Step 2 - Medicine 2010

1 із 201

A 40-year-old patient complains of colic pains in the lower abdomen and profuse bloody discharges from the genital tracts. Over the last 2 years she has been having menses for 15-16 days, profuse, with clots, painful. In anamnesis there are 2 medical abortions. On bimanual investigation: in the canal of the uterine cervix some fibromatous nodes are palpable, they are 3 cm in diameter, on the thin crus. Discharges are bloody, moderate. Choose the correct treatment tactics:

Operation: untwisting of the nodes

Hysterectomy without appendages

Step-by-step vitamin therapy

Hormonal hemostasis

Supravaginal ablation of the uterus without appendages

2 із 201

13 months after the first labor a 24-year-old patient complained of amenorrhea. Pregnancy ended in Caesarian section because of premature detachment of normally positioned placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood clotting. Choose the most suitable investigation:

Estimation of gonadotropin rate

Computer tomography of head

Progesteron assay

USI of small pelvis organs

Estimation of testosteron rate in blood serum

3 із 201

A 20-year-old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First medical aid involved application of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?

120 minutes

60 minutes

15 minutes

30 minutes

180 minutes

4 із 201

Head of a department and a trade-union 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-month-old grandson. Make an administrative decision:

To continue the worker in office with a warning of dismissal in case of repeated violation of labor discipline

-

To shift the solution of this problem on other officials or public organizations

To discharge the worker, i.e. to satisfy demands of the collective

To issue the sick list

5 із 201

25 unorganized children in the age 2-3 year will be observed on a pediatric district it in the current year. What scheduled number of initial visitations will make to this group of children?

50

20

200

100

40

6 із 201

A patient with high temperature came to a first-aid post in the evening. The fact of temporary disability was established. Indicate the order of examination in this case:

The night duty doctor should issue a medical certificate, which will be subsequently used for issuing a sick list from the date of the previous day

The sick list for up to 3 days should be issued

The sick list for 3 days should be issued

Any document shouldn’t be issued

The sick list for 1 day should be issued

7 із 201

An 8-year-old boy fell ill acutely: he presents with fever, weakness, headache, abdominal pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tender and hardened. What is your diagnosis?

Dysentery

Salmonellosis

Escherichiosis

Staphylococcal gastroenteritis

Cholera

8 із 201

An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, 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?

1 cm left from the left medioclavicular line

Along the left medioclavicular line

1 cm left from he left parasternal line

1 cm right from the left parasternal line

1 cm right from the left medioclavicular line

9 із 201

A 14-year-old boy has rheumatism. Over the last 2 years he has had 3 rheumatic attacks. What course of rheumatism does the patient have?

Prolonged

Persistent-reccurent

Latent

Acute

Subacute

10 із 201

The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure does the child have?

Aortal insufficiency

Rheumatism

Aortal stenosis

Mitral stenosis

Mitral insufficiency

11 із 201

An 18-month-old child was taken to a hospital on the 4-th day of the disease. The disease began acutely with temperature 39, weakness, cough, breathlessness. He is pale, cyanotic, has had febrile temperature for over 3 days. There are crepitative fine bubbling rales on auscultation. Percussion sound is shortened in the right infrascapular region. X-ray picture shows non-homogeneous segment infiltration 810 mm on the right, the intensification of lung pattern. Your diagnosis:

Segmentary pneumonia

Bronchiolitis

Interstitial pneumonia

Bronchitis

Grippe

12 із 201

A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby has a large cephalohematoma. The results of blood count are: Hb- 120g/l, Er- 3,5 • 1012/l, total serum bilirubin - 123 mmol/l, direct bilirubin - 11 mmol/l, indirect - 112 mmol/l. What are causes of hyperbilirubinemia in this case?

Erythrocyte hemolysis

Intravascular hemolysis

Bile condensing

Mechanical obstruction of the bile outflow

Disturbance of the conjugative function of liver

13 із 201

A 4-month-old girl with blond hair and blue eyes has 'mousy'odor of sweat and urine, delayed psychomotoric development. The most typical laboratory data for this disorder is:

Positive urine ferric chloride test

High level of glycosaminoglycanes in urine

Low level of thyroid gland hormones in blood

High level of oxyproline in urine

High concentration of chlorides in sweat

14 із 201

A man, aged 25, presents with facial edema, moderate back pains, body temperature of 37,5oC, BP- 180/100 mm Hg, hematuria (up to 100 in v/f), proteinuria (2,0 g/l), hyaline casts - 10 in v/f, specific gravity - 1020. The onset of the disease is probably connected with acute tonsillitis 2 weeks ago. The most likely diagnosis is:

Acute glomerulonephritis

Acute pyelonephritis

Cancer of the kidney

Chronic glomerulonephritis

Urolithiasis

15 із 201

A 62-year-old patient has DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What tactics of hypoglycemic therapy should be chosen?

Prescribe the short-acting insulin

Prescribe thelong-acting insulin

Give Glurenorm in place of Maninilum

To continue with the current therapy

Prescribe guanylguanidine

16 із 201

A neonate is 5 days old. What vaccination dose of BCG vaccine (in mg) is necessary for vaccination of this child?

0,05 mg

0,2 mg

0,1 mg

0,075 mg

0,025 mg

17 із 201

Patient, male, 16 years old was behind other children in development since early childhood and still has moderate mental retardation. He is short, has dismorphic body, his face is round, flattened, his eyes are narrow and slanted, and there are epi-cantial folds in the corners of his eyes. There is only one transversal flexor line on his palms. What is the probable etiology of this state?

Chromosome abnormality

Infection in mother during pregnancy

Pathological delivery

Gene abnormality

Maternal alcohol abuse during pregnancy

18 із 201

A patient who works as a nightman was diagnosed with of chronic arseni-ous intoxication. What form of anemia is characteristic for this disease?

Haemolytic anemia

Hyper sideric anemia

Iron deficiency anemia

Aplastic anemia

Normochromic anemia

19 із 201

A patient, aged 52, works as a street cleaner. He has been suffering from pneumoconiosis for 2 years. What treatment should be recommended?

Alkaline inhalations

Oil inhalations

Sulfonilamides

Antibiotics

Broncholitics

20 із 201

A 28-year-old patient was hospitalized with preliminary diagnosis 'influenza'. Roseolouspetechial rash appeared on the 5th day of disease on the trunk. The temperature is 41oC. Hyperemia of face, reddening of scleras, tremor of tongue, tachycardia, splenomegaly are present. What is the most likely diagnosis?

Epidemic typhus

Measles

Alcohol delirium

Leptospirosis

Typhoid fever

21 із 201

The diagnostics of the AIDS epidemic initially was made in the USA by means of:

The epidemiological method

The serological method

The virological method

The viroscopic method

The bacteriological method

22 із 201

A 20-year-old woman has a 3-4 month history of bloody diarrhoea; stool examination proved negative for ova and parasites; stool cultures negative for clostridium, campylobacter and yersinia; normal small bowel series; edema, hyperemia and ulceration of the rectum and sigmoid colon seen on sigmoidoscopic examination. Select the most likely diagnosis:

Ulcerative colitis

Carcinoid syndrome

Gastroenteritis

Zollinger-Ellison syndrome

Granulomatous colitis

23 із 201

A 36-year-old alcoholic patient has cirrhosis and pancreatic insufficiency due to recurrent pancreatitis. He complains of night blindness, decreased ability to taste food, and dry skin with hyperpigmentation. These complaints suggest deficiency of:

Zinc

Manganese

Selenium

Chromium

Copper

24 із 201

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:

Choledocholithiasis

Choledochal cyst

Carcinoma of the head of the pancreas

Benign biliary stricture

Malignant biliary stricture

25 із 201

A 30-year-old patient with complaints of occipital headache, disturbed sleep with nightmares came to a policlinic. BP was 150/95 mm Hg. He was diagnosed with hypertensic crisis. The patient should be registered in the following dispensary group for arterial hypertension surveillance:

In the second

In the third

In the fourth

In the fifth

In the first

26 із 201

A young patient who came to a poli- clinic was diagnosed with the 1 stage of hypertension. How often should he undergo the medical check-up?

Twice a year

4 times a year

3 times a year

Once a year

5 times a year

27 із 201

A 45-year-old male patient was admitted to the intensive care unit because of myocardial infarction. An hour later the ventricular facilitation occurred. Which of the following should be administered?

