Step 2 - Medicine 2015

1 із 200

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. The 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 issue the sick leave

To embark other officials or public organizations with this problem

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

-

2 із 200

A 50-year-old female patient complains of aching pain in the lower abdomen. She has a history of normal menstrual cycle. At the age of 40, the patient underwent a surgery for gastric ulcer. Examination findings: abdomen is soft, in the hypogastrium there is a well-defined nodular tumor of limited mobility. Vaginal examination findings: the cervix is clean, of cylindrical shape. Body of the uterus cannot be palpated separately. On both sides of the uterus palpation reveals tight tumors with an uneven surface. The tumors are immobile andl fill the whole pelvic cavity. What is the most likely diagnosis?

Krukenberg tumor

Subserous metrofibroma

Ovarian fibroid

Bilateral pioovarium

Ovarian granulosa cell tumor

3 із 200

A 38-year-old male patient complains of marked dyspnea that escalates with physical exertion. The problems, namely acute chest pain on the left and cough, arose unexpectedly 2 hours before at work. The pain abated, but there were progressing dyspnea, dizziness, pallor, cold sweat, cyanosis. Auscultation reveals the absence of vesicular breath sounds, radiograph shows a shadow on the left. What pathology can be suspected?

Left-sided spontaneous pneumothorax

Pulmonary infarction

Left-sided pneumonia

Lung abscess

Pleurisy

4 із 200

A 2-year-old boy has been admitted to the casualty department for the pain and deformity of his right thigh. Radiograph shows a femoral fracture with longitudinal displacement. What method of treatment is indicated for the patient?

Schede-type vertical suspension

Closed reduction

Use of Ilizarov apparatus

Periosteal osteosynthesis

Intramedullary osteosynthesis

5 із 200

What juice should be included in a complex drug and dietary therapy for patients with gastric ulcer or duodenal ulcer and increased gastric juice acidity in order to accelerate the ulcer healing?

Potato, potato and carrot

Pumpkin

Apple, birch and apple

Celery, parsley

Cabbage, cabbage and carrot

6 із 200

A 7-year-old child complains of itching, papular erythematous rash, dry skin. Objectively: there is lichenification in the popliteal fossae and antecubital spaces. What immunologic indicator if found in the blood serum will verify the diagnosis (atopic dermatitis)?

Total IgE

IgD

IgM

IgG

Secretory IgA

7 із 200

A 7-year-old patient presents with body temperature rise up to 39oC, dry cough, pain in the lateral abdomen. Objectively: there is cyanosis of the nasolabial triangle, inspiratory dyspnea with accessory muscle recruitment. Percussion reveals pulmonary dullness; among auscultation findings there are diminished breath sounds, crepitant rales. Respiratory rate is of 50/min, HR- 120/min. Evaluate the grade of respiratory failure in the patient:

II

III

IV

I

0

8 із 200

A 43-year-old alcohol abuser had not consumed alcohol for the last two days. In the evening he claimed to see rats and feel like they bite his feet. The patient is disoriented, agitated, all the time attempts to run somewhere. Specify the psychopathological syndrome:

Delirious

Ganser’s syndrome

Choreatic

Oneiroid

Amential

9 із 200

A 67-year-old male patient complains of rash, severe pain in the subscapular region on the right. Objectively: skin in the right subscapular region is covered with linearly arranged pinkred edematous lesions that are somewhat infiltrated, and have clear boundaries. On the lesion surface there are vesicles with transparent exudate. What is the most likely diagnosis?

Herpes zoster

Erysipelas

Atopic dermatitis

Impetigo

Duhring dermatitis

10 із 200

An 8-year-old boy was brought to the admission department by his parents. Parents report that he has had pain in the right knee for the last 9 months, recently mother has noticed some limitation of motion in his right leg, and morning stiffness that doesn’t last till the evening. What is the most likely diagnosis?

Juvenile rheumatoid arthritis

Osteomyelitis of the knee joint

Traumatic arthritis

Reactive arthritis

Rheumatism

11 із 200

A 13-year-old girl was admitted to the gynecology department for having a significant bleeding from the genital tract for 10 days. The patient has a history of irregular menstrual cycle since menarche. Menarche occurred at the age of 11. Recto-abdominal examination revealed no pathology. What is the provisional diagnosis?

Juvenile uterine bleeding

Endometrial polyp

Adenomyosis

Injury of the external genitalia

Werlhof’s disease

12 із 200

A 64-year-old male patient has a 35-year history of chronic pancreatitis. In the last 5 years, he claims to observe the pain abatement, bloating, frequent bowel movements up to 3-4 times a day, grayish, glossy stool with undigested food rests, the progressive loss of body weight. Change of symptoms in the patient is due to overlay of:

Exocrine pancreatic insufficiency

Endocrine pancreatic insufficiency

Chronic enterocolitis

Irritable bowel syndrome

Lactase deficiency syndrome

13 із 200

During the doctor’s round, a 56-year-old male patient with decompensated cirrhosis complains of dizziness, palpitations, moving black specks seen before the eyes, general weakness. The patient is pale, Ps- 110/min, AP- 90/50 mm Hg. What complication is most likely to have occurred in the patient?

Bleeding from esophageal varices

Hepatocellular insufficiency

Hepatic encephalopathy

Paroxysmal tachycardia

Acute coronary syndrome

14 із 200

A 57-year-old female patient complains of intense pain in the right hypochondrium irradiating to the right supraclavicular region. Skin and sclerae are icteric. There is tension and tenderness in the right hypochondrium on palpation. Body temperature is 38,8°C. Blood test results: WbC- 11,2 • 109/l, total bilirubin - 112 mmol/l (conjugated - 86 mmol/l, unconjugated 26 mmol/l). What is the most likely diagnosis?

Cholangitis

Acute pancreatitis

Pancreatic tumor

Perforated duodenal ulcer

Acute appendicitis

15 із 200

A 3-year-old girl has had an increase in body temperature up to 38, 5°C for four days. The child refuses to eat. Over the last two days, nose and mouth breathing has become difficult. Mesopharyngoscopy reveals hyperthermia and enlargement of tonsils, as well as hyperemia and bulging of the posterior wall of the oropharynx, which significantly narrows the oropharyngeal lumen. What complication of quinsy occurred in the patient?

Retropharyngeal abscess

Laryngostenosis

Paratonsillar abscess

Parapharyngeal abscess

Phlegmon of the mouth floor

16 із 200

Within a year, in a maternity hospital there were 616 livebirths, one stillbirth, one infant died on the 5th day of life. What index can most accurately describe this situation?

Perinatal mortality

Infant mortality

Natural increase

Birthrate

Total mortality

17 із 200

In one of the surgical departments the quality assurance testing of sterilization of surgical instruments was performed. After an instrument had been treated with 1% phenolphthalein, the solution turned pink. This indicates that the instrument has:

Drugs residues

Residual tissue

Disinfectant residues

Residual blood

Synthetic detergent residues

18 із 200

A 21-year-old female patient consulted a gynecologist about itching, burning, watery vaginal discharges with a fish-like smell. Speculum examination revealed that the cervical and vaginal mucosa was of a normal pink color. Vaginal examination revealed no alterations of the uterus and appendages. Gram-stained smears included clue cells. What is the most likely pathology?

Bacterial vaginosis (gardnerellosis)

Chlamydiosis

Gonorrhea

Candidiasis

Trichomoniasis

19 із 200

A 9-year-old patient has measles. On the 6th day after the rash appeared, the boy developed a condition manifested by dyspnea, barking cough, stenotic respiration. Objectively: the rash on the face, neck and torso turned brown. There is a branny desquamation. Respiratory rate is 22 /min. What complication should be diagnosed?

Laryngotracheitis

Pharyngitis

Bronchitis

Quinsy

Pneumonia

20 із 200

A 26-year-old secundipara at 40 weeks of gestation arrived at the maternity ward after the beginning of labor activity. 2 hours before, bursting of waters occurred. The fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was 100 cm, fundal height - 42 cm. Contractions occurred every 4-5 minutes and lasted 25 seconds each. Internal obstetric examination revealed cervical effacement, opening by 4 cm. Fetal bladder was absent. Fetal head was pressed against the pelvic inlet. What complication arose in childbirth?

Early amniorrhea

Discoordinated labor

Secondary uterine inertia

Clinically narrow pelvis

Primary uterine inertia

21 із 200

Examination of a 35-year-old patient with rheumatism revealed that the right heart border was 1 cm displaced outwards from the right parasternal line, the upper border was on the level with inferior margin of the 1st rib, the left border was 1 cm in from the left midclavicular line. Auscultation revealed atrial fibrillation, loud apical first sound, diastolic shock above the pulmonary artery. Echocardi-ocopy revealed abnormal pattern of the mitral valve motion. What heart disease is characterized by these symptoms?

Mitral stenosis

Aortic stenosis

Mitral valve insufficiency

Tricuspid valve insufficiency

Mitral valve prolapse

22 із 200

A 54-year-old male patient works as an engineer. At the age of 35, he got infected with syphilis and treated it with 'traditional remedies'. About 5 years ago, he became forgetful, unable to cope with work, told cynical jokes, bought useless things, collected cigarette butts in the street. Objectively: the patient is indifferent, has slow speech, dysarthria, can make only primitive judgments, is unabe to perform simple arithmetic operations or explain simple metaphors. The patient is untidy, takes no interest in anything, passive. Considers himself to be completely healthy. Qualify mental condition of the patient:

Total dementia

Somnolentia

Hysterical pseudodementia

Lacunar (dysmnestic) dementia

Korsakoff’s (amnesic) syndrome

23 із 200

A 13-year-old boy with hypertrophic cardiomyopathy complains of dyspnea on minimal exertion. EhoCG reveals asymmetric left ventricular hypertrophy, signs of pulmonary hypertension, dilatation of the left atrium. EF is 64%. The revealed alterations are indicative of:

Diastolic heart failure

Systolic heart failure

Symptomatic arterial hypertension

Primary pulmonary hypertension

Primary arterial hypertension

24 із 200

Study of natural illumination for a workplace in a secondary school classroom revealed that the angle of sunlight incidence was 25°, window opening angle - 3°, window-to-floor area ratio -1:4, daylight ratio - 0,5%, depth ratio - 2. What indicators do not meet hygienic standards?

Daylight ratio

Angle of incidence

Window-to-floor area ratio

Window opening angle

Depth ratio

25 із 200

Bakers at bread production work in conditions of high temperature and high heat radiation. What is used to increase the body’s resistance to the unfavorable effects of these harmful work environment factors?

Vitamin preparations

Pectin

Milk

Therapeutic and preventive diet number N° 3

Therapeutic and preventive diet N° 1

26 із 200

A 24-year-old male patient got a puncture injury below the Poupart’s ligament, which was accompanied by intense arterial bleeding. The best method to temporarily stop the bleeding in the patient would be:

Compression band

Wound suturing

Esmarch’s tourniquet

Maximum limb bending

Compressing a blood vessel with a clamp

27 із 200

5 days before, a 26-year-old female patient developed an acute condition. Objectively: marked headache, vomiting, weakness, poor appetite, temperature up to 39°C. Objecti- vely: the patient is in a moderately grave condition, excited. The face is hyperemic, sclerae are injected. The tongue is coated with brown fur. The trunk and limbs are covered with plentiful roseolous and petechial rash. Hepatosplenomegaly is present. Complement binding reaction with Rickettsia prowazekii is positive with the titer of 1:640. What drug should be administered?

Doxycycline

Penicillin

Streptomycin

Metronidazole

Chloramphenicol

28 із 200

A 39-year-old female patient complains of dyspnea when walking, palpitation, edemata in the evening. The patient’s height is 164 cm, weight - 104 kg. Objectively: overnutrition. Heart sounds are weak, and tachycardia is present. The menstrual cycle is not broken. Blood sugar is 5,6 mmol/l, ACTH-response tests revealed no alterations. X-ray of the Turkish saddle revealed no pathology. What disease is it?

