patient who has a history of intense bleedings from minor cuts and sores needs to have the roots of teeth extracted. Examination reveals an increase in volume of the right knee joint, limitation of its mobility. There are no other changes. Blood analysis shows an inclination to anaemia (Hb-120 g/l). Before the dental intervention it is required to prevent the bleeding by means of: A. Cryoprecipitate B. Epsilon-aminocapronic acid C. Fibrinogen D. Dried blood plasma E. Calcium chloride
A. Cryoprecipitate
A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2x3 cm large that was changing its position during the examination. What conclusion can be made?
A. Urinary bladder polyp
B. Malignant tumour of the urinary bladder
C. Concrement
D. Prostate adenoma
E. Primary ureter tumour
C. Concrement
An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, to-35,0oC. AP-100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient’s mouth. What is the most likely diagnosis?
A. Apparent death
B. Acute cardiovascular insufficiency
C. Hypothermia
D. Frostbite of trunk and extremities
C. Hypothermia
A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
A. Embryotomy
B. Cesarean
C. Forceps operation
D. Conservative labor management with episiotomy
E. Stimulation of labor activity
C. Forceps operation
A 35-year-old patient complains about pain and morning stiffness of hand joints and temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years. Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What examination should be administered? A. Immunogram B. Complete blood count C. Rose-Waaler reaction D. Roentgenography of hands E. Proteinogram
D. Roentgenography of hands
A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, painduringthe eyeballsmovement,joint’s pain. On examination: excited, to-39oC, Ps-110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?
A. Influenza with cerebral edema manifestations
B. Influenza, typical disease duration
C. Respiratory syncytial virus
D. Parainfluenza
E. Adenovirus infection
A. Influenza with cerebral edema manifestations
A 29-year-old female patient complains of dyspnea, heaviness and chest pain on the right, body temperature rise up to 37, 2oC. The disease is associated with a chest trauma received 4 days ago. Objectively: skin is pale and moist. Ps-90 bpm, regular. Palpation reveals a dull sound on the right, auscultation reveals significantly weakened vesicular breathing. In blood: RBCs-2,8·1012/l, colour index -0,9, Hb100 g/l, WBCs-8,0·109/l, ESR -17 mm/h. What results of diagnostic puncture of the pleural cavity can be expected?
A. Transudate B. Chylous liquid C. Exudate D. Haemorrhagic punctate E. Purulent punctate
D. Haemorrhagic punctate
A 54-year-old drowned man was rescued from the water and delivered to the shore. Objectively: the man is unconscious, pale, breathing cannot be auscultated, pulse is thready. Resuscitation measures allowed to save the patient. What complications may develop in the near future?
A 54-year-old drowned man was rescued from the water and delivered to the shore. Objectively: the man is unconscious, pale, breathing cannot be auscultated, pulse is thready. Resuscitation measures allowed to save the patient. What complications may develop in the near future? A. Cardiac arrest B. Respiratory arrest C. Encephalopathy D. Pulmonary edema E. Bronchospasm
D. Pulmonary edema
A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an in-patient hospital. He was diagnosed with progressing vegetative insufficiency. This disease relates to the following group of ionizing radiation effects: A. Hormesis B. Somatic C. Genetic D. Somato-stochastic E. Heterosis
D. Somato-stochastic
A military unit stopped for 3-day’s rest in aninhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field conditions:
A. Melt snow water B. Spring water C. River water D. Rain water E. Artesian well water
E. Artesian well water
Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics within the last 5 years. What statistical values can help in calculation of morbidity rates? A. Average values B. Standard values C. Relative values D. Absolute values E. Dynamic series
A. Average values
A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37,6oC. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall 0,4 cm, choledochus -0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis? A. Liver abscess B. Liver cancer C. Alveolar echinococcus of liver D. Cystous liver cancer E. Paravesical liver abscesses
C. Alveolar echinococcus of liver
A 55-year-old male had been treated at thesurgical department foracutelowerextremity thrombophlebitis. On the 7th day of treatment he suddenly developed pain in the left part of chest, dyspnea andcough. Bodytemperaturewas36,1oC, respiratory rate -36/min. The patient was also found to have diminished breath sounds without wheezing. Ps-140/min, thready. AP-70/50 mm Hg. The ECG shows Q-S1 syndrome.Whatisthemost likely diagnosis? A. Pulmonary embolism B. Myocardial infarction C. Cardiac asthma D. Bronchial asthma E. Pneumothorax
A. Pulmonary embolism
A 16-year-old adolescent was vaccinatedwithDTP.Ineightdaystherewas stiffness and pain in the joints, subfebrile temperature, urticarial skin eruption, enlargement of inguinal, cervical lymph nodes and spleen. What kind of allergic reaction is observed?