Defibrillation

Lidocaine injection

External chest compression

Cardiac pacing

Adrenalin injection

28 із 201

A 47-year-old obese man complained of periodic attacks of acute arthritis in the st left tarsophalangeal joint. Lab exam revealed increased serum rate of uric acid. What is the diagnosis?

Gout arthritis

Reiter’s disease

Osteoarthritis

Rheumatoid arthritis

Rheumatic arthritis

29 із 201

A 40-year-old woman who has worked in weaving branch for 10 years complains of frequent headache, sleeplessness, irritability, fatigue, tiredness. Physical examination revealed instability of blood pressure, internal organs are without changes. What is the most likely diagnosis?

Noise-induced disease

Asthenovegetative syndrome

Encephalopathy

Atopic bronchial asthma

Hypertension

30 із 201

A 45-year-old driver was admitted to the hospital with 5 hour substernal pain. Nitroglycerin is not effective. He is pale, heart sounds are regular but weak. HR -96 per minute, BP of 100/60 mm Hg. What is the most likely diagnosis?

Acute myocardial infarction

Acute left ventricular failure

Acute myocarditis

Stable angina

Pulmonary embolism

31 із 201

A 33-year-old man with a history of rheumatic fever complains of fever up to 38 — 39oC, abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is enlarged by 3 cm, spleen is palpable. Urine is brownyellow. What is the most likely diagnosis?

Infectious endocarditis

Acute nephritis

Acute hepatitis

Rheumatic fever

Aortic regurgitation

32 із 201

A 30-year-old patient complains of breathlessness, pain in the right rib arc region, dry cough and the edema of legs. He is ill for 2 months. He had been treated for rheumatic fever without any effect. On exam: cyanosis, edema of legs, BT of 36,6oC, RR of 28/min, HR of 90/min, BP of 110/80 mm Hg, crackles above low parts of both lungs, heart borders are displaced to the left and to the right, weak sounds, systolic murmur above the apex. What is the preliminary diagnosis?

Dilated cardiomyopathy

Acute myocarditis

Rheumatic fever, mitral stenosis

Infectious endocarditis

Acute pericarditis

33 із 201

A full term infant was born after a normal pregnancy, delivery, however, was complicated by marginal placental detachment. At 12 hours of age the child, although appearing to be in good health, passes a bloody meconium stool. For determining the cause of the bleeding, which of the following diagnostic procedures should be performed first?

Barium enema

An Apt test

An upper gastrointestinal series

Gastric lavage with normal saline

Platelet count, prothrombin time, and partial thromboplastin time

34 із 201

A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child most likely has congestive heart failure caused by:

Paroxysmal atrial tachycardia

A ventricular septal defect and transposition of the great vessels

Hypoplastic left heart syndrome

A large atrial septal defect and valvular pulmonary stenosis

Atrial flutter and partial atrioventricular block

35 із 201

A 6-year-old boy was brought to the emergency room with a 3-hour history of fever up to 39,5oC and sore throat. The child looks alert, anxious and has a mild inspiratory stridor. You should immediately:

Prepare to establish an airway

Order a chest x-ray and lateral view of the neck

Obtain an arterial blood gas and start an IV line

Admit the child and place him in a mist tent

Examine the throat and obtain a culture

36 із 201

For a patient with a stab injury to the femoral artery, the treatment of choice is:

End- to-end anastomosis

Interposition of Dacron graft

Interposition of homologous arterial graft

Ligation of both transected ends

Interposition of autogenous vein graft

37 із 201

Which of the following best summarizes indications for operation on an abdominal aortic aneurysm?

Any aneurysm greater than 5 cm in diameter

Only symptomatic aneurysm greater than 5 cm in diameter

Only ruptured aneurysm

Only symptomatic aneurysm

Any abdominal aortic aneurysm

38 із 201

Which of the following symptoms is the most typical for the adenoid hypertrophy?

Nasal obstruction

Giddiness

Deglutition disturbance

Olfaction disturbance

Headache

39 із 201

A 30-year-old woman complains of nasal blockage, sneezing, watery nasal discharges. The body temperature is normal. Objectively - edema of nasal mucous membrane on both sides, especially of the lower turbinate (with cyanosis). Blood test data - mild leukocytosis and eosinophilia. What is the diagnosis?

Allergic rhinitis

Infective rhinitis

Foreign body in the nose

Atrophic rhinitis

Acute sinusitis

40 із 201

A 27-year old patient with malaria caused by P. falciparum was treated with Chloroquine (600 mg base followed by 300 mg base in 6 hours, then 300 mg base a day for 2 days) without clinical and parasitologic responses to the treatment. What is the most likely reason for the failure to respond to the therapy?

Chloroquine resistant strain of P. falciparum

Late recognition of infection due to P. falciparum

Inappropriate route of administration

Glucose-6-phosphate dehydrogenase deficiency in patient

Hypersensitivity of the patient to Chloroquine

41 із 201

Ten hours before initial observation patient had frequent feces and vomiting. Fecal and vomiting masses looked like rice-water. Nausea and abdominal pain weren’t observed. Hiccup and convulsions of lower limbs, temperature 35,4oC, hoarse voice, greyish wry face, acrocyanosis were observed. Respiratory rate 40/min, threadlike pulse 120/min, blood pressure 40/0 mm/Hg, abdomen is drawn. What treatment measures should be taken first of all?

Intravenous rehydration

Cardiac glycosides

Antibotulinic serum injection

Antibiotic therapy

Disintoxicational therapy

42 із 201

A nurse of the kindergarten was taken to the hospital with complaints of accute pain in parumbilical region, convulsions of lower limbs, multiple bile vomiting, frequent watery foul feces of green colour in huge amounts. At the same time all the staff in the kindergarden got ill. Two days ago all of them ate cottage cheese with sour cream. General condition of patients is of moderate severity. Temperature 38, 2oC. Heart tones: rhythmic and muted. Heart rate 95 /min, arterial pressure: 160 mm/Hg. Abdomen is slightly swollen, painful. Liver +2 cm. What is the most likely diagnosis?

Salmonellosis

Enterovirus infection

Dysentery

Cholera

Food toxic infection

43 із 201

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:

Acute cholecystitis

Myocardial infarction

Sigmoid diverticulitis

Acute pancreatitis

Perforated peptic ulcer disease

44 із 201

A 50-year-old man comes to the emergency room with a history of vomiting of 3 days’ duration. His past history examination reveals that for about 20 years he has been suffering from epigasric pain lasting for 2 to 3 weeks, during early spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed a fullness in the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel sounds. The most likely diagnosis is:

Gastric outlet obstruction

Volvulus of the colon

Incarcerated umbilical hernia

Small bowel obstruction

Cholecystitis

45 із 201

A 24-year-old law student is brought to the emergency room complaining of severe abdominal pain of 6-8 hours duration. He had been to a party the night before. The pain is in the epigastrium radiating to the back and is accompanied by nausea. The patient had vomited twice prior to coming to the emergency room. Clinical examination revealed that the young man was anxious, with acute condition, with a regular pulse rate of 100/min, blood pressure of 100/68 mm Hg, and body temperature of 38,1oC. The most likely diagnosis is :

Acute pancreatitis

Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric adenitis

46 із 201

In which of the following disorders does the pathophysiology of portal hypertension involve presinusoidal intrahepatic obstruction?

Congenital hepatic fibrosis

Alcoholic cirrhosis

Hemochromatosis

Budd-Chiari syndrome

Cavernomatous transformation of the portal vein

47 із 201

A 25-year-old man was admitted to a hospital with a 2 month history of cough and fever. A chest x-ray showed extensive left upper lobe disease with a 2 cm cavity. All three points were strongly positive on direct smear and grew M. Tuberculosis, fully sensitive to all first-line drugs. Patient must be treated with:

Isoniazid + rifampicin + pyrazinamide

P-aminosalicylic acid + streptomycin

Isoniazid + ethambutol

Streptomycin + isoniazid

Kanamycin + ethambutol + pyrazinami-de

48 із 201

A 5-year-old boy was progressively getting worse compared to the previous 2 months. A chest x-ray has shown right middle lobe collapse. A tuberculin skin test was strongly positive. What is the most characteristic finding in primary tuberculosis?