Alimentary obesity

Cushing’s syndrome (primary hypercorti-solism)

Diabetes mellitus

Climax

Pituitary obesity

29 із 200

A 26-year-old male patient complains of a rash on the upper lip skin, which arose on a background of influenza with high-grade fever and is accompanied by pain and burning. The rash has been present for 3 days. Objectively: the skin of the upper lip is edematic and erythematous, grouped vesicles are filled with serous fluid and have a rough surface. What is the most likely diagnosis?

Herpetic vesicular dermatitis

Erythema multiforme

Eczema

Dermatitis herpetiformis

Contact dermatitis

30 із 200

A 6-year-old boy complains of paroxysmal pain that occurs after a mental stress, consuming cold drinks or ice cream. After clinical and instrumental examination the boy has been diagnosed with hypertensive biliary dyskinesia. The drugs of the following groups should be administered in the first place:

Antispasmodics and choleretics

Choleretics and cholekinetics

Sedatives and cholekinetics

Antibiotics

Antioxidants

31 із 200

A 15-year-old patient consulted a dermatologist about a painful lump in the armpit. Objectively: there is a walnutsized node, lymphadenitis, infiltration of the surrounding tissues. The patient has been di- agnosed with hidradenitis. What is the most likely causative agent of this disease?

Staphylococci

Mixed infection

Proteus vulgaris

Pseudomonas aeruginosa

Streptococci

32 із 200

A 36-year-old female has a 7-year history of pollen allergy. Over the last 2 years in August and September (during ragweed flowering), the patient has had 2-3 asthma attacks that could be treated with one dose of salbutamol. Objectively: body temperature - 36,5oC, respiratory rate 18 /min, Ps- 78/min, AP-115/70 mm Hg. There is vesicular breathing above the lungs. Cardiac sounds are sonorous, of regular rhythm. What drug would be most effective to prevent asthma attacks during the critical season for the patient?

Intalum inhalation

Theopecum administration

Berotec inhalation

Suprastin administration

Atrovent inhalation

33 із 200

A study of the structure of death causes in the urban population revealed that cardiovascular diseases accounted for 55,0% of all deaths. What statistic value represents these data?

Extensive index

Index of evidence

Index of correlation

Correspondence index

Intensive index

34 із 200

A 25-year-old female patient complains of marked weakness, sleepiness, blackouts, dizziness, taste disorder. The patient has a history of menorrhagia. Objectively: the patient has marked weakness, pale skin, cracks in the corners of mouth, peeling nails, systolic apical murmur. Blood test results: RBC -3, 4 • 1012/l, Hb- 70 g/l, color index - 0,75, platelets -140 • 109/l, WBC- 6,2 • 109/l. What is the most likely diagnosis?

Chronic posthemorrhagic anemia

Acute leukemia

B12-deficiency anemia

Acute posthemorrhagic anemia

Werlhof’s disease

35 із 200

A 51-year-old female is a weaving factory worker with 15 years of service record. During a regular preventive examination she complained of frequent headaches, poor sleep, tingling in the heart, irritability, rapid fatigability, hearing impairment. For years, the noise level has exceeded the maximum allowable concentration by 10-15 dB. A year ago, the patient underwent a course of treatment for essential hypertension. Specify the most likely diagnosis:

Noise disease

Arteriosclerotic encephalopathy

Essential hypertension

Asthenic-vegetative syndrome

Neurasthenia

36 із 200

A 49-year-old male patient who had been scheduled for a surgery for gastric cancer underwent preoperative infusion therapy. Up to 3,0 liters of liquid was introduced into the right cubital vein. The following day, he felt a dragging pain in the right shoulder. Objectively: on the inner surface of the shoulder there is a longitudinal hyperemic zone, edema of skin, a tender cord. What complication occurred in the patient?

Acute thrombophlebitis

Venepuncture and edema of paravenous tissue

Paravenous tissue necrosis

Paravenous tissue phlegmon

Acute lymphangitis

37 із 200

Some of the population of a city district have uneven teeth color. The individuals have white spots, transverse brown stripes on the incisors. Occurrence of these symptoms is associated with the quality of drinking water from a deep well. Which of the following components of water can be the cause of the disease?

F

J

Mg

Ca

Fe

38 із 200

A 22-year-old female patient has been delivered by an ambulance team to a surgical clinic with symptoms of acute intestinal obstruction. It is known from the past history that 2 years ago she was operated for acute destructive appendicitis. For two years, she has repeatedly complained of bloating and abdominal pain. Which of the following etiological factors has led to the intestinal obstruction in the patient?

Abdominal adhesions

Helminthiasis

Ileal diverticulum

Dolichosigma

Diet violation

39 із 200

Mother of a 10-month-old baby reports significant pallor, poor appetite, enlarged abdomen in the baby. As a neonate, the child underwent treatment in the in-patient hospital for jaundice and anemia. Objectively: the skin is pale and jaundiced, teeth are absent, abdomen is enlarged, spleen is palpable. Blood test results: Hb- 90 g/l, RBC- 3,0 • 1012/l, color index - 0,9, microspherocytosis, reti-culocytosis up to 20%, serum bilirubin - 37 mmol/l, unconjugated bilirubin - 28 mmol/l. What type of anemia has occurred in the patient?

Hemolytic anemia

B12-deficiency anemia

Iron-deficiency anemia

Hereditary elliptocytosis

Protein-deficiency anemia

40 із 200

A lumbar puncture was performed for a newborn suspected of having an intracranial birth injury. Bloody cerebrospinal fluid was obtained. What hemorrhage occurred in this case?

Subarachnoid

Epidural

Subtentorial

Supratentorial

Cephalohematoma

41 із 200

A 36-year-old female patient complains of intense pain in the knee joints and neck. In the morning she experiences pain in the interscapular region and leg joints; pain subsides after warm-up gymnastics. The patient is overnourished, there is a clicking sound in the knees when squatting, the knees are somewhat disfigured, painful on palpation. Blood test results: ESR-18 mm/h, WbC- 8,0 • 109/l. Radiography reveals subchondral sclerosis in the left knee. What is the basis of this pathology?

Degenerative processes in cartilage

Autoimmune process in the synovium

Beta-haemolytic streptococcus

Deposition of urates (tophi) in the articular tissues

Hemarthrosis

42 із 200

A 35-year-old female reports heart pain (aching and drilling) occurring mainly in the morning in autumn and spring and irradiating to the neck, back and abdomen; rapid heartbeat; low vitality. Occurrence of this condition is not associated with physical activity. In the evening, the patient’s condition improves. Study of somatic and neurological status, and ECG reveal no pathology. What pathology is most likely to have caused these clinical presentations?

Somatization depression

Pseudoneurotic schizophrenia

Hypochondriacal depression

Neurocirculatory asthenia

Resting stenocardia

43 із 200

An hour before an elective surgery, a 56-year-old patient of the surgical department got a dramatic increase in blood pressure, tachycardia, hand tremor. The patient is confused, anxious, depressed, fearful, is pessimistic about the operation outcome, refuses the surgery. What tactics should be chosen by a surgeon?

Start the surgery after correction of blood pressure

Predict the psychological state of the patient

Organize monitoring of the patient by his family members

Isolate the patient

Organize monitoring of the patient by medical personnel and mental health counselor

44 із 200

A 33-year-old female complains of escalating spastic pain in the abdomen after the psychoemotional stress. The patient has intermittent bowel movements, that is 2-3 bowel movements after waking up alternate with constipation lasting for 1-2 days. Objectively: body weight is unchanged, there is moderate pain on palpation of the sigmoid colon. Hb- 130 g/l, WBC- 5,2 • 109 /l, ESR- 9 mm/h. Proctosigmoidoscopy causes pain due to spastic bowel condition, intestinal mucosa is not changed. In the lumen there is a lot of mucus. What is the most likely diagnosis?

Irritable bowel syndrome

Malabsorption syndrome

Acute bowel ischemia

Crohn’s disease

Non-specific ulcerative colitis

45 із 200

An infant is 2 days old. He was born full-term with signs of intrauterine infection, and therefore receives antibiotics. Neonates should be given antibiotics at longer intervals and lower doses compared to older children and adults because:

Neonates have lower glomerular filtration

Neonates have a reduced activity of glucuronyl transferase

Neonates have lower concentration of protein and albumin in blood

Neonates have higher hematocrit

Neonates have a decreased blood pH

46 із 200

After a holiday in the Crimea, a 36-year-old female patient presents with severe pain in the elbow joints, dyspnea and weakness. The body temperature is of 37,6oC, the skin is pale, there is erythema of cheeks and nose, lower lip ulceration. Visual inspection reveals no changes in the joints, the right elbow movement is limited. There is murmur and pleural friction in the lungs below the right angle of the scapula. Cardiac sounds are muffled, there is tachycardia, gallop rhythm, Ps- 114/min. AP- 100/60. What is the most likely diagnosis?

SLE

Dry pleurisy

Rheumatoid arthritis

Infectious allergic myocarditis

Rheumatic heart disease

47 із 200

A 63-year-old male patient complains of cough with expectoration of mucous blood-streaked sputum, asthma, low-grade fever, general weakness. These presentations have been observed for 3 months. The patient has been a smoker since childhood. Objectively: to- 37,4oC, respiratory rate is 26/min, Ps- 82/min, rhythmic. AP- 130/85 mm Hg. There is limited breathing movement in the right side of chest cavity, as well as percussive dullness and diminished breath sounds. Radiograph shows a homogeneous opacity of the pulmonary field on the right with the mediastinum displacement to the affected side. What is the most likely diagnosis?

Central lung cancer

Pulmonary tuberculosis

Pleural effusion

Bronchiectasis

Pleuropneumonia

48 із 200

A 33-year-old male patient developed a condition that had a stormy clinical course: chills, fever up to 39oC, vomiting, epigastric pain, diarrhea with watery smelly feces. 6 hours before, he ate a raw egg, fried potatoes with stewed meat, drank some juice. What pathogen is likely to have caused this condition?

Salmonella

Campylobacter

Colibacillus

Vibrio cholerae

Shigella

49 із 200

Chief physician of a polyclinic encharged a district doctor with a task to determine the pathological prevalence of disease N in his district. What document allows to estimate the disease prevalence in the population of a medical district?

Prophylactic examinations register

Vouchers for medical appointments

Statistic coupons (+) and (-)

Statistic coupons (-)

Statistic coupons (+)

50 із 200

A 76-year-old male consulted a therapist about slow discharge of urine with a small jet. The patient reported no cardiac problems. Examination revealed atrial fibrillation with a heart rate of 72/min and without pulse deficit. There are no signs of heart failure. ECG confirms the presence of atrial fibrillation. From history we know that the arrhythmia was detected three years ago. What tactics for the treatment of atrial fibrillation in the patient should be chosen?

Does not require treatment

Obzidan

Digoxin

Ajmaline

Verapamil

51 із 200

A 53-year-old male has been admitted to a hospital for an attack of renal colic which has repeatedly occurred throughout the year. Objectively: in the region of auricles and the right elbow some nodules can be seen that are covered with thin shiny skin. Ps- 88/min, AP- 170/100 mm Hg. There is bilateral costovertebral angle tenderness (positive Pasternatsky’s symptom). The patient has been scheduled for examination. What laboratory value would be most helpful for making a diagnosis?

Uric acid

Rheumatoid factor

ESR

Urine sediment

Lactic acid

52 із 200

A 58-year-old female patient complains of spontaneous bruises, weakness, bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Ps- 100/min, AP-110/70 mm Hg. There are no changes of internal organs. Blood test results: RbC -3,0-1012/l, Hb - 92 g/l, colour index - 0,9, anisocytosis, poikilocytosis, WBC - 10109/l, eosinophils - 2%, stab neutrophils 12 %, segmented neutrophils - 68%, lymphocytes -11%, monocytes - 7%, ESR -12 mm/h. What laboratory test is to be determined next for making a diagnosis?