A. Cytoxic
B. Hypersensitivity of immediate type
C. Immunocomplex
D. Hypersensitivity of delayed type
C. Immunocomplex
A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. Thepainlastsfor up to10minutesandcan be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are rhythmic, Ps-78 bpm, AP-130/80 mm Hg. ECGcontains low amplitude of T wavein V4−5. What disease might be suspected?
A. Stable FC I stenocardia B. Instable stenocardia C. Stable FC III stenocardia D. Stable FC II stenocardia E. Stable FC IV stenocardia
C. Stable FC III stenocardia
In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and at night. Hecomplains of pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis? A. Chronic cholecystitis B. Duodenal ulcer C. Diaphragmatic hernia D. Stomach ulcer E. Chronic pancreatitis
B. Duodenal ulcer
A secundipara has regular birth activity. Three years ago she had cesarean section for the reason of acute intrauterine hypoxia. During parodynia she complains of extended pain in the area of postsurgical scar. Objectively: fetus pulse is rhythmic -140 bpm. Vaginal examination shows 5 cm cervical dilatation. Fetal bladder is intact. What is the tactics of choice?
A. Vaginal delivery
B. Augmentation of labour
C. Obstetrical forceps
D. Waiting tactics of labor management E. Cesarean section
E. Cesarean section
A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?
A. Reiter’s disease B. Coxarthrosis C. Rheumatoid arthritis D. Ankylosing spondylitis E. Spondylosis
D. Ankylosing spondylitis
A 58-year-old female patient complains about periodical headache, dizziness andearnoise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD-1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
A. Ihibitor of angiotensin converting enzyme B. β-blocker C. Calcium channel antagonist D. Thiazide diuretic E. α-blocker
A. Ihibitor of angiotensin converting enzyme
At the radiological unit of a hospital gamma-devices of radiotherapy of “Agat”type and other closed sources of ionizing radiation are used for treatment of malignant neoplasms. What measures are to be taken to protect personnel during working with radioactive sources of such type?
A. Reduction of working time and screening of the source
B. Capsulation of devices and organization of room ventilation
C. Screening of the source and the use of means of individual protection of respiration organs
D. The increase of distance to the source and individual hygiene compliance
E. Systematical cleansing of surfaces from the radioactive contamination and shortening of working time
A. Reduction of working time and screening of the source
A 20-year-old adolescent lives in the nidus of tuberculous infection. The tuberculine Mantoux test with 2 TU was determined as hyperergic. What signs determine the hyperergic test of this adolescent? A. 6 mm papula, necrosis B. 20 mm papula C. 24 mm hyperemia D. 4 mm papula E. 12 mmhyperemia
A. 6 mm papula, necrosis
A survey radiograph of a miner (24 years of service record, the dust concentration in the workplace is at the rate of 260-280 mg/m3 with 15% of free silica) shows lung changes that are typical for pneumoconiosis. What type of pneumoconiosis is it? A. Silicatosis B. Carboconiosis C. Anthracosilicosis D. Anthracosilicatosis E. Silicosis
C. Anthracosilicosis
A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid? A. Seduxen B. Isoptin C. Lydocain D. Novocainamides E. Strophantin
C. Lydocain
A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac work, pain in the left chest half with irradiation to the left scapula.Treatment is uineffective. On physical exam: heart’s sounds are diminished, soft systolic murmur on the apex. Ps -100/min, arrhythmical, BP -115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): leftventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis? A. Coronarography B. Veloergometria C. X-ray kymography D. ECG in the dynamics E. Echocardiography
E. Echocardiography
A 27-year-old woman presents at the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She hasn’t get pregnant. On examination: genital development is without pathology, uterine tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?
A. Immunologic infertility
B. Chronic adnexitis
C. Abnormalities in genital development D. Anovular menstrual cycle
E. Genital endometriosis
D. Anovular menstrual cycle
- To study physical development of children and adolescents, anthropometric studies are widely used. Choose a physiometric method of study from the below given.