Hilar or paratracheal lymph node enlargement

Cavity formation

Atelectasis with obstructive pneumonia

Miliary tuberculosis

Hematogenous dissemination leading to extrapulmonary tuberculosis

49 із 201

A 50-year-old man was examined in the clinic for persistent cavitation and sputum. He was treated with rifampi-cin, isoniazid, ethambuthol. The most common toxic effect of ethambutol is:

Optic neuritis

Peripheral neuropathy

Hepatic enzyme elevation

Mental symptoms

Eighth cranial nerve damage

50 із 201

A 3-year-old child has been admi- tted 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 - 3,01012 /l, Hb- 87 g/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?

Sternal puncture

Ultrasound

Computer tomography

Lymph node puncture

Lymph node biopsy

51 із 201

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?

Allergic dermatitis

Neurodermatitis

Dermatitis simplex

Eczema

Erysipelas

52 із 201

Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8 scores. During the delivery there was a short-term difficulty with extraction of shoulder girdle. After birth the child had the proximal extremity dysfunction and the arm couldn’t be raised from the side. The shoulder was turned inwards, the elbow was flexed, there was also forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?

Duchenne-Erb palsy

Intracranial haemorrhage

Trauma of thoracic spine

Right hand osteomyelitis

Trauma of right hand soft tissues

53 із 201

Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?

Defect of interventricular septum

Pulmonary artery stenosis

Fallot’s tetrad

Defect of interatrial septum

Coarctation of aorta

54 із 201

A 27-year-old patient with a history of ronchial asthma was stung by a bee. He had a sensation of chest compression, breath shortage, difficult expiration, sense of heat in the upper half of body, dizziness, apparent itch, convulsions. Objectively: noisy wheezing breath, AP - 90/60 mm Hg, Ps- 110 bpm. Auscultation revealed weak rhythmic heart sounds, rough respiration above lungs, sibilant rales. What drug group should be administered in the first place?

Glucocorticoids

Analgetics

Methylxanthines

Anticonvulsive

Cardiac glycosides

55 із 201

A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most likely diagnosis?

Hypertrophic cardiomyopathy

Essential hypertension

Aortic stenosis

Myocardium infarction

Coarctation of aorta

56 із 201

On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child developed ataxia, nystagmus, intention tremor, muscle hypotonia. Liquor analysis shows insignificant lymphocytic pleocytosis, slightly increased protein rate. What complication is it?

Encephalitis

Postherpetic neuralgia

Pneumonitis

Purulent meningitis

Acute nephritis

57 із 201

Clinic of a research instutute for occupational diseases examined a worker who works at a concentration plant and diagnosed him with chronic dust bronchitis. The case is investigated by a commission including the representatives of: the plant, clinic, territorial SES, department of Social Insurance Fund, trade union. According to the 'regulation on investigation of...', the commission should be headed by the representative of the following authority:

Territorial SES

Social Insurance Fund

Trade union

Plant

Clinic

58 із 201

Basing upon the data of laboratory assessment of sanitary state of soil in a certain territory, the soil was found to be low-contaminated according to the sanitary indicative value; contaminated according to the coli titer; low-contaminated according to the anaerobe titer (Cl. Perfringens). This is indicative of:

Fresh fecal contamination

Insufficient intensity of soil humification

Insufficient insolation and aeration of soil

Constant entry of organic protein contaminations

Old fecal contamination

59 із 201

A 28-year-old patient underwent endometrectomy as a result of incomplete abortion. Blood loss was at the rate of 900 ml. It was necessary to start hemotransfusion. After transfusion of 60 ml of erythrocytic mass the patient presented with lumbar pain and fever which resulted in hemotransfusion stoppage. 20 minutes later the patient’s condition got worse: she developed adynamia, apparent skin pallor, acrocyanosis, profuse perspiration. to- 38,5oC, Ps-110/min, AP- 70/40 mm Hg. What is the most likely diagnosis?

Hemotransfusion shock

Anaphylactic shock

Septic shock

DIC syndrome

Hemorrhagic shock

60 із 201

A painter working at a motorcar plant was diagnosed with acute intoxication with amide compounds of benzene, moderate severity grade. The in-patient treatment resulted in considerable health improvement. What expert decision should be made in this case?

The patient should be issued a sick list for out-patient treatment

-

The patient may get back to work providing he will keep to hygiene and sanitary regulations

The patient should be referred to the Medical and Social Expert Commission for assigning the disability group because of an occupational disease

The patient should be referred to the Medical and Social Expert Commission for determination of percentage of work capicty loss

61 із 201

A maternity hospital registered 616 live births, 1 stillbirth, 1 death on the 5th day of life over a 1 year period. What index allows the most precise estimation of this situation?

Perinatal mortality

Neonatal mortality

Natality

Natural increase

Crude mortality rate

62 із 201

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?

Concrement

Primary ureter tumour

Urinary bladder polyp

Prostate adenoma

Malignant tumour of the urinary bladder

63 із 201

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?

Hypothermia

-

Acute cardiovascular insufficiency

Frostbite of trunk and extremities

Apparent death

64 із 201

A 28-year-old parturient complai- ns about headache, vision impairment, psychic inhibition. Objectively: AP- 200/110 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?

Forceps operation

Stimulation of labor activity

Cesarean

Conservative labor management with episiotomy

Embryotomy

65 із 201

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?

Roentgenography of hands

Immunogram

Complete blood count

Rose-Waaler reaction

Proteinogram

66 із 201

A 68-year-old female patient complains about temperature rise up to 38, 3oC, haematuria. ESR- 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?

Renal cancer

Urolithiasis

Polycystic renal disease

Chronic glomerulonephritis

Renal amyloidosis

67 із 201

Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as 'pure'?

Up to 4500

Up to 7500

Up to 2500

Up to 5500

Up to 3500

68 із 201

A patient who has been consuming refined foodstuffs for a long time complains about headache, fatiguability, depression, insomnia, irritability. Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles, during walking the patient lands onto his heel first, then on the external edge of foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes of myocardium. There are also gastrointestinal disorders. What is the most likely diagnosis?

Hypovitaminosis B1

Hypovitaminosis B2

Hypovitaminosis B15

Hypovitaminosis B6

Hypovitaminosis B12

69 із 201

A 9-year-old boy has been suffering from bronchoectasis since he was 3. Exacerbations occur quite often, 3-4 times a year. Conservative therapy results in short periods of remission. The disease is progressing, the child has physical retardation. The child’s skin is pale, acrocyanotic, he has 'watch glass'nail deformation. Bronchography revealed saccular bronchiectases of the lower lobe of his right lung. What is the further treatment tactics?

Surgical treatment

Sanatorium-and-spa treatment

Further conservative therapy

Physiotherapeutic treatment

Tempering of the child’s organism

70 із 201

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:

Somato-stochastic

Hormesis

Heterosis

Somatic

Genetic

71 із 201

A child is 4 years old, has been ill for 5 days. There are complaints of cough, skin rash, to- 38, 2 oC, face puffiness, photophobia, conjunctivitis. Objectively: there is bright, maculo-papulous, in some areas confluent rash on the face, neck, upper chest. The pharynx is hyperemic. There are seropurulent discharges from the nose. Auscultation revealed dry rales in lungs. What is the most likely diagnosis?

Measles

Rubella

Enterovirus exanthema

Scarlet fever

Adenoviral infection

72 із 201

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 5,5x2,7 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?

Alveolar echinococcus of liver

Cystous liver cancer

Liver cancer

Paravesical liver abscesses

Liver abscess

73 із 201

A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?

Acute thrombophlebitis

Vein puncture and edema of paravenous cellular tissue

Acute lymphangitis

Phlegmon of paravenous cellular tissue

Necrosis of paravenous cellular tissue

74 із 201

A children’s health camp received a party of tinned food. External examination of the tins revealed that they had deep dents; formed a concavity when pressed and didn’t immediately return to the initial state; rust was absent; the tins were greased with inedible fat. Specify the bloat type:

Physical

Chemical

Physicochemical

Combined

Biological

75 із 201

In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after having meals and at night. He complains about 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?

Duodenal ulcer

Diaphragmatic hernia

Chronic cholecystitis

Chronic pancreatitis

Stomach ulcer

76 із 201

On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?

The second intercostal space along the medioclavicular line

The sixth intercostal space along the anterior axillary furrow

The seventh intercostal space along the anterior axillary furrow

The fifth intercostal space along the medioclavicular line

The eighth intercostal space along the posterior axillary furrow

77 із 201

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. ESR - 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?

Ankylosing spondylitis

Spondylosis

Coxarthrosis

Reiter’s disease

Rheumatoid arthritis

78 із 201

A 58-year-old female patient complains about periodical headache, dizziness and ear noise. 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?