Platelets

Clotting time

Fibrinogen

Osmotic resistance of erythrocytes

Reticulocytes

53 із 200

A 48-year-old male in-patient undergoes treatment for essential hypertension of II-B stage. It is known from history that he works in a design engineering office. His job involves neuroemotional stress. Which of these foodstuffs do not stimulate the central nervous system and can be recommended for the patient?

Whole milk

Carbonated beverages

Meat broths

Mushroom broths

Vegetable broths

54 із 200

In an urban settlement situated on the ri-verbank, an outbreak of hepatitis A was registered. The disease might have water origin. This assumption can be confirmed by growth of the following values of water quality:

Number of coli-phages

Index of fecal coli-forms

Oxidability

Presence of benign leptospirosis pathogen

Escherichia coli index

55 із 200

A 48-year-old male patient complains of pain in the lower extremities, especially when walking, intermittent claudication, numbness in the fingers, cold extremities, inability to walk more than 100 meters. Sleeps with his leg lowered. The patient has been a smoker since he was 16, abuses alcohol, has a history of CHD. The left lower extremity is colder than the right one, the skin of extremities is dry, pedal pulse cannot be palpated, femoral pulse is preserved. What is the most likely diagnosis?

Obliterating endarteritis

Raynaud’s disease

Deep thrombophlebitis

Diabetic angiopathy

Leriche syndrome

56 із 200

A 38-year-old male complains of tonic tension of the masticatory muscles, so that he cannot open his mouth. 12 days before, he was bitten by an unknown dog. Objectively: there is pronounced tension and twitching of the masticatory muscles. What is the most likely diagnosis?

Tetanus

Trigeminal neuralgia

Apyretic tetanus

Rabies

Hysteria

57 із 200

A 72-year-old male had had a moderate headache. Two days later, he developed the progressing speech disorders and weakness in the right extremities. The patient has a history of myocardial infarction, arrhythmia. Study of the neurologic status revealed elements of motor aphasia, central paresis of the VII and XII cranial nerves on the right, central hemiparesis on the same side and hyperaesthesia. What is the most likely diagnosis?

Ischemic stroke

Brain tumor

Epidural hematoma

Transient ischemic attack

Hemorrhagic stroke

58 із 200

A 28-year-old female patient has been admitted to the gynecology department for abdominal pain, spotting before and after menstruation for 5 days. The disease is associated with the abortion which she had 2 years ago. Anti-inflammatory treatment had no effect. Bimanual examination findings: the uterus is enlarged, tight, painful, smooth. Hysteroscopy reveals dark red holes in the fundus with dark blood coming out of them. What diagnosis can be made on the grounds of these clinical presentations?

Inner endometriosis

Polymenorrhea

Hypermenorrhea

Submucous fibromatous node

Dysfunctional uterine bleeding

59 із 200

2 weeks after having quinsy, a 26-year-old male patient got facial edemata, moderate pain in the sacrum. Objectively: body temperature is 37, 5oC, AP- 100/80 mm Hg. Urinalysis results: RBC- up to 100 fresh cells in per HPF, protein - 2,2 g/l, hyaline cyli- nders - up to 10 per HPF, relative density -1002. What is the most likely diagnosis?

Acute glomerulonephritis

Urolithiasis

Nephroma

Chronic glomerulonephritis

Acute pyelonephritis

60 із 200

Examination of a full-term 6-day-old infant revealed that different areas of skin had erythemas, flaccid bubbles, eroded surface, cracks, peeling of the epidermis looking like being scalded with boiling water. There was positive Nikolsky’s symptom. General condition of the child was serious. The child was restless, hypersensitive, febrile. What is the most likely diagnosis in this case?

Ritter’s exfoliative dermatitis

Finger’s pseudofurunculosis

Neonatal pemphigus

Neonatal phlegmon

Epidermolysis

61 із 200

A 39-year-old female patient complains of rapid fatigability, drowsiness, dry skin, hair loss, swelling of the face. A month ago, she underwent a surgery for thyrotoxicosis. The patient has the following gland dysfunction:

Thyroid (hypothyroidism), due to inadequate operative technique

Parathyroid, due to the gland removal during surgery

Pituitary, due to a tumor

Ovarian, due to a tumor

Adrenal

62 із 200

A 27-year-old patient has a severe headache, nausea and vomiting. Objectively: body temperature is 38,9°C, there is a haemorrhagic stellate rash on the legs. The patient takes meningeal pose in bed. Meningeal symptoms are strongly positive. Deep reflexes are brisk, uniform. Pathological reflexes are absent. It has been suspected that the patient has epidemic cerebrospinal meningitis. Which of additional tests should be performed in the first place to verify the diagnosis?

Lumbar puncture

Survey craniogram

Rheoencephalography

Electroencephalography

Echoencephalography

63 із 200

3 hours before, a 68-year-old male patient got a searing chest pain radiating to the neck and left forearm, escalating dyspnea. Nitroglycerin failed to relieve pain but somewhat reduced dyspnea. Objectively: there is crimson cyanosis of face. Respiratory rate is 28/min. The patient has vesicular breathing with isolated sibilant rales. Heart sounds are muffled, with a gallop rhythm. Ps- 100/min, AP- 100/65 mm Hg. ECG shows negative T-wave in V2 — V6 leads. What drug can reduce the heart’s need for oxygen without aggravating the disease?

Isosorbide dinitrate

Streptokinase

Atenolol

Corinfar

Aminophylline

64 із 200

A 5-year-old girl has had thirst, polyuria, increased appetite for two months. At the same time, there is a 3 kg decrease in body weight. During the last week, these presentations got accompanied by nocturnal enuresis. Examination revealed hyperglycemia at the rate of 14 mmol/l. The child has been diagnosed with type I diabetes. What is the most likely genesis of this disease?

Autoimmune

Viral

Bacterial

Neurogenic

Viral and bacterial

65 із 200

An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:

0,1-0,2 U/kg of body weight per hour

0,2-0,3 U/kg of body weight per hour

0,4-0,5 U/kg of body weight per hour

0,05 U/kg of body weight per hour

0,3-0,4 U/kg of body weight per hour

66 із 200

A 12-year-old girl undergoes regular gastroenterological check-ups for duodenal ulcer, biliary dyskinesia. What is the recommended frequency of anti-relapse treatment?

Twice a year

Every two months

Once a year

Three times a year

Every 3 months

67 із 200

On the 2nd day of disease a 27-year-old patient complains of unbearable headache, repeated vomiting. Objectively: the patient is in a grave condition. He is conscious but adynamic. Lies in a forced position with his head thrown back. There is no skin rash. Nuchal muscles are evidently rigid, there are Kernig’s and Brudzinski’s signs. t°- 39, 5°C, Ps- 120/min, AP- 130/80 mm Hg. The leading syndrome of this disease is caused by:

Liquor hypertension

Hyperthermy

Liquor hypotension

Affection of the cranial nerve nuclei

Haemorrhages in the adrenal glands

68 із 200

Two years ago, a 46-year-old patient was diagnosed with stage I silicosis. Currently the patient complains of escalating dyspnea, pain in the infrascapular regions. Radiograph shows a diffuse enhancement and distortion of lung markings, as well as multiple nodular shadows 2-4 mm in diameter. There is interlobar pleural density on the right. Dense shadows are found in the hilar regions. Specify the form of radiographic pulmonary fibrosis in this case:

Nodular

Tumor-like

Nodal

Interstitial nodular

Interstitial

69 із 200

A 63-year-old female complains of general weakness, a feeling of heaviness, compression in the epigastrium, postprandial fullness, nausea, belching after meals. These symptoms have been observed for about 15 years. Objectively: body temperature is 36,4oC, respiratory rate 20 /min, Ps - 88/min, blood pressure - 115/75 mm Hg. Skin and mucous membranes are pale. Blood test results: RBC -2,0-1012/l, Hb -100 g/l. Tests revealed parietalcell antibodies. What is the most likely reason for the development of anemia in this patient?

Production of antibodies to intrinsic factor

Disruption of hemoglobin synthesis

Impaired iron absorption

Disruption of erythropoietin synthesis

Increased loss of iron

70 із 200

During dressing of a poorly-granulating wound Pseudomonas aeruginosa infection was revealed. What medication would be optimal for the wound d-bridement?

Boric acid solution

Sulfonamides

Biogenic stimulators

Antibiotics

Salicylic acid

71 із 200

A 39-year-old male patient complains of moderate pain and weakness in the shoulder, back and pelvic girdle muscles, that has been progressing for the last 3 weeks; great difficulty in getting out of bed, going up and down the stairs, shaving. Dermatomyositis has been suspected. Blood test results: Hb-114 g/l, WBC- 10,8 - 109/l, eosinophils - 9%, ESR -22 mm/h, C-reactive protein - (++). The alteration in the following laboratory value wil be of decisive diagnostic significance:

Creatine phosphokinase

Gamma-globulins

dsDNA antibodies

Sialic acids

Ceruloplasmin

72 із 200

A 60-year-old female patient complains of recurrent pain in the proximal interphalangeal and wrist joints, their periodic swelling and reddening that have been observed for 4 years. X-ray picture represents changes in form of osteoporosis, joint space narrowing and single usuras. What is the most likely diagnosis?

Rheumatoid arthritis

Multiple myeloma

Pseudogout

Gout

Osteoarthritis

73 із 200

A 30-year-old female patient has been delivered to a hospital for sudden dyspnea progessing to asthma, sensation of having a 'lump in the throat', hand tremor, fear of death. The attack has developed for the first time and is associated with a strong emotion. There is no previous history. Objectvely: respiratory rate - 28/min, Ps- 104/min, rhythmic, AP- 150/85 mm Hg. The patient has rapid superficial vesicular breathing with extended expiration. Percussion findings: heart borders are not changed. Cardiac sounds are loud, rhythmic. What is the most likely diagnosis?

Neurocirculatory asthenia

Cardiac asthma

Hypertensive crisis

Bronchial asthma

Thyrotoxic crisis

74 із 200

A 42-year-old male patient wth essential hypertension presents with headache, palpitations, unexplained fear. Objectively: Ps-100/min, AP- 200/100 mm Hg, the left border of cardiac dullness is displaced by 1,5 cm to the left, vesicular breathing is present. ECG shows sinus tachycardia, signs of left ventricular hypertrophy. What drug should be administered as an emergency?

Obzidan

Furosemide

Dibazol

Magnesium sulfate

Reserpine

75 із 200

A 37-year-old male patient has a histrory of diabetes of moderate severity. On the left side of face the patient has a carbuncle. What severe complication might have occurred in the patient?

Cavernous sinus thrombosis

Endarteritis

Thrombophlebitis

Thromboembolism

Lymphangitis

76 із 200

A 42-year-old female patient complains of a dull pain in her left side, low-grade fever, accelerated painful urination in small portions. These presentations have been observed for three years. For a long time, the patient has had cystitis with frequent exacerbations, there is pulmonary tuberculosis in the past history. Urinalysis results: microscopic hematuria, leukocyturia. What is the most likely provisional diagnosis?

Renal tuberculosis

Urolithiasis

Chronic cystitis

Renal tumor

Chronic pyelonephritis

77 із 200

A woman at 30 weeks pregnant has had an attack of eclampsia at home. On admission to the maternity ward AP- 150/100 mm Hg. Predicted fetal weight is 1500 g. There is face and shin pastosity. Urine potein is 0,66°/oo. Parturient canal is not ready for delivery. An intensive complex therapy has been started. What is the correct tactics of this case management?