A. Measurement of growth B. Determination of vital capacity of lungs C. Determination of thorax form D. Determination of vertebra form E. Determination of body weight
B. Determination of vital capacity of lungs
An electro-gas welding operator working at a machine workshop performs welding and cutting of metal, which is accompanied by intense UV-radiation. His welding station is equipped with effective mechanical ventilation. What occupational disease is most likely to develop in an electro-gas welding operator? A. Photoelectric ophthalmia B. Heatstroke C. Vegetative-vascular dystonia D. Chronic overheating E. Pneumoconiosis
A. Photoelectric ophthalmia
A 60-year-old female patient had been admitted to a hospital for acute transmural infarction. An hour later the patient’s contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate -30/min, heart rate -130/min, AP-90/60 mm Hg. Heart sounds were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with medium moist rales in the lower parts of lungs on the right and on the left. Body temperature 36, 4oC. What drug should be given in the f irst place? A. Aminophylline B. Promedol C. Dopamine D. Heparin E. Digoxin
B. Promedol
A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuty of vision of the left eye is 0,01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eyeground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?
A. Leukoma of the cornea B. Open-angle glaucoma C. Disorder of blood circulation in retina vessels D. Senile cataract E. Exfoliation of the retina
D. Senile cataract
A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months. Who has the right to extend the duration of medical certificate for this patient?
A. Medical superintendent
B. Medical advisory commission after medico-social expert commission examination
C. Medical advisory commission after inpatient treatment
D. District doctor by agreement with a department chief
E. Medico-social expert commission
B. Medical advisory commission after medico-social expert commission examination
A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3th day appeared changes of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces-golden-yellow. Mother’s blood group is (II)Rh−, child-(II)Rh+. On the third day child’s Hb-200 g/L, RBC-6,1 · 1012/L, bilirubin in blood 58 mk mol/L due to unconjugated bilirubin, Ht-0,57. What is the child’s jaundice explanation?
A. Bile ducts atresia B. Physiologic jaundice C. Hemolytic disease of newborn D. Brain delivery trauma E. Fetal hepatitis
D. Brain delivery trauma
On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient’s condition is moderately severe. Respiratory rate -28-30/min, Ps-96 bpm, AP-110/70mmHg.Respirationabovethe left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?
A. Pyopneumothorax B. Exudative pleuritis C. Acute focal pneumonia D. Pleural empyema E. Acute pulmonary abscess
E. Acute pulmonary abscess
A 25-year-old woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?
A. Chlamydiosis B. Gonorrhea C. Trichomonas colpitic D. Vagina candidomicosis E. Bacterial vaginosis
C. Trichomonas colpitic
A 50-year-old locksmith has a longterm record of work under the effect of mercury vapors with concentration exceeding MPC by 5-10 times. Clinical examination revealed the lability of vasomotors of skin, pulse and arterial pressure; total hyperhydrosis; asymmetric innervation of facial and lingual muscles, positive subcortical reflexes, intention tremor. Against the background of increased emotional excitability the patient presents with lack of self-confidence, shyness. A dentist found him to have parodontosis, chronic stomatitis. What disease can be suspected?
A. Chronic mercury intoxication B. Acute mercury intoxication C. Parkinson’s syndrome D. Residual effects of neuroinfection E. Vascular encephalopathy
A. Chronic mercury intoxication
4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and tothe left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?
A. Duodenal ulcer B. Chronic gastroduodenitis C. Chronic pancreatitis D. Zollinger-Ellison syndrome E. Chronic calculous cholecystitis
C. Chronic pancreatitis
A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis. She hasn’t been examined recently. Objectively: malnutrition, dry skin with signs of scratching. Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are absenr. Whattesting must beadministered in the first place?
A. Blood sugar test on an empty stomach B. Complete blood count C. Endoscopy of stomach D. Lymph node biopsy E. Blood sterility testing
A. Blood sugar test on an empty stomach
A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?
A. Breast cancer B. Lacteal cyst with suppuration C. Fibrous adenoma of the left mammary gland D. Lactational mastitis E. Phlegmon of mammary gland
D. Lactational mastitis
Several hours before, a 28-yearold patient suddenly developed acute headache and repeated vomiting, then lost consciousness. Objectively: focal neurological symptoms were not found. Pronounced meningeal symptoms were revealed. AP -120/80 mm Hg. According to clinical and liquorological findings the patient was diagnosed with subarachnoid haemorrhage. After administration of dehydrants the patient’s condition somewhat improved. What is the maincomponent offurtheremergency care? A. Anticoagulants B. Coagulants C. Antiaggregants D. Fibrinolytics E. Corticosteroids
B. Coagulants
A 24-year-old man on the 5th day of acute respiratory disease with high grade temperature started having strong headaches, systemic dizziness, sensation of double vision, paresis of mimic muscles to the right, tickling by swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction of the emergent therapy.