Ihibitor of angiotensin converting enzyme

Calcium channel antagonist

Thiazide diuretic

o-blocker

/3-blocker

79 із 201

A 50-year-old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?

Bacteriological study

Dispensary surveillance

Antibiotic prophylaxis

Vaccination

Isolation

80 із 201

A child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and illdefined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother’s side has bronchial asthma. What is the most likely diagnosis?

Atopic dermatitis

Contact dermatitis

Urticaria

Strophulus

Seborrheal eczema

81 із 201

2 weeks after recovering from angina an 8-year-old boy developed edemata of face and lower limbs. Objectively: the patient is in grave condition, AP- 120/80 mm Hg. Urine is of dark brown colour. Oliguria is present. On urine analysis: relative density - 1,015, protein - 1,2 g/l, RBCs are leached and cover the whole vision field, granular casts - 1-2 in the vision field, salts are represented by urates (big number). What is the most likely diagnosis?

Acute glomerulonephritis with nephritic syndrome

Acute glomerulonephritis with isolated urinary syndrome

Acute glomerulonephritis with nephrotic syndrome, hematuria and hypertension

Nephrolithiasis

Acute glomerulonephritis with nephrotic syndrome

82 із 201

A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour ago 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 are muffled, diastolic shock on the pulmonary artery. There are 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 first place?

Promedol

Digoxin

Dopamine

Aminophylline

Heparin

83 із 201

A 52-year-old male patient complains about attacks of asphyxia, pain in his right side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his side. Objectively: heart rate - 102/min, respiratory rate - 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?

Angiography of pulmonary vessels

Study of external respiration function

ECG

Coagulogram

Echocardioscopy

84 із 201

A primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?

Incipient abortion

Missed miscarriage

Incomplete abortion

Risk of abortion

Abortion in progress

85 із 201

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-110/70 mm Hg. Respiration above the 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?

Acute pulmonary abscess

Pyopneumothorax

Acute focal pneumonia

Pleural empyema

Exudative pleuritis

86 із 201

350 workers of a mettalurgical plant had to undergo a yearly preventive examination. A territorial polyclinic carried out preventive examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive work of the polyclinic should be applied in this case?

Coverage of preventive medical examinations

Percentage of temporarily disabled people

Frequency of case detection during examinations

Percentage of people who were provided with diet meal

Percentage of people who underwent rehabilitation at an after-work sanatorium

87 із 201

A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl didn’t undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin got a waxen hue. What disease may be assumed?

Autoimmune thyroiditis

Diffuse toxic goiter

Juvenile basophilism

Subacute thyroiditis

Thyroid carcinoma

88 із 201

A newborn’s head is of dolichocephalic shape, that is front-to-back elongated. Examination of the occipital region of head revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. The delivery tok place with the following type of fetus head presentation:

Posterior vertex presentation

Brow presentation

Anterior vertex presentation

Presentation of the bregma

Face presentation

89 із 201

A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with mercazolil?

Propranolol

Verapamil

Corinfar

Procaine hydrochloride

Radioactive iodine

90 із 201

Over a current year among workers of an institution 10% haven’t been ill a single time, 30% have been ill once, 15% - twice, 5% - 4 times, the rest - 5 and more times. What is the percentage of workers relating to the I health group?

55%

22 %

10 %

60 %

40 %

91 із 201

A 16-year-old boy was admitted to the hospital for the reason of intractable nasal haemorrhage and intolerable pain in the right cubital articulation. Objectively: the affected articulation is enlarged and exhibits defiguration and skin hyperaemia. There are manifestations of arthropathy in the other articulations. Ps- 90 bpm; colour index - 1,0, WBC - 5,6 • 109/l, thrombocytes- 220 • 109/l, ESR - 6 mm/h. Lee-White coagulation time: start - 24’, finish 2710 ' What drug will be the most effective for this patient treatment?

Cryoprecipitate

Aminocapronic acid

Vicasol

Erythromass

Calcium chloride

92 із 201

A 42-year-old woman complains about bruises on her both legs and prolonged menstruation; general weakness, tinnitus cerebri. Objectively: multiple macular haemorrhages on the legs and body. The patient presents with tachypnoe, tachycardia, systolic murmur in all auscultatory points. AP- 75/50 mm Hg. Blood count: RBC - 1,9 • 1012/l, Hb- 60 g/l, colour index - 0,9, WBC - 6,5 • 109/l, thrombocytes - 20 • 109/l, ESR- 12 mm/h. Duke bleeding time - 12 minutes. Bone marrow analysis revealed plenty of juvenile immature forms of megacaryocytes without signs of thrombocyte pinch-off. What is the most likely diagnosis?

True thrombocytopenic purpura

Willebrand’s disease

Type A haemophilia

Tupe B haemophilia

Acute megacaryoblastic leukemia

93 із 201

minutes. Bone marrow analysis revealed plenty of juvenile immature forms of megacaryocytes without signs of thrombocyte pinch-off. What is the most likely diagnosis?

True thrombocytopenic purpura

Tupe B haemophilia

Type A haemophilia

Acute megacaryoblastic leukemia

Willebrand’s disease

94 із 201

A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness, dizziness, memory impairment, sleepiness at daytime and insomnia at night, sense of hair in the mouth, colicky pains in the right subcostal region. What is the most likely diagnosis?

Chronic tetraethyl lead intoxication

Chronic mercury intoxication

Chronic lead intoxication

Alcoholic delirium

Chronic manganese intoxication

95 із 201

A 30-year old woman taken by influenza has empty stomach glycemia at the rate of 11,3 millimole/l, glucosuria at the rate of 25 g/l. The patient is 168 cm tall and weighs 67 kg. What test would be the most informative for the diagnosis specification?

Insulinemia on an empty stomach

Daily glycemia variability

Glucose tolerance test

Glycemia test an hour after taking meals

Daily glucosuria variability

96 із 201

A 52-year-old male patient has an 18 year history of diabetes mellitus. One year ago he had cystitis. The patient takes 0,005 g of maninil thrice a day. Objectively: height - 176 cm, weight - 82 kg. Glycemia variability on an empy stomach is at the rate of 10,3-12,4 millimole/l. Analyses revealed proteinuria at the rate of 0,033 g/l. The most efficient way to prevent diabetic nephropathy progress will be:

To replace maninil with insulin

To decrease daily caloric content

To administer antibacterial therapy

To increase maninil dosage

To supplement the present therapy with insulin

97 із 201

A 34-year-old female patient complains about weakness, 12 kg weight loss within 6 months, sweating, palpitation, irritability. Objectively: III grade thyroid gland is elastic, diffuse enlargement is present, there is also a node in the right lobe. Cervical lymph nodes are not enlarged. What treatment tactics would be the most rational?

Operation after antithyroid therapy

Immediate surgical intervention

Conservative antithyroid therapy

Immediate gamma-ray teletherapy

Radioactive iodine administration

98 із 201

On the next day after being taken by influenza a 46-year-old woman presented with intensified headache, dizziness, nausea. Objectively: the patient is conscious, psychomotor excitement is present; there is general hyperesthesia, moderate meningeal syndrome, nystagmus. Tendon teflexes are higher on the right, right extremities display muscle weakness, right-sided pathological Babinski’s sign is present. Liquor is transparent, pressure is 220 mm of water column; cytosis is 46/3 with prevailing lymphocytes. What is the most likely diagnosis?

Influenzal meningoencephalitis

Parenchymatous subarachnoidal haemorrhage

Subarachnoidal haemorrhage

Bacterial meningoencephalitis

Ischemic stroke

99 із 201

After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?

Radiation therapy + operation + chemotherapy

Operation only

Operation + radiation therapy

Chemotherapy only

Radiation therapy only

100 із 201

A 34-year-old male patient was delivered to the neurological department with complaints of intense headache, double vision, light and noise intolerance. The attack came suddenly while load lifting. Objectively: torpor, moderate divergent strabismus, diplonia. Bilateral Kernig’s symptoms. No paresises. Bloody liquor. What medication should be administered in the first line?

Epsilon-aminocapronic acid

Heparin

Glutamic acid

Nicotinic acid

Acetylsalicilic acid

101 із 201

A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a significant relief. Which of the following mechanisms of action provided antishock effect of morphine in this patient?