Delivery by cesarean section

Continue therapy and prolong pregnancy for 3-4 weeks

Treat preeclampsia and achieve the delivery by way of conservative management

Labor induction by intravenous oxytocin or prostaglandins

Continue therapy and prolong pregnancy for 1-2 weeks

78 із 200

Examination of a dead man who died from hanging revealed that cadaver spots disappeared when pressed upon and restored after 50 seconds, rigor mortis was moderately expressed only in the masticatory muscles and the muscles of neck and fingers. Body temperature was 31°C. Specify the time of death:

6-7 hours

8-10 hours

16-24 hours

10-18 hours

1-2 hours

79 із 200

A 65-year-old male patient complains of dyspnea that is getting worse with exertion, morning cough with expectoration of mucous sputum. For about 15 years, he has been subject to regular medical check-up for chronic bronchitis. The patient takes berodual (16 inhaled doses per day). Objectively: body temperature is 36,8°C, RR- 24/min, Ps- 110/min, AP- 145/90 mm Hg. Auscultation reveals a lot of dry rales above the lungs. FEV1- 65%. What is the optimal tactics of further management of the patient?

To administer inhalation corticosteroids

To administer theophylline

To administer antibiotics

To increase the daily dose of berodual

To include short-acting /32-agonists in the therapy

80 із 200

A 49-year-old countryman got an itching papule on the dorsum of his right hand. In the centre there is a vesicle with serosangi-nous exudate. Within the next 2 days the patient developed a painless edema of hand and forearm. On the 4th day the temperature rose to 38, 5°C, in the right axillary region a large painful lymph node was found. One day before the onset of the disease the patient had examined a dead calf. What is the most likely diagnosis?

Cutaneous anthrax

Lymphocutaneous tularemia

Carbuncle

Bubonic plague

Erysipelas

81 із 200

An employee of a petrol station with 15 years of service record having contact with ethylated gasoline presents with memory impairment, bradycardia, sensation of having a hair in the mouth, skin paresthesia. In this case, one can assume intoxication with the following substance:

Tetraethyl lead

Lead chloride

Organophosphates

Nitrobenzene

Benzene

82 із 200

A 38-year-old female suddenly developed acute inflammatory rash in form of roseolas, papules, vesicles that are scattered on the skin of trunk in irregular and predominantly focal manner. The rash appeared a few hours after visiting a restaurant. The patient complains of itching skin. What is the most likely diagnosis?

Toxicodermatosis

-

Contact dermatitis

Eczema

Atopic dermatitis

83 із 200

The institutions which take part in medical examinations can be prevention and treatment facilities, medical board of Ministry of Defense, medical board of Ministry of Home Affairs, medico-social expert commissions, forensic medical boards etc. What institutions are responsible for temporary disability examination?

Prevention and treatment facilities

Medical boards of the Ministry of Defense

Medical boards of the Ministry of Home Affairs

Medico-social expert commissions

Sanitary-and-prophylactic institutions

84 із 200

After lifting a load, a 36-year-old male patient has experienced a severe pain in the lumbar region, which spread to the right leg and was getting worse when he moved his foot or coughed. Objectively: the long back muscles on the right are strained. Achilles jerk is reduced on the right. There is a pronounced tenderness of paravertebral points in the lumbar region. The straight leg raise (Lasegue’s sign) is positive on the right. What additional tests should be performed in the first place?

Radiography of the spinal column

Electromyography

Lumbar puncture

Magnetic resonance tomography

Computed tomography

85 із 200

A 17-year-old male patient consulted a therapist about malaise, chills, runny nose, aching muscles and joints, nausea and diarrhea. The patient asks to prescribe him a lot of painkillers and sedatives (tramadol or solpadein that help the best, and diazepam). Pharyngeal mucosa is pale pink, clean. Auscultation reveals vesicular breathing. Tachycardia is present. The pupils are dilated, there is sluggish response to light. There are injection marks on the forearm skin. During examination, the patient’s manner is vulgar, irritable, rude and untruthful. Make a diagnosis:

Opioid addiction

Acute respiratory disease

Food-born toxic infection

Sedative drug addiction

Painkillers addiction

86 із 200

A 4-year-old boy had untimely vaccination. He complains of painful swallowing, headache, inertness, fever. Objectively: the child is pale, has enlarged anterior cervical lymph nodes, swollen tonsils with cyanotic hyperemia, tonsils are covered with gray-white pellicles which cannot be easily removed. When the pellicles are forcibly removed, the tonsils bleed. What is the most likely diagnosis?

Oropharyngeal diphtheria

Follicular tonsillitis

Pseudomembranous tonsillitis

Infectious mononucleosis

Lacunar tonsillitis

87 із 200

Public nurseries are designed as a single or several one- or two-storey buildings linked by covered walkways. Planning the structure of preschool instiutions is based upon the following principle:

Principle of age distribution

Principle of group isolation

Principle of age-sex distribution

Principle of autonomy

Principle of sex distribution

88 із 200

A city somatic hospital with 300 beds has a main building which houses the therapeutic and surgical departments. Several separate buildings house the maternity, pediatric and radiologic departments that are connected to the main building by underground walkways and aboveground covered skybridges. Specify the building system of the hospital:

Central-unit

Centralized

Free

Combined

Decentralized

89 із 200

A 43-year-old female patient complains of dyspnea, swelling of legs, abdomen enlargement, pricking heart pain. She has a history of tuberculous bronchadenitis, quinsies. The patient’s condition deteriorated 6 months ago. Objectively: cyanosis, bulging neck veins, vesicular breathing. Heart borders are not displaced. Heart sounds are muffled, Ps- 106/min, liver is +4 cm, ascites is present. Low voltage on the ECG has been revealed. Radiograph shows a thin layer of calcium deposits along the left contour of heart. What treatment should be recommended to the patient?

Treatment by a cardiac surgeon

Digitalis preparations

Anti-TB drugs

Vasodilators, nitrates

Diuretics

90 із 200

A 26-year-old female patient has an 11-year history of rheumatism. Four years ago she suffered 2 rheumatic attacks. Over the last 6 months there have been paroxysms of atrial fibrillation every 2-3 months. What option of antiarrhythmic therapy or tactics should be proposed?

Prophylactic administration of cordarone

Lidocaine administration

Immediate hospitalization

Heparin administration

Defibrillation

91 із 200

Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and B(III) groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result indicative of?

Faulty standard sera

The fourth blood group

The first blood group

The second blood group

The third blood group

92 із 200

A 9-year-old girl has been admitted to a hospital for an elevated body temperature (39,8°C), painful dry cough, abdominal pain on the right. Examination reveals dullness on percussion on the right, diminished breath sounds, crepitus. What study is required to make a diagnosis?

Radiography of the chest cavity

Bronchoscopy

Pleural puncture

Bronhography

USI of the chest cavity

93 із 200

A newborn has purulent discharges from the umbilical wound, the skin around the navel is swollen. The baby’s skin is pale, with a yellow-gray tint, generalized hemorrhagic rash is present. What is the most likely diagnosis?

Sepsis

Omphalitis

Thrombocytopathy

Hemolytic disease of the newborn

Hemorrhagic disease of the newborn

94 із 200

A pregnant 26-year-old woman was admitted to a hospital for abdominal pain and bleeding from the genital tract. Bimanual examination revealed that uterus was the size of 9 weeks of pregnancy, the cervical canal let a finger through. Fetal tissues could be palpated in the orifice. There was moderate vaginal bleeding. What is the tactics of choice?

Instrumental extraction of fetal tissue

Administration of hormones

Hemostatic and antianemic therapy

Therapy for the maintenance of pregnancy

Surveillance

95 із 200

On the second day of the disease a 22-year-old male patient complains of high-grade fever, headache in the region of forehead and superciliary arches, and during eye movement; aching muscles and joints. Objectively: body temperature is 39oC. Face is hyperemic, sclerae are injected. The mucous membrane of the soft palate and posterior pharyngeal wall is bright hyperemic and has petechial hemorrhages. What changes in the hemogram are typical for this disease?

Leukopenia

Accelerated ESR

Neutrocytosis

Leukocytosis

Anemia

96 із 200

A 44-year-old male patient complains of severe non-localized abdominal pain, pain in the right shoulder girdle, repeated vomiting, red urine. The onset of the disease is associated with alcohol consumption. The face is hyperemic. AP- 70/40 mm Hg. Abdominal radiography reveals no pathological shadows. Hemodiastase is 54 mg/h/l. Prothrombin is 46%. What is the provisional diagnosis?

Acute pancreatitis

Perforated gastric ulcer

Thrombosis of mesenteric vessels

Acute myocardial infarction

Aneurysm of the abdominal aorta

97 із 200

A 41-year-old male patient was delivered to a hospital unconscious. During the previous 7 days he had been taking large doses of biseptolum for a cold. The night before, he began complaining of dyspnea, especially when lying down, swollen legs, 2-day urinary retention. In the morning he had seizures and lost consciousness. Objctively: noisy breathing at the rate of 30 /min, edematous legs and lumbar region, Ps- 50/min. Plasma creatinine is 0,586 mmol/l, plasma potassium - 7,2 mmol/l. What treatment is necessary for this patient?

Hemodialysis

Glucocorticosteroids

Heparin

Plasma volume expanders

Large doses of verospiron

98 із 200

A 10-year-old child with a history of nonrheumatic carditis has periodic attacks manifested by heart pain, dyspnea, pallor, high blood pressure, a dramatic increase in heart rate up to 180 /min. What drug would be most effective to treat this patient?

Obsidan

Verapamil

Lidocaine

Ajmaline

Procainamide

99 із 200

A 45-year-old male patient with acute abscess of the left lung has suddenly developed acute chest pain and dyspnea while coughing, tachycardia has increased. The control Ro-gram shows left lung collapse, the air in the left pleural cavity and a horizontal fluid level. What is the mechanism of this complication?

Abscess burst into the pleural cavity

Acute cardiovascular insufficiency

Inflammation spread to the visceral pleura

Atelectasis of the left lung

Bullae rupture of the left lung

100 із 200

A 24-year-old male patient had been diagnosed with class III diffuse toxic goiter. There is moderate hyperthyroidism. A surgery was suggested, and the patient agreed to it. What preoperative measures should be taken for prevention of thyrotoxic crisis in the postoperative period?

Administration of antithyroid drugs

Detoxification therapy

Bed rest

Administration of corticosteroids

Minimally invasive surgical techniques

101 із 200

A 26-year-old male patient complains of pain in the right knee, which is getting worse in the morning. Two weeks before, he consulted an urologist about prostatitis. Objectively: conjunctivitis is present. There is also periarticular edema of the knee joint, redness of the overlying skin. Rheumatoid factor was not detected. Until further diagnosis is specified, it would be reasonable to start treatment with the following antibiotic:

Tetracyclines

Aminoglycosides

Lincosamides

Cephalosporins

Penicillins

102 із 200

A 66-year-old female patient has been admitted to a hospital for massive gross hematuria with release of shapeless blood clots, frequent painful urination. The patient also reports a moderate weight loss within 3-4 months. Gross hematuria that was not accompanied by pain and dysuria first occurred three months ago for no apparent reason, and after a few days the bleeding subsided independently. What is the most likely diagnosis?

Bladder tumor

Acute cystitis

Renal tumor

Urolithiasis

Chronic cystitis

103 із 200

A 36-year-old female pesented to a gynecological hospital with a significant bleeding from the genital tract and a 1-month delay of menstruation. Bimanual examination revealed soft barrelshaped cervix. Uterus was of normal size, somewhat softened. Appendages were unremarkable on both sides. Speculum examination revealed that the cervix was cyanotic, enlarged, with the the external orifice disclosed up to 0,5 cm. Urine hCG test was positive. What is the most likely diagnosis?