A. Hemodesis B. Glucocorticoids C. Cephtriaxon D. Lasix E. Zovirax
E. Zovirax
A 30-year-old patient was delivered to the admission ward of the infectious disease department. The disease had started acutely on the background of normal temperature with the appearance of frequent, liquid, profuse stool without pathological impurities. Diarrhea was not accompanied by abdominal pain. 12 hours later there appeared recurrent profuse vomiting. The patient rapidly developed dehydration. What is the most likely diagnosis?
A. Cholera B. Shigellosis C. Staphylococcal food toxicoinfection D. Salmonellosis E. Campylobacteriosis
A. Cholera
A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal pain, dizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are rales in the lower parts of lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic murmur conducted to the vessels of neck. AP-130/90 mm Hg, heart rate -90/min, regular rhythm. The liver extends 5 cm under the edge of costal arch, shin edemata are present. Specify the assumed valvular defect:
A. Pulmonary artery stenosis B. Aortic stenosis C. Mitral insufficiency D. Ventricular septal defect E. Tricuspid regurgitation
B. Aortic stenosis
A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts an hour or more. The patient has a nearly 2year history of this disease. Objectively: Ps-76 bpm. AP-110/70 mm Hg. Heart borders are norma, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
A. No changes B. Leukocytosis C. Thrombocytopenia D. Leukemic hiatus E. Increased ESR
A. Nochanges
A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous month. Objectively: body temperature -37,4oC, malnutrition, skin is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3 cmbelow the costal margin. What is the most likely diagnosis?
A. Sprue B. Bacillary dysentery C. Non-specific ulcerative colitis D. Intestinal enzymopathy E. Helminthic invasion
C. Non-specific ulcerative colitis
A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last severalmonths shehas beenunder outpatient monitoring for the increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. HR-110/min, AP-220/140 mm Hg. Heartsounds areweakened. Inblood: WBCs-9,8·109/l, ESR -22 mm/h. Blood glucose -9,8 millimole/l. What disease is the most likely cause of this crisis?
A. Preeclampsia B. Essential hypertension C. Pheochromocytoma D. Primary hyperaldosteronism E. Diabetic glomerulosclerosis
C. Pheochromocytoma
A 19-year-old woman complains of pain in the abdomen and joints, asks for more analgetics and somnifacient injections. The patient was examined. Gynecological and urological pathologies are absent. There are signs of previous punctures along superficial veins of the extremities. The patient does not explain the origin of punctures. Tendon reflexes of upper and lower extremities are the same, quick. Photoreaction of the pupil of the eye is weak. The tongue is grey coated. During communication the patient in affectively not even-tempered. There is diarrhea without pathologic inclusions. What tactics is necessary to improve the condition of this patient?
A. Consultation of an expert in narcology B. Prescription of medications the patient asks for
C. Additional consultation of surgeon
D. Treatment with antibiotics
E. Consultation of infectious diseases doctor
A. Consultation of an expert in narcology
A 1,5-year-old child fell ill acutely with high temperature 38oC, headache, fatigue. The temperature declined on the f ifth day, muscular pain in the right leg occuredinthemorning,therewereno movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis? A. Hip joint arthritis B. Viral encephilitis C. Polyartropathy D. Osteomyelitis E. Polyomyelitis
E. Polyomyelitis
Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called musculovenous pump. This term refers to the following group of muscles: A. Buttock region muscles B. Abdominal wall muscles C. Shin muscles D. Thigh muscles E. Foot muscles
C. Shin muscles
A 7-year-old child was brought to a doctor for a check. The child has a 4-year history of bronchial asthma, asthma attacks occur mainly in spring and summer. Allergy tests revealed hypersensitivity to poplar seed tufts, field herbs. What recommendation should be given? A. Physiotherapy B. Specific hyposensitization C. Treatment at a health resort D. Phytotherapy E. Needle reflexotherapy
B. Specific hyposensitization
A farmer hurt his right foot during working in a field and came to the emergency station. He doesn’t remember when he got last vaccination and he has never served in the army. Examination of his right foot revealed a contaminated wound up to 5-6 cm long with uneven edges. The further treatment tactics will be:
A. Surgical d-bridement only
B. To make an injection of tetanus anatoxin
C. To make an injection of antitetanus serum
D. To make an injection of tetanus anatoxin and antitetanus serum
E. To administer an antibiotic
D. To make an injection of tetanus anatoxin and antitetanus serum
A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, lightcolored feces and dark urine. In blood: neutrophilic leukocytosis -13,1 · 109/l, ESR-28 mm/h. What is the most likely diagnosis?
A. Chronic recurrent pancreatitis
B. Chronic calculous cholecystitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
B. Chronic calculous cholecystitis
In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?