Stimulation of opiate receptors

Intensification of GABA-ergic reactions

Stimulation of benzodiazepine receptors

Inhibition of dopamine mediation

Block of central cholinergic receptors

102 із 201

After supercooling a 38-year-old woman developed muscle pain, body temperature rise up to 39 oC, headache, dysuria, positive Pasternatsky’s symptome. In the urine: leukocyturia, bacteriuria. In blood: Decrease in Hb rate down to 103 g/l, left shift leukocytosis, ESR acceleration up to 32 mm/h. Blood urea - 6,0 millimole/l. What is the most likely diagnosis?

Acute pyelonephritis

Acute cystitis

Acute glomerulonephritis

Renal tuberclosis

Urolithiasis

103 із 201

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, light-colored feces and dark urine. In blood: neutrophilic leukocytosis -13,1 • 109/l, ESR - 28 mm/h. What is the most likely diagnosis?

Chronic calculous cholecystitis

Fatty degeneration of liver

Hypertensive dyskinesia of gallbladder

Chronic recurrent pancreatitis

Chronic cholangitis, exacerbation stage

104 із 201

A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation. She was hospitalized with suspicion of placental presentation. Under what conditions is it rational to conduct the internal examination for the diagnosis specification?

In the operating room prepared for the operation

In the examination room of antenatal clinic

In the delivery room keeping to all the aseptics regulations

In the admission ward of maternity hospital

The examination is not to be conducted because of risk of profuse haemorrhage

105 із 201

A 72-year-old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most likely diagnosis?

Microbial eczema

Seborrheic eczema

Allergic dermatitis

Cutaneous tuberculosis

Streptococcal impetigo

106 із 201

A 30-year-old patient presented with body temperature rise up to 38,5oC, pain in the small articulations of hands; face edemata and erythema. In blood: RBCs -2,6 • 1012/l; Hb- 98 r/n; WBCs - 2 • 109/l; ESR - 58 mm/h. In the urine: protein - 3,1 g/l; RBCs -10-15 in the vision field. What disease can be suspected in this case?

Systemic lupus erythematosus

Systemic scleroderma

Acute glomerulonephritis

Periarteritis nodosa

Sepsis

107 із 201

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?

Scabies

Eczema

Dermatitis

Toxicoderma

Ringworm of body

108 із 201

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?

Erysipelas

Microbial eczema

Toxicoderma

Haemorrhagic vasculitis

Contact dermatitis

109 із 201

Surgical department admitted a 37-year-old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?

Removal of necrotic tissues and timely surgical processing of the wound

Infiltration of soft tissues around the wound with antibiotic solution

Wound lavage with 6% solution of hydrogen peroxide

Injection of specific serum 30 000 U

Injection of specific serum 3 000 U

110 із 201

A 35-year-old patient was admitted to the in-patient psychiatric facility for the first time. He was diagnosed with paranoid schizophrenia. What is the most rational treatment method?

Neuroleptic therapy

Physiotherapy

Vitamin therapy

Psychotherapy

Reflex therapy

111 із 201

A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progressing under conditions of weak general peripheric resistance and decreased cardiac output. What antihypotensive drug should be injected to the patient in the first place?

Dopamine

Adrenaline

Mesatonum

Prednisolone

Noradrenaline

112 із 201

A patient came to the traumatology centre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of glass. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?

Ulnar

Musculoskeletal

Radial

Axillary

Median

113 із 201

A patient was delivered to the admission ward 40 minutes after a minor trauma with complaints of pain in the thoracic spine. He has a history of pulmonary tuberculosis. Roentgenography results: suspected compression fracture of the VIII and IX thoracic vertebrae. What pathological process in spine might have stimulated pathological fracture of vertebral bodies?

Tuberculous spondylitis

Traumatic fracture

Syphilis

Malignant tumour metastasis

Osteomyelitis

114 із 201

On the next day after esophagoscopy and biopsy a 44-year-old female patient developed emphysema of both supraclavicular regions, deglutition pain and pain behind the breastbone, cyanosis. Body temperature - 39oC. In blood: WBCs -16 • 109/l, left shift in the neutrophils. Xray picture shows a limited shadow of the posterior mediastinum at a level with trachea bifurcation. The patient was diagnosed with esophagus rupture. What treatment tactics would be the most rational?

Surgical: mediastinum drainage, gastric fistula establishment

Conservative antibacterial treatment

Surveillance

Radical surgical treatment with esophagus suturing

Surgical: gastric fistula establishment

115 із 201

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. In blood: creatinine - 0,62 millimole/l, hypoproteinemia, albumines - 32 g/l, potassium - 6,8 milli-mole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?

Haemodialysis

Antibacterial therapy

Haemosorption

Enterosorption

Blood transfusion

116 із 201

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?

Blood glucose analysis on an empty stomach

Glucosuric profile

Glucose tolerance test

Acetone in urine test

Glucose in urine test on the base of daily diuresis

117 із 201

A 19-year-old patient complains about skin rash that appeared 2 days ago after eating smoked fish. The rash disappears after 4-6 hours but then turns up again. It is accompanied by itch. Objectively: trunk and upper limbs are covered with multiple pink blisters as big as a pea or a bean. What is the most likely diagnosis?

Acute urticaria

Quincke’s edema

Purigo

Allergic dermatitis

Toxicodermia

118 із 201

A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?

Cancer

Fibroadenoma

Lipoma

Mastopathy

Cyst

119 із 201

A 40-year-old female patient has been observing profuse menses accompanied by spasmodic pain in the lower abdomen for a year. Bimanual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpable. Bloody discharges are profuse. What is the most likely diagnosis?

Nascent submucous fibromatous node

Cervical myoma

Cervical carcinoma

Abortion in progress

Algodismenorrhea

120 із 201

A 65-year-old patient complains about pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). Prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?

Computer tomography of pelvis

Roentgenography of lumbar spine

Bone scintigraphy

Excretory urography

Roentgenography of chest

121 із 201

A 44-year-old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times higher than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?

Anthracosis

Silicatosis

Asbestosis

Anthracosilicosis

Siderosis

122 із 201

Study of morbidity rate in a city N revealed that population of different administrative districts differed in age structure. What statistic method allows to eliminate influence of this factor upon morbidity indices?

Standardization

Calculation of average values

Analysis of dynamic series

Wilcoxon’s t-criterion

Correlative regressive analysis

123 із 201

A driver had been fixing a car in a closed garage and afterwards complained about headache, dizziness, nausea, muscle asthenia, sleepiness. Objectively: pulse and respiratory rate elevation, excitement, hypertension, delirium of persecution. What is the most likely diagnosis?

Intoxication with carbon oxide

Hypertensive crisis

Posttraumatic encephalopathy

Asthenovegetative syndrome

Intoxication with ethyl gasoline

124 із 201

A worker who undergoes regular medical check-up for duodenal ulcer received a subsidized 24- day sanatorium voucher from his plant. The term of annual leave of a worker is 24 calender days, it will take 4 days more to get to the sanatorium and back home. What is the procedure of obtaining a 4-day sick-leave?

Medical Expert Commission issues a 4-day sick list

The doctor in charge issues a 4-day sick list

The doctor in charge issues a health certificate and sanatorium patient’s file for 28 days

Medical Expert Commission issues a 28-day sick list

Medical Expert Commission issues a 4-day health certificate

125 із 201

The total area of a ward at the therapeutical department is 28 m2. What is the maximum number of beds that can be exploited in this ward?

4

5

2

3

1

126 із 201

2 days ago a patient presented with acute pain in the left half of chest, gneral weakness, fever and headache. Objectively: between the 4 and 5 rib on the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm in diameter filled with transparent liquid. What diease are these symptoms typical for?

Herpes zoster

Herpetiform Duhring’s dermatosis

Pemphigus

Streptococcal impetigo

Herpes simplex

127 із 201

A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps-132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the first-aid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?

Dressing ward

Admission-and-sorting tent

Evacuation

Isolation ward

In the manner of self-help

128 із 201

A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps-120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:

With ambulance vehicle in the 1st turn

With a passing vehicle in the 2nd turn

With ambulance vehicle in the 2nd turn

With a passing vehicle in the 1st turn

With a passing vehicle in the 3rd turn

129 із 201

On the 5th day after labor body temperature of a 24-year-old parturient suddenly rose up to 38, 7oC. She complains about weakness, headache, abdominal pain, irritability. Objectively : AP- 120/70 mm Hg, Ps- 92 bpm, to- 38, 7oC. Bimanual examination revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal lets in 2 transverse fingers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR - 30 mm/h. What is the most likely diagnosis?