Cervical pregnancy

Abortion in progress

Uterogestation

Ectopic pregnancy

Threatened miscarriage

104 із 200

A 47-year-old female patient has an 8-year history of ulcerative colitis, has been treated with glucocorticoids. She complains of cramping pain in the umbilical region and left iliac region which has significantly increased during the past 2 weeks, diarrhea with mucus and blood 4-6 times a day, elevated body temperature up to 38 — 39°C, headache and pain in the knee joints. Objectively: the patient is in moderate condition, Ps- 108/min, AP- 90/60 mm Hg; heart and lungs are unremarkable; the tongue is moist; abdominal muscle tone is significantly decreased; peristaltic noises are absent. What complication developed in the patient?

Toxic dilatation of the colon

Colon carcinoma

Enterorrhagia

Perforation of the colon

Stricture of the colon

105 із 200

A 10-year-old child has been admitted to a hospital with a closed craniocerebral injury with a suspected cerebral edema. The patient is in grave condition, unconscious. The dyspnea, tachycardia, hypertension are present. Muscle tone is increased, there is nystagmus, pupillary and oculomotor reactions are impaired. The mandatory component of intensive care is dehydration. What diuretic is adequate in this case?

Furosemide

Moduretic

Mannitol

Spironolactone

Hydrochlorthiazide

106 із 200

For 3 days, a 28-year-old emale patient had had the body temperature increase up to 38°C, weakness, poor appetite, nausea, a single vomiting. On the 4th day the temperature was normal, the condition improved, but the jaundice developed. Objectively: moderate ictericity of skin, +3 cm enlarged liver of elastic consistency. Ortner’s, Kehr’s and Voznesensky’s symptoms are negative. What test will verify the diagnosis?

IgM Anti-HAV detection

Complete blood count

Ultrasound of the abdomen

Total bilirubin

AST activity

107 із 200

An 11-year-old girl has been immunized according to her age and in compliance with the calendar dates. What vaccinations should the children receive at this age?

Diphtheria and tetanus

TB

Hepatitis B

Polio

Pertussis

108 із 200

A 40-year-old male patient has had heaviness in the epigastric region for the last 6 months. He has not undergone any examinations. The night before, he abused vodka. In the morning there was vomiting, and 30 minutes after physical activity the patient experienced dizziness and profuse hematemesis. What pathology should be suspected in the first place?

Mallory-Weis’s syndrome

Gastric ulcer

Menetrier’s disease

Zollinger-Ellison syndrome

Perforated ulcer

109 із 200

A 55-year-old patient complains of severe itching, burning and pain in the eyes, skin redness in the outer corners of the palpebral fissure. Objectively: skin around the outer corners of the palpebral fissure is macerated, eczematous, there are single moist cracks. Palpebral conjunctiva is hyperemic, quaggy. There are minor discharges in form of stringing mucus. What is the most likely diagnosis?

Chronic conjunctivitis

Blepharitis

Sty

Acute conjunctivitis

Atopic eyelid dermatitis

110 із 200

A 3-month-old infant has occipital alopecia, restless sleep, excessive sweating. What disease can you think of?

Rickets

Phosphate diabetes

Spasmophilic diathesis

Anemia

Chondrodystrophy

111 із 200

A 50-year-old male in a grave condition has been admitted to the intensive care unit. It is known from life history that the patient works in agriculture, and 3 hours ago was engaged into insecticide treatment of crops for control of colorado potato beetle. Condition on admission: acrocyanosis, bronchorrhea, tachypnea, AP- 100/60 mm Hg, Ps- 44/min. What method of efferent therapy would be most appropriate at this stage?

Hemosorbtion

Plasmapheresis

Hemodialysis

Plasma dialysis

Lymphosorption

112 із 200

An 80-year-old patient complains of constantly urinating small amounts, a feeling of pressure in the lower abdomen. Objectively: there is a suprapubic spherical bulging with percussion dullness over it. What syndrome occurred in the patient?

Paradoxical ischuria

Enuresis

Dysuria

Pollakisuria

Urinary incontinence

113 із 200

Carpathian region is characterized by permanently high (over 80%) air humidity. In the cold season the population of this region feels very cold at moderately low temperatures. This is due to an increase in the heat transfer by:

Convection

Conduction

Radiation

Emission

Evaporation

114 із 200

An 18-year-old girl complains of breast pain and engorgement, headaches, irritability, swelling of the lower extremities. These symptoms have been observed since menarche and occur 3-4 days before the regular menstruation. Gynecological examination revealed no pathology. Make a diagnosis:

Premenstrual syndrome

Neurasthenia

Renal disease

Mastopathy

Cardiovascular disorder

115 із 200

A 56-year-old male patient has been delivered to the emergency department with frostbite on both feet. What aid should be rendered to the victim?

Apply a bandage, give an injection of vasodilators

Rub the feet with snow

Administer heart medications

Apply an alcohol compress

Put the feet into hot water

116 із 200

A 21-year-old male patient got a deep cut wound in his right thigh. In the emergency room a surgeon on duty performed primary debridement of the wound and primary wound closure with a suture. After 4 days, there appeared pain, redness, edema, purulent discharge from the wound gap, body temperature rose up to 39°C. What kind of wound complication can you think of and what actions should be taken?

Wound abscess, remove the sutures and drain the wound

Erysipelas, prescribe antibiotics

Tetanus, active-passive immunization against tetanus

Lymphangitis, apply a hot compress

Infiltration, apply a hot compress

117 із 200

A general practitioner visited a 2-year-old child and diagnosed him with measles. The child attends a nursery, has a 5-year-old sister. What document must be filled in for the effective antiepidemic measures in the given health locality?

Emergency notification on infectious disease (form N° 058/o)

Sick leave

House call record (form N° 031/o)

Carer’s leave certificate

Infant’s record (report form N° 112/o)

118 із 200

An employee has been diseased for 4 months, further treatment is necessary, the patient is incapacitated. Who is authorized to provide further disability examination of this patient?

Medical and social expert board

Medical consultative board

Physician in charge and chief of department

Deputy chief responsible for disability examination

Chief physician of a medical facility

119 із 200

It has been suspected that a newborn has congenital diaphragmatic hernia (asphyctic incarceration). What study will allow to confirm the diagnosis?

Plan radiography of the chest cavity

Irrigography

Pneumoirrigoscopy

Fibroesophagogastroduodenoscopy

Plan abdominal radiography

120 із 200

A 25-year-old female presented to a women’s welfare clinic and reported the inability to get pregnant within 3 years of regular sexual activity. Examination revealed increased body weight, male pattern of pubic hair growth, excessive pilosis of thighs, dense enlarged ovaries, monophasic basal temperature. What is the most likely diagnosis?

Polycystic ovarian syndrome

Gonadal dysgenesis

Premenstrual syndrome

Adrenogenital syndrome

Adnexitis

121 із 200

A factory’s sectorial doctor selects a group of persons who often fall ill for thorough monitoring. At the same time he takes into consideration the number of etiologically related cases with temporary disability in each of the employees over the last year. An employee falls into this group if the number of sickness cases is:

4 or more

6 or more

3 or more

1 or more

2 or more

122 із 200

A 23-year-old female consulted a gynecologist on the 20th day postpartum period about pain in the left breast, purulent discharge from the nipple. Objectively: Ps-120/min, t0 - 39°C. The left breast is painful, larger than the right one, hyperemic. In the upper quadrant there is an infiltrate sized 10x15 cm with a softening inside. Blood test results: ESR- 50 mm/h, WBC- 15,0 • 109/l. What is the tactics of choice?

Refer to the surgical department for operative treatment

Lance the breast abscess in the women’s health clinic

Refer to the postpartum department

Refer to the gynecology department 6- Refer to a polyclinic surgeon for conservative treatment

123 із 200

A family lives in the town situated within the zone of radiation pollution. A 6-year-old child had been ill with ARVI for 19 days. The child was undergoing outpatient treatment and was nursed by his mother, a cafe worker. Specify the order of disability examination:

Sick leave is granted for the entire period of the child’s illness

Sick leave is not granted, only a carer’s leave certificate is issued

Sick leave is granted for 14 days, after this period is over, no document is issued

Sick leave is granted for 7 days, after this period is over, a carer’s leave certificate is issued

Sick leave is granted for a total of 14 days, and after that period is over, a carer’s leave certificate is issued

124 із 200

A 49-year-old female patient with schizophrenia is all the time listening to something, insists that 'there is a phone in her head'as she hears the voice of her brother who tells her to go home. The patient is anxious, suspicious, looks around all the time. Specify the psychopathological syndrome:

Hallucinatory

Depressive

Generalized anxiety disorder

Paraphrenic

Paranoiac

125 із 200

During the first home visit to a full-term boy after his discharge from the maternity hospital a pediatrician revealed a symmetrical swelling of mammae without skin changes over them, swelling of the scrotum. The body temperature was of 36, 5°C. The baby was calm, sucked the mother’s breast actively. What condition should you think of?

Hormonal crisis of the newborn

Congenital adrenal dysfunction

Necrotic neonatal phlegmon

Sclerema

Neonatal mastitis

126 із 200

A 30-year-old male patient complains of inertness, low-grade fever, bleeding gums, frequent quinsies, aching bones. Objectively: the patient has pale skin and mucous membranes, sternalgia, +2 cm liver, +5 cm painless spleen. Blood test results: RBC-2,7 • 1012/l, Hb- 80 g/l, WBC- 3 • 109/l, eosinophils - 4%, basophils - 5%, blasts -4segmented neutrophils -17%, lymphocytes -29%, myelocytes - 25%, promyelocytes -12%, monocytes - 2%, platelets - 80 • 109 /l, ESR -57 mm/h. What test should be performed to verify the diagnosis?

Sternal puncture

Chest X-ray

Lumbar puncture

Trephine biopsy

Lymph node biopsy

127 із 200

A 46-year-old male patient complains of periodic epigastric pain that occurs at night. Objectively: HR- 70/min, AP- 125/75 mm Hg, tenderness in the epigastric region is present. EGD confirms duodenal ulcer of 0,6 cm in diameter. Test for H. Pylori is positive. Which of the given antisecretory drugs will be a compulsory element of the treatment regimen?

Omeprazole

Atropine

Famotidine

Maalox

Pirenzepine

128 із 200

A 47-year-old male patient has been lately complaining of compressing chest pain that occurs when he walks a distane of 700-800 m. Once a week, he drinks 2 liters of beer. Rise in arterial pressure has been observed for the last 7 years. Objectively: Ps- 74/min, AP- 120/80 mm Hg. The bicycle ergometry performed at workload of 75 watts shows 2 mm ST-segment depression in V4 — V6 leads. What is the most likely diagnosis?

Exertional stenocardia, II functional class

Exertional stenocardia, IV functional class

Exertional stenocardia, III functional class

Vegetative-vascular dystonia of hypertensive type

Alcoholic cardiomyopathy

129 із 200

A puerperant is 28 years old. It’s the 3rd day post-partum after a second, normal, term delivery. The body temperature is of 36,8°C, Ps- 72/min, AP- 120/80 mm Hg. Mammary glands are moderately engorged, the nipples are clean. Abdomen is soft, painless. The fundus is 3 fingers’ breadth below the navel. Moderate bloody lochia are present. What diagnosis can be made?

Physiological course of the postpartum period

Postpartum metroendometritis

Lactostasis

Remains of placental tissue after childbirth

Subinvolution of uterus

130 із 200

A 29-year-old unconscious patient has been delivered to a hospital. Objectively: skin and mucous membranes are pale, cyanotic, breath sounds are dramatically diminished on the right and cannot be auscultated in the lower parts, at the level of the 6 rib along the anterior axillary line there is a wound hole with moderate bleeding and passage of air during inspiration. Radiography reveals a bullet in the pleural cavity. What is the medical tactics of choice?