A. All dead bodies of the unknown persons
B. Body of poisoned person
C. Body of drowned man
D. Body of person with internal hemorrhage
E. Body of person with a sudden death
A. All dead bodies of the unknown persons
A 36-year-old patient complains of skin rash that appeared a week ago and doesn’t cause any subjective problems. Objectively: palm and sole skin is covered with multiple lenticular disseminated papules not raised above the skin level. The papules arereddish, dense on palpation and covered with keratinous squamae. What is the provisional diagnosis?
A. Palmoplanar psoriasis B. Verrucosis C. Secondary syphilis D. Palmoplanar rubrophytosis E. Palm and sole callosity
C. Secondary syphilis
A 5-grade pupil complains about extensive skin rash accompanied by intensive itch, especially at night. Objectively: there are small red papules set mostly in pairs in the region of interdigital folds on both hands, on the flexor surface of radicarpal articulations, abdomen and buttock skin as well as internal surface of thighs. In the centre of some papules vesicles or serohaemorrhagic crusts can be seen. There are multiple excoriations. What is the most likely diagnosis?
A. Scabies B. Dermatitis C. Ringworm of body D. Toxicoderma E. Eczema
A. Scabies
A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis? A. Haemorrhagic vasculitis B. Microbial eczema C. Contact dermatitis D. Toxicoderma E. Erysipelas
E. Erysipelas
A 47-year-old patient came to see a doctor on the 7th day of disease. The disease developed very fast: after the chill body temperature rose to 40oC and lasted up to 7 hours, then dropped abruptly, which caused profuse sweat. There were three such attacks occuringonce in two days. Two days ago the patient arrived from Africa. Objectively: pale skin, subicteric sclera, significantly enlarged liver and spleen. What is the cause of fever attacks in this disease? A. Erythrocytic schizogony B. Tissue schizogony C. Exotoxin of a causative agent D. Endotoxin of a causative agent E. Gametocytes
A. Erythrocytic schizogony
On the 2 nd day of illness a 27-yearold patient complains of the unbearable headache, repeated vomiting. Objectively: the patient is in a grave condition. He is conscious but adynamic. Lies in a forced position with his headthrownback. There is no skin rash. Occipital muscles are evidently rigid, there are Kernig’s and Brudzinski’s signs. to-39,5oC,Ps120/min., AP-130/80 mm Hg. What is the reason for the leading syndrome of this disease?
A. Hyperthermy B. Liquor hypotension C. Affection of the cranial nerve nuclei D. Haemorrhages into the adrenal glands E. Liquor hypertension
E. Liquor hypertension
A patient has chronic heart failure of the II stage. He takes furosemide regularly three times a week. He had developed bronchopneumonia and had been administered combined pharmacotherapy. On the fifth day of therapy the patient complained of hearing impairment. What drug coadministered with furosemide might have caused the hearing loss? A. Nystatin B. Linex C. Gentamicin D. Tavegil E. Mucaltin
C. Gentamicin
A 54-year-old female patient has been admitted to a hospital 12 days after the beginning of acute pancreatitis. Objectively: the patient is in grave condition. The body temperature is hectic. Ps -112 bpm. The abdomen is swollen. Epigastrium palpation reveals a very painful infiltration falling in the localization of pancreas. Abdominal cavity contains fluid. There is an edema of the left lumbar region. In blood: WBCs-18·109/l. What is the required tactics of the patient’s treatment?
A. Surgical treatment B. Further conservative treatment C. Peritoneal dialysis D. Increase in antienzymes E. Massive antibacterial therapy
A. Surgical treatment
To replace the blood loss replacement 1000 ml of the same group of Rhesus compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?
A. Citrate shock B. Citrate intoxication C. Allergic reaction D. Anaphylactic shock E. Pyrogenous reaction
B. Citrate intoxication
A 24-year-old emotionally-labile womanpresents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue followi ng the divorce. On examination: palm hyperhydrosis, pulse rate-72-78bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case? A. Schizophrenia B. Ipochondric neurosis C. Compulsive neurosis D. Neurasthenia E. Depressive neurosis
D. Neurasthenia
A 30-year-old woman with a long history of chronic pyelonephritis complains about considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP-200/120 mm Hg. Inblood: creatinine -0,62 millimole/l, hypoproteinemia, albumines -32 g/l, potassium -6,8 millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?
A. Haemodialysis B. Antibacterial therapy C. Enterosorption D. Haemosorption E. Blood transfusion
A. Haemodialysis
A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
A. Acetone in urine test
B. Glucose in urine test on the base of daily diuresis
C. Blood glucose analysis on an empty stomach
D. Glucose tolerance test
E. Glucosuric profile
C. Blood glucose analysis on an empty stomach