Endometritis

Pelviperitonitis

Parametritis

Lochiometra

Metrophlebitis

130 із 201

An 11-yearold girl was taken by an acute disease: she got pain in the lumbar region, nausea, vomiting, frequent urination, body temperature 39oC. Objectively: the abdomen is soft, painful on palpation in the lumbar region. Common urine analysis revealed considerable leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?

Acute pyelonephritis

Acute vulvovaginitis

Chronic glomerulonephritis

Acute glomerulonephritis

Acute appendicitis

131 із 201

A patient is active, lively, fussy. He opposes the examination. His speech is fast and loud, his statements are spontaneous and inconsequent. Specify the psychopathological state of this patient:

Psychomotor agitation

Paranoid syndrome

Catatonic agitation

Behavioral disorder

Delirium

132 із 201

A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle, purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:

Hypertonic solution

Dimexide

Ichthyol ointment

Chloramine

Vishnevsky ointment

133 із 201

A 37-year-old patient was delivered to a hospital in unconscious state. He got a closed abdominal injury. He is suspected to have internal haemorrhage, intraabdominal injury. He is being prepared an emergency operation. By means of standard sera a physician determined his blood group and got the following results: 0(I) - no agglutination, A(II) - no agglutination, B(III) - no agglutination. What is the patient’s blood group?

0(I)

A(II)

B(III)

AB(IV)

-

134 із 201

A 36-year-old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?

Valvular pneumothorax

Subcutaneous emphysema

Closed pneumothorax

Open pneumothorax

Mediastinitis

135 із 201

An 18-year-old primigravida in her 27-28 week of gestation underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:

Noncarrying of pregnancy

Fetus hypotrophy

Premature placenta detachment

Late gestosis

Intestinal obstruction

136 із 201

A 30-year-old patient presents with sudden loss of consciousness, tonoclonic spasms, AP150/100 mm Hg, heart rate - 100/min. Before the attack he felt dizziness, sense of irreality, inexplicable fear. After the attack the patient failed to remember it. What is the most likely diagnosis?

Epilepsy

Vestibular syncope

Morgagni-Adams-Stokes syndrome

Transitory ischemic attack

Hyperventilation ischemic attack

137 із 201

A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: to- 37, 3oC, respiration rate - 19/min, heart rate=Ps - 92/min; AP- 120/80 mm Hg. Vesicular respiration. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and can be still heard after cough. ECG showed no pathological changes. What is the most likely giagnosis?

Acute pleuritis

Pericarditis sicca

Intercostal neuralgia

Spontaneous pneumothorax

Subcutaneous emphysema

138 із 201

HIV displays the highest tropism towards the following blood cells:

T-helpers

T-killers

Erythrocytes

Thrombocytes

T-suppressors

139 із 201

In terms of megacalorie (1000 kcal = 4184 kJ) the ration of an adult includes 30 g of proteins, 37 g of fats, 137 g of carbohydrates, 15 mg of vitamin C, 0,6 mg of thiamine (vitamin B1). The ration is UNBALANCED as to the contents of:

Vitamin C

Thiamine

Fats

Proteins

Carbohydrates

140 із 201

A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC - 11 • 109/l, stab neutrophils 6 %, segmented neutrophils - 70%, lymphocytes - 8%, ESR - 42 mm/h. What is the ethiological factor pneumonia?

Legionella

Mycoplasm

Pneumococcus

Streptococcus

Staphylococcus

141 із 201

A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: 'drumsti-ck'distal phalanges. What examination would be the most informative for making a diagnosis?

Bronchography

Survey radiograph of lungs

Bronchoscopy

Bacteriological analysis of sputum

Pleural puncture

142 із 201

A heat station working on solid fuel is located in a residential district. On cloudy foggy days in december there was an increase in diseases with upper airway affection and signs of general intoxication. There were also mortal cases among the elderly people. What is the most likely factor that provoked toxic effect?

Suspended materials

Low air temperature

Temperature gradient

High air humidity

Calm

143 із 201

A 32-year-old female patient consulted a doctor about a skin affection of her body, face and extremities which turned up after peroral intake of biseptol. The patient was diagnosed with drug toxi-coderma. What treatment methods would be the most effective for this patient?

Extracorporal therapy

Disintoxication therapy

Immunotherapy

Anti-inflammatory therapy

Antihistamine therapy

144 із 201

A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?

Uterine endometriosis

Adnexal endmetriosis

Subserous uterine fibromyoma

Uterine carcinoma

Endomyometritis

145 із 201

On the tenth day after discharge from the maternity house a 2-year-old patient consulted a doctor about body temperature rise up to 39oC, pain in the right breast. Objectively: the mammary gland is enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful. What is the most likely diagnosis?

Lactational mastitis

Abscess

Tumour

Erysipelas

Dermatitis

146 із 201

A 47-year-old male patient got a flame burn of trunk and upper extremities and was delivered to the hospital. The patient is in grave condition, confused mental state, with fever. AP- 80/50 mm Hg, Ps-118 bpm. It was locally stated that the patient got III B degree burns with total area of 20%. What medical actions should be taken?

Injection of narcotic analgetics and powdered blood substitutes

Initial surgical d-bridement

Administration of detoxicating blood substitutes

Necrotomy of burn surface, haemotransfusion

Antibacterial and detoxicating therapy

147 із 201

A 54-year-old female patient was admitted to the hospital with evident acrocyanosis, swollen cervical veins, enlarged liver, ascites. Cardiac borders are dilated. Heart sounds cannot be auscultated, apical beat is undetectable. AP is 100/50 mm Hg. X-ray picture of chest shows enlarged heart shadow in form of a trapezium. What pathology might have caused these symptoms?

Cardiac tamponade

Complex heart defect

Acute cardiac insufficiency

Exudative pleuritis

Hiatal hernia

148 із 201

A 16-year-old female patient underwent an operation on account of diffuse toxic goiter of the III-IV degree 12 years ago. Now she has recurrence of thyrotoxicosis. The patient was offered operative intervention, but it is necessary first to localize the functioning gland tissue. What method should be applied for this purpose?

Gland scanning

Puncture aspiration biopsy

Roentgenography of esophagus

USI

Roentgenography of neck

149 із 201

A 26-year-old woman complains of having bloody discharges from the genitals for the last 14 days, abdominal pain, general fatiguability, weakness, weight loss, body temperature rise, chest pain, obstructed respiration. 5 weeks ago she underwent induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarges up to 8-9 weeks of gestation. In blood: Hb- 72 g/l. Urine test for chorionic gonadotropin gave the positive result. What is the most likely diagnosis?

Chorioepithelioma

Uterine fibromyoma

Uterus perforation

Uterine carcinoma

Metroendometritis

150 із 201

A 1,5-year-old child was taken by an acute disease: body temperature up to 39oC, frequent vomiting up to 5 times. Nervous system tests revealed positive Kernig’s and Brudzinski’s signs. The given symptoms relate to:

Meningeal signs

Infectious toxicosis signs

Encephalic syndrome

Discoordination syndrome

Motor disorder syndrome

151 із 201

A pediatrician had a conversation with a mother of a 7-month-old breast-fed boy and found out that the child was fed 7 times a day. How many times should the child of such age be fed?

5 times

3 times

7 times

6 times

4 times

152 із 201

1 day ago a 19-year old male patient got a trauma after a fall from 1,5 m height when he 'bestrode'a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?

Epicystostomy

Primary suturing of urethra

Urine bladder catheterization for urine diversion

Cold to the perineum, hemostatic therapy

Urethra bougienage

153 із 201

A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?

Sepsis

Putrid phlegmon

Erysipelas

Allergic reaction

Erysipeloid

154 із 201

A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?

Iridocyclitis

Keratitis

Acute attack of glaucoma

Choroiditis

Iritis

155 із 201

Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he felt acute pulsating pain at the end of the nail bone which was getting worse at pressing. Nail fold became hyperemic, body temperature rose up to 37,5oC, there was a change in nail plate colour. What is the most likely diagnosis?

Subungual panaritium

Erysipelas

Paronychia

Erysipeloid

Abscess

156 із 201

Statistic of patients of common medical practice displays constant increase in elderly and old people number. What kind of pathology is expected to prevail in the morbidity structure of population in question?