Emergency thoracotomy

Thoracoscopy with removal of bullet

Thoracostomy

Tight bandage on a wound

Converting a tension pneumothorax into a simple (open) pneumothorax

131 із 200

A patient had four generalized convulsive seizures within a day. Between the seizures the patient did not come to waking consciousness (was in a coma or stupor). Specify his state:

Status epilepticus

Frequent generalized seizures

Frequent jacksonian seizures

Hysterical attacks

Frequent complex partial seizures

132 із 200

A 12-year-old boy presents with nausea, frequent repeated vomiting that first occurred after eating canned vegetables. Objectively: the patient has dry mucous membranes, muscular hypotonia, anisocoria, mydriasis, dysphagia and dysarthria. What is the most likely diagnosis?

Botulism

Shigellosis

Yersiniosis

Cholera

Salmonellosis

133 із 200

A full-term neonate weighing 4500 g was born asphyxiated with Apgar score of 4-6 points. During the delivery shoulder dystocia occurred. Neurologic assessment revealed non-focal neurologic symptoms, total flaccid paresis of the upper extremities since the arm was atonic and pronated. Grasping, Babkin’s and Moro’s reflexes were absent. What segments of spinal cord had been affected?

Cv - Thi

Thi - Thv

Ci -Cii

Ciii- Civ

ThVi - ThVu

134 із 200

A newborn (mother’s I pregnancy) weighing 3500 g has been found to have jaundice, lethargy, reduced reflexes. Objectively: second grade jaundice of skin with saffron tint, liver - +2 cm, spleen - +1 cm. Urine and feces are yellow. Blood count: Hb- 100 g/l, RBC-3, 2 • 1012/l, WBC18, 7 • 109/l, mother’s blood type - 0(I) Rh(+), baby’s blood type - A(II) Rh(-), bilirubin -170 mmol/l, indirect fraction. ALT, AST rates are normal. What is the most likely disease in the child?

Hemolytic disease of newborn, AB0-conflict

Perinatal hepatitis

Hemolytic disease of newborn, Rh-conflict

Biliary atresia

Physiologic jaundice

135 із 200

As a result of a road accident a 45-year-old male patient got multiple injuries, namely closed fractures of the right humerus and the left antebrachial bones with a displacement of bone fragments, a closed blunt abdominal injury. The patient was delivered to the emergency department 30 minutes after the injury. Objectively: the skin is pale. AP-90/20 mm Hg, there is pain and deformation at the fracture sites. Abdomen is tense, palpation causes severe pain, there is rebound tenderness (positive Blumberg’s sign). What is the treatment tactics of choice?

Urgent diagostic laparotomy

Additional tests to specify the diagnosis

Fracture immobilization, analgesia

Local anesthetic blockade of fractures

Infusion therapy to stabilize blood pressure

136 із 200

A 34-year-old male visited Tajikistan. After return, he complains of fever up to 40°C which occurs every second day and is accompanied by chills, sweating. Hepatosplenomegaly is present. Blood test results: RBC- 3 • 1012/l, Hb- 80 g/l, WBC- 4 • 109/l, eosinophils -1%, stab neutrophils - 5%, segmented neutrophils - 60%, lymphocytes - 24%, monocytes -10%, ESR - 25 mm/h. What is the provisional diagnosis?

Malaria

Infectious mononucleosis

Sepsis

Leptospirosis

Typhoid fever

137 із 200

A 23-year-old male patient consulted a doctor about pain occurring in the lower third of the thigh with weight bearing activities and unloaded. The patient denies any injuries to the region. Objectively: the skin is of normal color, deep palpation reveals pastosity and tenderness, movements of the knee joint are limited. Radiograph of the distal femoral metaepiphyseal region shows a zone of degradation and spicules. In blood: immature cells are present, there are no signs of inflammation. What is the most likely diagnosis?

Osteosarcoma

Chronic osteomyelitis

Multiple myeloma

Marble bone disease

Hyperparathyroid dystrophy

138 із 200

It is planned to organize a rural outpatient clinic. The patients will be able to visit the doctors of the following specialities:

Therapeutist, dentist, pediatrician, obstetrician-gynecologist

Pediatrician, obstetrician-gynaecologist, ophthalmologist

Pediatrician, therapeutist, ophthalmologist

Therapeutist, pediatrician, neurologist

Obstetrician-gynaecologist, therapeutist

139 із 200

A 12-year-old girls has minor functional and morphological abnormalities: 1,0 D myopia, reduced body resistance. The patient has no history of chronic diseases. Over the last year, there were 4 cases of respiratory diseases. The girl belongs to the following health group:

II

I

V

III

IV

140 із 200

4 weeks after a myocardial infarction, a 56-year-old male patient developed acute heart pain, pronounced dyspnea. Objectively: the patient’s condition is extremely grave, there is marked cyanosis of face, swelling and throbbing of neck veins, peripheral pulse is absent, the carotid artery pulse is rhythmic, 130 bpm, AP- 60/20 mm Hg. Auscultation of heart reveals extremely muffled sounds, percussion reveals heart border extension in both directions. What is the optimal treatment tactis for this patient?

Pericardiocentesis and immediate thoracotomy

Oxygen inhalation

Conservative treatment, infusion of adrenomimetics

Pleural cavity drainage

Puncture of the pleural cavity on the left

141 із 200

A puerperant is 32 years old, it’s her first childbirth, term precipitate labor, the III period is unremarkable, the uterus is contracted, tight. Examination of the birth canal revealed a rupture in the left posterior vaginal wall that was closed with catgut. Two hours later, the patient complained of a feeling of pressure on the anus, pain in the perineum, minor vaginal discharges, edema of the vulva. These clinical presentations are indicative most likely of:

Vaginal hematoma

Hysterocervicorrhexis

Hypotonic bleeding

Hysterorrhesis

Hemorrhoids

142 із 200

A hospital nutrition unit received a batch of beef. Sanitation physician examined the meat and revealed the presence of 5 bladder worms per 40 cm2 of meat. Give the hygienic assessment of meat:

Liable to technical utilization

Poor-quality

Good-quality

Conditionally admissible

Adulterated

143 із 200

A 47-year-old female patient complains of having pain on swallowing and difficult passing of solid food for two months. The patient has taken to the liquid and semi-liquid food. During the last week the liquid food has barely passed through. General condition is satisfactory, the patient is undernourished, the appetite is preserved, there is a fear of eating. What is the provisional diagnosis?

Esophageal carcinoma

Esophageal stricture

Esophageal foreign body

Esophageal achalasia

Esophageal varices

144 із 200

A 31-year-old female patient complains of infertility, amenorrhea for 2 years after the artificial abortion that was complicated by endometritis. Objectively: examination of the external genitalia revals no pathology, there is female pattern of hair distribution. According to the functional tests, the patient has biphasic ovulatory cycle. What form of infertility is the case?

Uterine

Hypothalamic

Immunological

Pituitary

Ovarian

145 із 200

A 49-year-old male patient consulted a doctor about difficult swallowing, voice hoarseness, weight loss. These symptoms have been gradually progressing for the last 3 months. Objectively: the patient is exhausted, supraclavicular lymph nodes are enlarged. Esophagoscopy revealed no esophageal pathology. Which of the following studies is most appropriate in this case?

Computed tomography of chest and mediastinum

X-ray of lungs

Radioisotope investigation of chest

Ultrasound investigation of mediastinum

Multiplanar imaging of esophagus

146 із 200

A 36-year-old male patient complains of having headache, obstructed nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had his right maxillary premolar filled. Radiolography revealed an intense opacity of the right maxillary sinus. Diagnostic puncture revealed a large amount of thick malodorous crumbly pus. What is the most likely diagnosis?

Chronic suppurative odontogenic sinusitis

Chronic atrophic sinusitis

Tumor of the maxillary sinus

Chronic purulent sinusitis

Acute purulent sinusitis

147 із 200

A 5-year-old boy has a history of repeated pneumonia, frequent acute respiratory viral diseases. Objectively: exertional dyspnea, minor fatigabilty. There is a systolic murmur having its epicenter in the IV intercostal space on the left. Left relative dullness is found along the midclavicular line. According to the findings of instrumental methods of examination ( electrocardiography, echocardiography), the patient has been diagnosed with ventricular septal defect, subcompensation stage. What is the main method of treatment?

Operative therapy

Does not require treatment

Conservative treatment

Phytotherapy

Indomethacin

148 із 200

A patient with autoimmune thyroiditis accompanied by multinodular goiter underwent the right lobe ectomy and subtotal resection of the left lobe. What drug should be administered to prevent postoperative hypothyroidism?

L-thyroxine

Iodomarin

Lithium drugs

Insulin

Merkazolil

149 із 200

A 49-year-old female patient has type 1 diabetes of moderate severity. The disease is complicated by retinopathy and polyneuropathy. Besides that, repeated analyses of the daily urinary excretion of albumin revealed microalbuminuria (200300 mg/day). Glomerular filtration rate is 105 ml/min. Blood pressure is within normal range. Normalization of the following indicator should be the first-priority task in the secondary prevention of diabetic nephropathy:

Glycosylated hemoglobin

Fasting glucose

Glycemia 2 hours after a meal

C-peptide

Blood insulin

150 із 200

10 days after birth, a newborn developed a sudden fever up to 38,1oC. Objectively: the skin in the region of navel, abdomen and chest is erythematous; there are multiple pea-sized blisters with no infiltration at the base; single bright red moist erosions with epidermal fragments on the periphery. What is your provisional diagnosis?

Epidemic pemphigus of newborn

Syphilitic pemphigus

Streptococcal impetigo

Vulgar impetigo

Atopic dermatitis

151 із 200

An emergency physician arrived to provide medical care for a hangman taken out of the loop by his relatives. The doctor revealed no pulse in the carotid arteries, lack of consciousness, spontaneous breathing and corneal reflexes; cadaver spots on the back and posterior parts of extremities. A person can be declared dead if the following sign is present:

Cadaver spots

Unconsciousness

Lack of corneal reflexes

Lack of spontaneous breathing

Pulselessness

152 із 200

A 69-year-old male patient has been hospitalized with hypothermia. Objectively: the patient is pale, has shallow breathing. AP-100/60 mm Hg, Ps- 60/min. Palpation of the abdomen and chest reveals no pathological signs. The body temperature is of 34,8oC. The patient’s breath smells of alcohol. Give treatment recommendations:

Warm bath + intravenous administration of warm solutions

Antishock therapy

Body warming with hot-water bags

Rubbing with alcohol and snow

Forced diuresis

153 із 200

A 26-year-old male patient consulted a doctor abut sore throat, fever up to 38,2oC. A week before, the patient had quinsy, didn’t follow medical recommendations. On examination, the patient had forced position of his head, trismus of chewing muscles. Left peritonsillar region is markedly hyperemic, swollen. What is the provisional diagnosis?

Left-sided peritonsillar abscess

Phlegmonous tonsillitis

Meningitis

Pharyngeal diphtheria

Tonsil tumour

154 із 200

A 21-year-old female patient has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest. Body temperature is 38,8°C. The condition developed three days ago. Respiratory rate is 42/min, auscultation reveals shallow breathing. There is percussive dullness on the right starting from the middle of the blade, breath sounds cannot be heard. The left border of heart is 3 cm displaced outwards. Embryocardia is present, HR is 110 /min. The right hypochondrium is painful on palpation. What urgent therapeutic measures should be taken in this situation?

Emergency puncture of the pleural cavity

Transferring the patient to the thoracic surgery department

Injection of cardiac glycosides

Injection of Lasix

Administration of penicillin antibiotics

155 із 200

A 77-year-old male patient complains of inability to urinate, bursting pain above the pubis. The patient developed acute condition 12 hours before. Objectively: full urinary bladder is palpable above the pubis. Rectal prostate is enlarged, dense and elastic, well-defined, with no nodes. Interlobular sulcus is distinct. Ultrasonography results: prostate volume is 120 cm3, it projects into the bladder cavity, has homogeneous parenchyma. Prostate-specific antigen rate is of 5 ng/ml. What is the most likely disease that caused acute urinary retention?

Prostatic hyperplasia

Tuberculosis of the prostate

Prostate carcinoma

Sclerosis of the prostate

Acute prostatitis

156 із 200

At the first minute of life a full-term infant born with umbilical cord entangled around his neck has total cyanosis, apnea, HR- 80/min, hypotonia and areflexia. There are no signs of meconium aspiration. After the airway suctioning the newborn did not start breathing. What is the next action of the doctor?

ALV with a 100% O2 mask

Intravenous administration of etamsylate

Stimulation of the skin along the spine

Intravenous administration of adrenaline

Tracheal intubation and ALV

157 із 200

Examination of an 11-year-old boy revealed frequent nosebleeds, fatigue when walking, underdevelopment of the lower half of the body, increased blood pressure in the upper extremities and decreased pressure in the lower ones, extension of the left heart border, blowing systolic murmur in the interscapular region. ECG shows the horizontal axis of heart. Radiography reveals left cardiomegaly, costal usuration. What is the most likely diagnosis?

Aortarctia

Patent ductus arteriosus

Aortic stenosis

Ventricular septal defect

Atrial septal defect

158 із 200

During the preventive examination a 17-year-old young man reports no health problems. Objectively: the patient is undernourished, asthenic; blood pressure is 110/70 mm Hg, Ps80 /min. Heart borders are within normal range. Auscultation reveals three apical heart sounds, murmurs are absent. ECG shows no pathological changes, PCG registers the S3 occurring 0,15 seconds after the S2. How can you interpret these changes?

Physiologic S3

Fout-ta-ta-rou (three-component rhythm)

Protodiastolic gallop rhythm

Presystolic gallop rhythm

Physiologic S4

159 із 200

After having the flu, a 39-year-old male patient with a history of Addison’s disease developed a condition manifested by weakness, depression, nausea, vomiting, diarrhea, hypoglycemia. AP75/50 mm Hg. Blood test results: low corticosterone and cortisol, 13-oxycorticosteroids, 17oxycorticosteroids levels. What condition developed in the patient?

Acute adrenal insufficiency

Acute enterocolitis

Acute gastritis

Collapse

Diabetes mellitus

160 із 200

A female patient complains of being unable to get pregnant for 5 years. A complete clinical examination brought the following results: hormonal function is not impaired, urogenital infection hasn’t been found, on hysterosalpingography both tubes were filled with the contrast medium up to the isthmic segment, abdominal contrast was not visualized. The patient’s husband is healthy. What tactics will be most effective?

In-vitro fertilization

Hydrotubation

ICSI within in-vitro fertilization program

Laparoscopic tubal plasty

Insemination with husband’s sperm

161 із 200

A 19-year-old primiparous woman with a body weight of 54,5 kg gave birth at 38 weeks gestation to a full-term live girl after a normal vaginal delivery. The girl’s weight was 2180,0 g, body length - 48 cm. It is known from history that the woman has been a smoker for 8 years, and kept smoking during pregnancy. Pregnancy was complicated by moderate vomiting of pregnancy from 9 to 12 weeks pregnant, edemata of pregnancy from 32 to 38 weeks. What is the most likely cause of low birth weight?

Fetoplacental insufficiency

Low weight of the woman

First trimester preeclampsia

Third trimester preeclampsia

Woman’s age

162 із 200

In a cold weather, the emergency room admitted a patient pulled out of the open water. There was no respiratory contact with the water. The patient is excited, pale, complains of pain, numbness of hands and feet, cold shiver. Respiratory rate is 22/min, AP- 120/90 mm Hg, Ps110 /min, rectal temperature is 34, 5oC. What kind of warming is indicated for this patient?

Passive warming

Hot compresses

Hemodialysis with blood warming

Infusion of 37oC solutions

Warm bath

163 із 200

A week before, a 65-year-old male patient suffered an acute myocardial infarction. His general condition has deteriorated: he complains of dyspnea at rest, pronounced weakness. Objectively: edema of the lower extremities, ascites is present. Heart borders are extended, paradoxical pulse is 2 cm displaced from the apex beat to the left. What is the most likely diagnosis?

Acute cardiac aneurysm

Recurrent myocardial infarction

Acute pericarditis

Pulmonary embolism

Cardiosclerotic aneurysm

164 із 200

A 41-year-old patient cosulted a dermatologist about discoloration, thickening, brittleness of toenails. These symptoms have been present for about five years. Objectively: nail plates in all toes are thickened, of dirty yellow color, lustreless, crumble over the edge. Microscopy of the nail plate material treated with alkali revealed mycelial filaments. Material inoculation onto Sabouraud medium resulted in growth of the Trichophyton rubrum colony. What is the most likely diagnosis?

Rubromycosis of toenails

Candidal onychia

Nail dystrophy

Psoriasis of the nails

Epidermophytosis of nails

165 із 200

Examination of an electric welder with 15 years of service record revealed dry rales in the lower lung fields. Radiograph shows diffuse nodules sized 3-4 mm in the middle and lower lung fields. What disease can be suspected?

Heavy-metal coniosis

Silicosis

Silicatosis

Carbon pneumo coniosis

Bronchitis

166 із 200

A 12-year-old boy periodically has short episodes (10-15 seconds) of a brief loss of awareness with a dazed look and eyes stare in an upright position, blank expression of face, absence of motions and subsequent amnesia. Specify the described state:

Obnubilation

Absence seizure

Trance

Sperrung

Fugue

167 із 200

Evaluation results of sanitary and hygiene conditions in a 4-bed ward were as follows: ward area - 30 m2, height - 3,2 m, temperature - 20oC, humidity - 55%, air velocity - 0,1 m/s, window-to-floor area ratio -1:5, daylight ratio - 0,6%, concentration of carbon dioxide in the air - 0,1%. Which of the given indicators does not meet hygienic requirements?

Daylight ratio

Window-to-floor area ratio

Air velocity

Concentration of carbon dioxide in the air

Ward area

168 із 200

A 25-year-old patient works as a tractor driver. Four days ago, he got pain in the left axillary region, general weakness, fever up to 38oC. He hadn’t sought medical helf until a painful solid lump appeared in this region. Objectively: in the left axilla there is a very painful cone-shaped mass sized 3x2,5 cm, with a destruction in the center of the pointed vertex. The surrounding skin is hyperemic, there are purulent discharges. What is the most likely diagnosis?

Hydradenitis

Furuncle

Carbuncle

Abscess

Lymphadenitis

169 із 200

A 19-year-old male patient complains of intense pain in the left knee joint. Objectively: the left knee joint is enlarged, the overlying skin is hyperemic, the joint is painful on palpation. Blood test results: RBC- 3,8 • 1012/l, Hb-122 g/l, lymphocytes - 7,4 • 109/l, platelets - 183 • 109/l. ESR- 10 mm/h. Duke bleeding time is 4 minutes, Lee-White clotting time - 24 minutes. A-PTT is 89 sec. Rheumatoid factor is negative. What is the most likely diagnosis?

Hemophilia, hemarthrosis

Thrombocytopathy

Hemorrhagic vasculitis, articular form

Werlhof’s disease

Rheumatoid arthritis

170 із 200

A 29-year-old female patient complains of dyspnea and palpitations on exertion. According to her mother, as a child she had heart murmur, did not undergo any examinations. Objectively: the patient has pale skin, Ps- 94/min, rhythmic. AP- 120/60 mm Hg. In the II intercostal space on the left auscultation reveals a continuous rasping systolodiastolic murmur, diastolic shock above the pulmonary artery. Blood and urine are unremarkable. What is the most likely diagnosis?

Patent ductus arteriosus

Ventricular septal defect

Tetralogy of Fallot

Atrial septal defect

Aortarctia

171 із 200

A 6-year-old boy had had a quinsy. 9 days later, there appeared edemata of the face, extremities and trunk, general health condition deteriorated. Urine became turbid. Objectively: expressive edemata, ascites. AP-100/55 mm Hg, diuresis - 0,2 l of urine per day. Results of the biochemical blood analysis: total protein - 50 g/l, cholesterol - 11,28 mmol/l, urea - 7,15 mmol/l, creatinine - 0,08 mmol/l. Urinalysis results: leukocytes - 3-5 per HPF, red blood cells are absent. What is the provisional diagnosis?

Acute glomerulonephritis

Urolithiasis

Acute pyelonephritis

Acute renal failure

Chronic glomerulonephritis

172 із 200

A 13-year-old boy has had abdominal pain, bloating, nausea, liquid fatty gray stool with putrid smell for the last 3 years. Palpation reveals epigastric tenderness, as well as tenderness in the Desjardins’ pancreatic point, Chauffard’s triangle; there is positive Mayo-Robson’s sign. Failure of exocrine pancreatic function has been suspected. What is the most informative method for evaluating the state of exocrine pancreatic function?

Fecal elastase-1 determination

Blood and urine amylase determination

Sonography of the pancreas

Blood serum trypsin determination

Scatological study

173 із 200

Explosion of a tank with benzene at a chemical plant has killed and wounded a large number of people. There are over 50 victims with burns, mechanical injuries and intoxication. Specify the main elements of medical care and evacuation of population in this situation:

Sorting, medical assistance, evacuation

Sorting, recovery, rescue activity

Isolation, rescue activity, recovery

Sorting, evacuation, treatment

Medical assistance, evacuation, isolation

174 із 200

A 36-year-old injured has been taken to the emergency station with open tibi-al fractures. Examination reveals bleeding: pulsating blood spurts out of the wound. What medical manipulations are required at this stage of medical care?

Apply a tourniquet on the thigh proximal to the source of bleeding and transport the patient to the operating room

Apply a tourniquet on the thigh distal to the source of bleeding and transport the patient to the operating room

Transport the patient to the operating room

Immobilize the fracture and transport the patient to the operating room

Stop the bleeding by a compressive bandage and transport the patient to the operating room

175 із 200

The outpatient department of a city hospital works also as a 60-bed day hospital for somatic patients. The department operates in a single-shift mode. What specialist selects patients for admission to the day hospital?

District doctor

Chief physician of the hospital

Deputy chief of the hospital

Resident doctor

Chief of the outpatient department

176 із 200

A 67-year-old female patient with hypertensive crisis has asthma, cough with expectoration of frothy pink sputum, moist rales in the lungs. The patient stays in sitting position, respiratory rate is 40/min, AP-214/136 mm Hg, heart rate - 102/min. What is the most rational tactics of this patient management?

Intravenous administration of furosemide

Urgent pneumography

Bed rest, lying position

Intravenous administration of a ^-blocker

Tactics can be determined after ECG and chest radiography

177 із 200

A 23-year-old primigravida at 39 weeks gestation has been admitted to the maternity ward with irregular contractions. The intensity of uterine contractions is not changing, the intervals between them stay long. Bimanual examination reveals that the cervix is centered, soft, up to 1,5 cm long. There is no cervical dilatation. What diagnosis should be made?

Pregnancy I, 39 weeks, preliminary period

Pregnancy I, 39 weeks, birth 1,1 period, the acceleration phase

Pregnancy I, 39 weeks, pathological preliminary period

Pregnancy I, 39 weeks, labor I, period 1, the active phase

Pregnancy I, 39 weeks, labor 1,1 period, the latent phase

178 із 200

A 49-year-old male patient complains of retrosternal pain, heartburn, weight loss of 8 kg over the last year, constipation, weakness. The patient has been a smoker for 20 years, and has a 10- year history of gastroesophageal reflux disease. The patient is asthenic, has dry skin. EGD revealed an ulcer in the lower third of the esophagus and esophageal stricture accompanied by edema, hyperemia and multiple erosions of the mucosa. What study is required for more accurate diagnosis?