Chronic pathology

Infectious pathology

Occupational pathology

Acute pathology

Non-epidemic pathology

157 із 201

A 30-year-old patient consulted a doctor about menstruation absence for 2 years after labour, loss of hair, body weight loss. The labour was complicated by a haemorrhage caused by uterus hypotonia. Objectively: the patient is asthenic, external genitals are hypoplastic, the uterus body is small and painless. The appendages are not palpaple. What is the most likely diagnosis?

Sheehan’s syndrome

Turner’s syndrome

Ovarian amenorrhea

Exhausted overy syndrome

Galactorrhea-amenorrhea syndrome

158 із 201

A 25-year-old patient complains of burning and pain during urination, purulent discharges from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic, hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis: recent acute gonorrheal urethritis. What supplemental data of clinical examinations will alow to specify the diagnosis?

Microscopy of the urethral discharges

Yeast cells detection during discharge microscopy

Common urine analysis

Serological blood analysis

Coccal cells detection during discharge microscopy

159 із 201

A 28-year-old patient has been admitted to the gynecological department three days after a casual coitus. She complains about pain in her lower abdomen and during urination, profuse purulent discharges from the vagina, body temperature rise up to 37,8oC. The patient was diagnosed with acute bi- lateral adnexitis. Supplemental examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes within the whole visual field, diplococcal bacteria located both intra- and extracellularly. What is the etiology of acute adnexitis in this patient?

Gonorrheal

Chlamydial

Colibacterial

Staphylococcal

Trichomonadal

160 із 201

A boy is 8 year old. His physical development is compliant with his age. The child has had cardiac murmur since birth. Objectively: skin and visible mucous membranes are of normal colour. AP- 100/70 mm Hg. Auscultation revealed systolo-diastolic murmur and diastolic shock above the pulmonary artery. ECG shows overload of the left heart. Roentgenoscopy shows coarsening of the lung pattern, heart shadow of normal form. What is the most likely diagnosis?

Atrioseptal defect

Fallot’s tetrad

Patent ductus arteriosus

Pulmonary artery stenosis

Aorta coarctation

161 із 201

A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?

Disturbed urine outflow from the kidney

Destruction of glomerules

Renal artery spasm

Ureteric twists

Increase in relative density of urine

162 із 201

A 25-year-old woman came to a maternity welfare clinic and complained about being unable to conceive within 3 years of regular sexual life. Examination revealed weight gain, male pattern of hair distribution on the pubis, excessive pilosis of thighs. Ovaries were dense and enlarged, basal temperature was monophase. What is the most likely diagnosis?

Sclerocystosis of ovaries

Tubo-ovaritis

Gonadal dysgenesis

Adrenogenital syndrome

Premenstrual syndrome

163 із 201

A 32-year-old gravida complai- ns about episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied byquickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?

Postcava compresseion by the gravid uterus

Pressure rise in the veins of extremities

Vegetative-vascular dystonia (cardial type)

Pressure fall in the veins of extremities

Psychosomatic disorders

164 із 201

A 49-year-old woman complains about headache, head and neck going hot, increased perspiration, palpitation, arterial pressure rise up to 170/100 mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, body weight increase by 5 kg over the last half a year. What is the most likely diagnosis?

Climacteric syndrome

Arterial hypertension

Premenstrual syndrome

Postcastration syndrome

Vegetative-vascular dystonia

165 із 201

The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be the most informative for the analysis of this data?

Correlation factor

Fitting criterion

Student’s criterion

Standardized index

Sign index

166 із 201

A 38-year-old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, ostealgia. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen - by 5 cm, painless. In blood: erythrocytes -2, 7 • 1012/l, Hb- 84 g/l, leukocytes - 58 • 109/l, eosinophils - 1%, stab neutrophils - 2%, segmented neutrophils - 12%, lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR- 57 mm/h. What is the most likely diagnosis?

Chronic lymphatic leukemia

Chronic myeloleukemia

Acute myeloleukemia

Acute lymphatic leukemia

Lymphogranulomatosis

167 із 201

A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR - 20 mm/h, crude protein 85 /l, y-globulines - 25%. What is the most likely diagnosis?

Systemic scleroderma

Raynaud’s disease

Rheumatoid arthritis

Systemic lupus erythematosus

Dermatomyositis

168 із 201

A 36-year-old female patient complains of general weakness, edemata of her face and hands, rapid fatiguability during walking, difficult diglutition, cardiac irregularities. These symptoms turned up 11 days after a holiday at the seaside. Objectively: face erythema, edema of shin muscles. Heart sounds are muffled, AP is 100/70 mm Hg. In blood: ASAT activity is 0,95 millimole/h-l, ALAT - 1,3 millimole/h-l, aldolase - 9,2 IU/l, creatine phosphokinase - 2,5 millimole P/g-l. What method of study would be the most specific?

Muscle biopsy

Determination of cortisol concentration in blood and urine

Echocardiogram

ECG

Electromyography

169 із 201

A 33-year-old patient has acute blood loss: erythrocytes - 2,2 - 1012/l, Hb- 55 g/l, blood group is A(II)Rh+. Accidentally the patient got a transfusion of donor erythrocyte mass of AB(IV)Rh+ group. An hour later the patient became anxious, got abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature - 38,6oC. After catheterization of urinary bladder 12 ml/h of dark-brown urine were obtained. What complication is it?

Acute renal insufficiency

Toxic infectious shock

Cardial shock

Citrate intoxication

Allergic reaction to the donor erythrocyte mass

170 із 201

A 45-year-old man has been exhibiting high activity for the last 2 weeks, he became talkative, euphoric, had little sleep, claimed being able 'to save the humanity'and solve the problem of cancer and AIDS, gave money the starangers. What is the most likely diagnosis?

Maniacal onset

Catatonic excitation

Schizo-affective disorder

Agitated depression

Panic disorder

171 із 201

A 67-year-old female patient suffering from the essential hypertension suddenly at night developed headache, dyspnea that quickly progressed to asphyxia. Objectively: the patient is pale, with sweaty forehead, AP- 210/140 mm Hg, heart rate - 120/min, auscultation revealed solitary dry rales and moist rales in the lower parts. The shins are pastose. What kind of emergency aid would be the most efficient in this case?

Nitroglycerin and furosemide intravenously

Digoxin and nitroglycerin intravenously

Enalapril and furosemide intravenously

Labetalol and furosemide intravenously

Nitroglycerin intravenously and capoten internally

172 із 201

A patient suffering from gastroesophageal reflux has taken from time to time a certain drug that 'reduces acidity'over 5 years. This drug was recommended by a pharmaceutist. The following side effects are observed: osteoporosis, muscle asthenia, indisposition. What drug has such following effects?

Aluminium-bearing antacid

Gastrozepin

Inhibitor of proton pump

Metoclopramide

#2-blocker

173 із 201

A 26-year-old patient complains about considerable muscle weakness, dizziness, extended abdominal pain, nausea and vomiting giving no relief. The disease has been gradually developing within 6 months. There was progress of general weakness, skin darkening. The patient fell into grave condition after an ARD: there appeared abdominal pain and frequent vomiting. Objectively: the skin is dry with diffuse pigmentation. Heart sounds are significantly weakened, heart rate - 60/min, AP- 80/40 mm Hg. The abdomen is slightly painful in the epigastrial region. In blood: WBCs - 8,1 • 109/l, glucose - 3,0 millimole/l. What is the most likely diagnosis?

Chronic adrenal insufficiency. Addisonian crisis

Acute cholecystitis

Acute food poisoning

Toxic infectious shock

Acute pancreatitis

174 із 201

A puerpera is 25 years old, it is her second day of postpartum period. It was her first labour, it took place at full term. The lochia should be:

Bloody

Purulent

Mucous

Serous

Sanguino-serous

175 із 201

A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6 years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What is the optimal treatment method?

Surgical laparoscopy

Sanatorium-and-spa treatment

Hormonal therapy with androgenic hormones

Anti-inflammatory therapy

Conservative therapy with estrogen-gestagenic drugs

176 із 201

A 20-year-old man complains about pain arising in the lower third of femoral bone under stress and at rest. He denies having a trauma. Objectively: the skin is of normal colour, deep palpation reveals pastosity and pain, knee joint motions are limited. X-ray picture of the metaepyphisis of distal femur shows a destruction zone and spicules. In blood: immature cell forms, no signs of inflammation. What is the most likely diagnosis?

Osteogenic sarcoma

Myelomatosis

Hyperparathyroid dystrophy

Chronic osteomyelitis

Marble-bone disease

177 із 201

A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?