Biopsy of the esophageal mucosa

X-ray examination of the esophagus

Respiratory test for Helicobacter pylori

Fecal occult blood test

pH-metry of the esophagus and the stomach

179 із 200

A 63-year-old male patient with persistent atrial fibrillation complains of moderate dyspnea. Objectively: peripheral edemata are absent, vesicular breathing is present, heart rate - 72/min, AP-140/90 mm Hg. What combination of drugs will be most effective for the secondary prevention of heart failure?

Beta-blockers, ACE inhibitors

Cardiac glycosides, ACE inhibitors

Cardiac glycosides, diuretics

Beta-blockers, cardiac glycosides

Diuretics, beta-blockers

180 із 200

A 57-year-old male patient had an attack of retrosternal pain that lasted more than 1,5 hours. Objectively: the patient is inert, adynamic, has pale skin, cold extremities, poor volume pulse, heart rate - 120/min, AP- 70/40 mm Hg. ECG shows ST elevation in II, III, aVF leads. What condition are these changes typical for?

Cardiogenic shock

Acute pancreatitis

Perforated gastric ulcer

Arrhythmogenic shock

Acute pericarditis

181 із 200

During an exam, a 22-year-old female student fainted. She grew up in a family with many children, has a history of frequent acute respiratory infections. Objectively: the patient has pale skin and mucous membranes, split-end hair, brittle nails. Blood test results: RBC-2, 7 • 1012 /l, Hb- 75 g/l, color index - 0,7, WBC-3,2 • 109/l, platelets - 210 • 109/l, ESR- 30 mm/h. Blood serum iron is 6 mmol/l. What is the most likely diagnosis?

Iron-deficiency anemia

Aplastic anemia

Vegetative-vascular dystonia

Acute leukemia

B12-deficiency anemia

182 із 200

During the ultrasound study of carotid and vertebral arteries a 74-year-old patient developed a condition manifested by dizziness, weakness, nausea, transient loss of consciousness. Objectively: pale skin, AP-80/60 mm Hg, Ps- 96/min of poor volume. ECG shows sinus tachycardia, left ventricular hypertrophy. Focal neurological symptoms were not found. What is the provisional diagnosis?

Carotid sinus syncope

Orthostatic syncope

Complete atrioventricular block

Acute cerebrovascular accident

Morgagni-Adams-Stokes attack

183 із 200

On the 10th day postpartum a puerperant woman complains of pain and heaviness in the left breast. Body temperature is 38,8°C, Ps- 94 bpm. The left breast is edematic, the superoexternal quadrant of skin is hyperemic. Fluctuation symptom is absent. The nipples discharge drops of milk when pressed. What is a doctor’s further tactics?

Antibiotic therapy, immobilization and expression of breast milk

Opening of the abscess and drainage of the breast

Inhibition of lactation

Compress to both breasts

Physiotherapy

184 із 200

During the breast self-exam a 37-year-old female patient revealed a lump in the lower inner quadrant of her left breast. Palpation confirms presence of a mobile well-defined neoplasm up to 2 cm large. Peripheral lymph nodes are not changed. What is the way of further management?

Ultrasound examination of breasts, mammography, fine-needle aspiration biopsy

Ultrasound monitoring of genitals during the entire course of antiestrogens therapy, systemic enzyme therapy, phytotherapy

Anti-inflammatory therapy, physiotherapy

Radical mastectomy

Case follow-up

185 із 200

An 8-year-old child was hospitalized for fever up to 39,8°C, inertness, moderate headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was performed. The obtained fluid had raised opening pressure, it was transparent, with the cell count of 450 cells per 1 mcL (mainly lymphocytes - 90%), glucose level of 2,6 mmol/l. What causative agent might have caused the disease in the child?

Enterovirus

Pneumococcus

Staphylococcus

Meningococcus

Koch’s bacillus

186 із 200

A 25-year-old female has a self-detected tumor in the upper outer quadrant of her right breast. On palpation there is a painless, firm, mobile lump up to 2 cm in diameter, peripheral lymph nodes are not changed. In the upper outer quadrant of the right breast ultrasound revealed a massive neoplasm with increased echogenicity sized 21x18 mm. What is the most likely diagnosis?

Fibroadenoma

Diffuse mastopathy

Mammary cancer

Lactocele

Mastitis

187 із 200

A 49-year-old female patient complains of itching, burning in the external genitals, frequent urination. The symptoms have been present for the last 7 months. The patient has irregular menstruation, once every 3-4 months. Over the last two years she has had hot flashes, sweating, sleep disturbance. Examination revealed no pathological changes of the internal reproductive organs. Complete blood count and urinalysis showed no pathological changes. Vaginal smear contained 20-25 leukocytes per HPF, mixed flora. What is the most likely diagnosis?

Menopausal syndrome

Trichomonas colpitis

Bacterial vaginosis

Cystitis

Vulvitis

188 із 200

A 45-year-old male patient complains of acute pain in his right side irradiating to the right thigh and crotch. The patient claims also to have frequent urination with urine which resembles a meat slops. The patient has no previous history of this condition. There is costovertebral angle tenderness on the right (positive Pasternatsky’s symptom). What is the most likely diagnosis?

Urolithiasis

Acute cholecystitis. Renal colic

Acute pancreatitis

Acute pyelonephritis

Acute appendicitis

189 із 200

After a holiday in the Crimea, a 49-year-old male patient with a history of lung tuberculosis felt increased weakness, periodic dizziness, easing bowel movements with abdominal pain, the need for additional salting his meals. The patient has noted that his condition improves after some sweet tea and validol taken sublingually. Objectively: there is an intense darkening of skin, AP- 70/50 mm Hg, glycemia is 3,0 mmol/l. What is the possible cause of health deterioration:

Chronic adrenal insufficiency

Coronary artery disease

Diabetes mellitus

Chronic pancreatitis

Pulmonary tuberculosis

190 із 200

A 42-year-old male patient has been delivered to a hospital in a grave condition with dyspnea, cough with expectoration of purulent sputum, fever up to 39, 5oC. The first symptoms appeared 3 weeks ago. Two weeks ago, a local therapist diagnosed him with acute right-sided pneumonia. Over the last 3 days, the patient’s condition deteriorated: there was a progress of dyspnea, weakness, lack of appetite. Chest radiography confirms a rounded shadow in the lower lobe of the right lung with a horizontal fluid level, the right sinus is not clearly visualized. What is the most likely diagnosis?

Abscess of the right lung

Atelectasis of the right lung

Pleural effusion

Acute pleuropneumonia

Right pulmonary empyema

191 із 200

An 11-year-old boy complains of general weakness, fever up to 38,2oC, pain and swelling of the knee joints, feeling of irregular heartbeat. 3 weeks ago, the child had quinsy. Knee joints are swollen, the overlying skin and skin of the knee region is reddened, local temperature is increased, movements are limited. Heart sounds are muffled, extrasystole is present, auscultation reveals apical systolic murmur that is not conducted to the left inguinal region. ESR is 38 mm/h. CRP is 2+, antistreptolysin O titre - 400. What is the most likely diagnosis?

Acute rheumatic fever

Juvenile rheumatoid arthritis

Non-rheumatic carditis

Vegetative dysfunction

Reactive arthritis

192 із 200

A 28-year-old male patient complains of sour regurgitation, cough and heartburn that occurs every day after having meals, when bending forward or lying down. These problems have been observed for 4 years. Objective status and laboratory values are normal. FEGDS revealed endoesophagitis. What is the leading factor in the development of this disease?

Failure of the lower esophageal sphincter

Hypergastrinemia

Hypersecretion of hydrochloric acid

Duodeno-gastric reflux

Helicobacter pylori infection

193 із 200

On admission a 35-year-old female reports acute abdominal pain, fever up to 38,8oC, mucopurulent discharges. The patient is nulliparous, has a history of 2 artificial abortions. The patient is unmarried, has sexual contacts. Gynecological examination reveals no uterus changes. Appendages are enlarged, bilaterally painful. There is profuse purulent vaginal discharge. What study is required to confirm the diagnosis?

Bacteriologic and bacteriascopic studies

Curettage of uterine cavity

Laparoscopy

Hysteroscopy

Vaginoscopy

194 із 200

A 20-year-old female consulted a gynecologist about not having menstrual period for 7 months. History abstracts: early childhood infections and frequent tonsillitis, menarche since 13 years, regular monthly menstrual cycle of 28 days, painless menstruation lasts 5-6 days. 7 months ago the patient had an emotional stress. Gynecological examination revealed no alterations in the uterus. What is the most likely diagnosis?

Secondary amenorrhea

Spanomenorrhea

Primary amenorrhea

Cryptomenorrhea

Algomenorrhea

195 із 200

A 48-year-old female has been admitted to the gynecology department for pain in the lower right abdomen and low back pain, constipations. Bimanual examination findings: the uterus is immobile, the size of a 10-week pregnancy, has uneven surface. Aspirate from the uterine cavity contains atypical cells. What diagnosis can be made?

Hysterocarcinoma

Cervical cancer

Chorionepithelioma

Colon cancer

Metrofibroma

196 із 200

A 27-year-old male patient consulted a doctor about pain in the lower third of the thigh with weight bearing activities and unloaded. Two years ago, the patient underwent treatment in the casualty depatment for the open fracture of the lower third of femur. The fracture healed slowly, the healing process was accompanied by prulent inflammation. Objectively: edema of the lower third of the thigh, elevated local temperature. Radiograph shows signs of destruction and sequestration. What is the most likely diagnosis?

Chronic post-traumatic osteomyelitis

Osteosarcoma

Hematogenous osteomyelitis

Multiple myeloma

Tuberculosis of femur

197 із 200

A 30-year-old male patient had been admitted to the TB hospital because of the following changes detected by fluorography: an ill-defined shadow of low intensity up to 1 cm in diameter in the S1 of the right lung. CT scan showed a destruction area in the center of the shadow. Sputum analysis revealed MTB. The patient was diagnosed with focal tuberculosis. What phases of tuberculosis are the identified changes typical for?

Infiltration and disintegration

Disintegration and dissemination

Resorption and scarring

Infiltration and dissemination

Calcification and resorption

198 із 200

A 43-year-old female complains of significant weakness, sore throat, occurrence of multiple unexplained bruises on her skin. These symptoms have been present for a week, the disease is associated with quinsy which she had some time before. Objectively: body temperature 38,9oC, respiratory rate -24/min, Ps- 110/min, AP- 100/65 mm Hg. The patient has pale skin, petechial rash on the extremities, enlarged lymph nodes. Blood test results: Hb- 80 g/l, RBC2,2 • 1012/l; WBC-3, 5 • 109/l; blasts - 52%; eosinophils - 2%; stab neutrophils - 3%; segmented neutrophils - 19%; lymphocytes - 13%; monocytes - 1%; platelets - 35 • 109/l. ESR 47 mm/h. What test is required to specify the diagnosis?

Immunophenotyping

Cytogenetic study

Lymph node biopsy

Protein electrophoresis

Determination of anti-platelet antibody titer

199 із 200

A 47-year-old male patient complains of compressive chest pain that occurs both at rest and during light physical activity; irregular heartbeat. These problems arose 3 months ago. The patient’s brother died suddenly at the age of 30. Objectively: Ps- 84/min, arrhythmic, AP130/80 mm Hg. ECG confirms signs of left ventricular hypertrophy, abnormal Q-waves in V4 — V6 leads. EchoCG reveals that interventricular septum is 1,7 cm, left ventricular wall thickness is 1,2 cm. What is the most likely diagnosis?

Hypertrophic cardiomyopathy

Neurocirculatory asthenia

Exertional angina

Pericarditis

Myocarditis

200 із 200

Within the structure of the region’s population the share of persons aged 0 to 14 years is 25%, the share of persons aged 50 years and older is 30%. What concept most accurately describes this demographic situation?

Regressive type of population age structure

Cohort reproduction

Immigration of population

Progressive type of population age structure

Stationary type of population age structure