Streptococcus

Pneumococcus

Proteus

Staphylococcus

Klebsiella

178 із 201

A department chief of an in-patient hospital is going to inspect resident doctors as to observation of medical-technological standards of patient service. What documentation should be checked for this purpose?

Health cards of in-patients

Annual report of a patient care institution

Registry of operative interventions

Statistic cards of discharged patients

Treatment sheets

179 із 201

Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a mettalic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:

Mercury

Tetraethyl lead

Toluol

Manganese

Lead

180 із 201

A full-term infant has respiratory rate of 26/min, heart rate of 90/min, blue skin, muscle hypotonia. During catheter suction of mucus and amniotic fluid from the nose and mouth the child reacted with a grimace. Low reflexes. Auscultation revealed weakened vesicular respiration above lungs. Heart sounds are loud. After 5 minutes the respiration became rhythmic, at the rate of 38/min, heart rate of 120/min. What is the most likely diagnosis?

Asphyxia

Respiratory distress syndrome

Birth trauma

Bronchopulmonary dysplasia

Inborn pneumonia

181 із 201

Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:

Antibacterial therapy

Intrauterine instillation of dioxine

Contracting agents

Haemostatic therapy

Instrumental revision of uterine cavity

182 із 201

A 35-year-old man complains about intense lumbar pain irradiating to the inguinal area, external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive Pasternatsky’s symptom. Urine analysis revealed that RBCs and WBCs covered the total field of microscope; the urine exhibited high protein concentration. These clinical presentations were most likely caused by the following pathology:

Urolithiasis, renal colic

Intestinal obstruction

Osteochondrosis, acute radicular syndrome

Renal infarct

Cholelithiasis, biliary colic

183 із 201

Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel is 2x2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in its volume and composition. Muscle tone is within norm. What is the most likely diagnosis?

Pylorospasm

Craniostenosis

Meningitis

Microcephaly

Pylorostenosis

184 із 201

A patient consulted a venereologist about painful urination, reddening of the external opening of urethra, profuse purulent discharges from the urethra. He considers himself to be ill for 3 days. He also associates the disease with a casual sexual contact that took place for about a week ago. If provisional diagnosis 'acute gonorrheal urethritis'is confirmed, then bacteriological study of urethral discharges will reveal:

Gram-negative diplococci

Spirochaete

Gram-positive diplococci

Mycoplasma

Proteus vulgaris

185 із 201

As a result of load lifting a 68-year-old female felt acute pain in the lumbar region, in a buttock, posterolateral surface of her right thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior ti-bial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue’s sign. What examination method would be the most effective for specification of the diagnosis of discogenic compression of L5 root?

Magnetic resonance scan

Angiography

Lumbar puncture

Spinal column X-ray

Electromyography

186 із 201

A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?

To perform the Heimlich manoever

To make a subcutaneous injection of dexamethasone

To use an inhalation of ^-adrenoceptor agonist

To perform conicotomy immediately

To send for an anesthesiologist and wait for him

187 із 201

A 28-year-old patient was delivered to the admission ward in the unconscious state with generalized epileptic attacks taking place every 15-20 minutes. During transportation the patient was given two injections of diazepam, magnesia sulphate, but they failed to bring the patient to consciousness. What department should render emergency aid?

Resuscitation department

Neurological department

Surgcal department

Psychiatric department

Therapeutic department

188 із 201

On the second day after preventi- ve vaccination a 2-year-old boy presented with abdominal pain without clear localization, body temperature rose up to 38oC. On the third day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and around the joints. Knee joints were edematic and slightly painful. Examination of other organs and systems revealed no pathological changes. What is the most likely diagnosis?

Haemorrhagic vasculitis

DIC syndrome

Meningococcemia

Urticaria

Thrombocytopenic purpura

189 із 201

On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?

Vesiculopustulosis

Impetigo

Miliaria

Impetigo neonatorum

Epidermolysis bullosa

190 із 201

A 60-year-old patient complains about asphyxia, palpitation, rapid fati-guability. He has 8 year history of essential hypertension. Objectively: the left cardiac border is 2 cm deviated to the left from the medioclavicular line, heart sounds are rhythmic and weak; there is diastolic shock above aorta. AP- 170/100 mm Hg. Liver - +2 cm; shin pastosity is present. ECG shows deviation of cardiac axis to the left, left ventricle hypertrophy. Ejection fraction - 63%. What type of cardiac insufficiency is observed?

Diastolic

Systolic

It’s a norm

Combined

Unspecified

191 із 201

A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. Xray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?

Posttraumatic osteomyelitis

Posttraumatic phlegmon

Hematogenic osteomyelitis

Wound abscess

Suture sinus

192 із 201

Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated on the grounds of this report?

Common morbidity rate

Index of morbidity with temporary disability

Index of basic non-epidemic morbidity

Index of hospitalized morbidity

Index of pathological affection

193 із 201

A 49-year-old patient undergoes regular medical check-up for uterine fi-bromyoma. Within the last year the uterus has enlarged up to 20 weeks of gestation. What is the rational way of treatment?

Surgical treatment

Treatment with prostaglandin inhibitors

Further surveillance

Hormonal therapy

Embolization of uterine arteries

194 із 201

A patient is being prepared for the operation on account of varix dilatation of lower extremities veins. Examination of the patient’s soles revealed flour-like desquamation along the skin folds. All the toenails are greyish-yellow, thickened and partially decayed. What dermatosis should be suspected?

Rubromycosis

Candidosis

Pityriasis versicolor

Microsporia

Microbial eczema

195 із 201

A 46-year-old patient was issued a 10-day sick list because of exacerbation of chronic cholecystitis. The patient’s general condition got better, but the clinical manifestations of the disease are still present. What authority is entitled to extend the sick list?

Medical Expert Commission

Head doctor

Family doctor

Deputy head doctor for medical-labour expertise

Deputy head doctor for terapeutic management

196 із 201

A 43-year-old female patient was delivered to the hospital in grave condition. She suffers from Addison’s disease. The patient had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented, skin and muscle turgor is decreased. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate - 96/min. In blood: Na -120 mi-llimole/l, K - 5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:

Cortisol

Adrenaline

Corticotropin (ACTH)

Noradrenaline

Adrostendion

197 із 201

Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:

Live birth

Primary atelectasis

Secondary atelectasis

Hyaline membrane disease

Stillbirth

198 із 201

A maternity house has admitted a primagravida complaining of irregular, intense labour pains that have been lasting for 36 hours. The woman is tired, failed to fall asleep at night. The fetus is in longitudinal lie, with cephalic presentation. The fetus heartbeat is clear and rhythmic, 145 /min. Vaginal examination revealed that the uterine cervix was up to 3 cm long, dense, with retroflexion; the external orifice was closed; the discharges were of mucous nature. What is the most likely diagnosis?

Pathological preliminary period

Secondary uterine inertia

Physiological preliminary period

Primary uterine inertia

Uterine cervix dystocia

199 із 201

A 52-year-old patient works as a secretary and has 30 year record of service. She complains of spasms in her right hand during working and inability to type and write. Up to 80% of her work involves hand load. The patient has been presenting with these symptoms for 2 years. Objectively: the right hand is tense, there is an increase in muscle tone, attempts to write cause spasms. Examination revealed no pathological changes of CNS. What is the most likely diagnosis?

Spastic form of coordination neurosis

Paretic form of coordination neurosis

Hysteric neurosis

Neuralgic form of coordination neurosis

Chronic manganese intoxication

200 із 201

During examination at a military commissariat a 15-year-old teenager was found to have interval sysolic murmur on the cardiac apex, diastolic shock above the pulmonary artery, tachycardia. Which of the suuplemental examination methods will be the most informative for the diagnosis specification?

Echocardiography

Roengenography

Electrocardigraphy

Rheography

Phonocardiography

201 із 201

A 67-year-old female patient complains about edemata of face and legs, pain in the lumbar area that is getting worse at moving; great weakness, sometimes nasal haemorrhages, rise of body temperature up to 38,4oC. Objectively: painfulness of vertebral column and ribs on palpation. Laboratorial study revealed daily proteinuria of 4,2 g, ESR- 52 mm/h. What changes of laboratory indices are to be expected?

Whole protein of blood serum -101 g/l

y-globulins -14%

Haemoglobin - 165 g/l

Albumins - 65%

Leukocytes -15,3 g/l