Step 2 - Medicine 2006

A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localised in frontal region of head, accompanied by nausea and stomach discomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. Inbetween the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index - 29), AP- 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?

Benign intracranial hypertension

Epilepsy

Chronic subdural hematoma

Migraine

Hypertensive encephalopathy

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A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a crosscountry race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37,50C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb- 123 g/L, leukocytes - 5,6 * 103 * * * * * 9/L, thrombocytes -354 * 109/L, prothrombin time -12 seconds (normally 10-15 seconds), partly activated thromboplastin time - 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?

Schoenlein-Henoch disease

Hemophilia A

Vitamin K deficiency

Thrombocytopenia

Hemophilia B

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On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bendi- ng forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation wi- th frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the ri- ght chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?

Tietze’s syndrome

Pulmonary embolism

Dressler’s syndrome

Acute pericarditis

Dissecting aortic aneurysm

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A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in occipital region and vomiting. In the medical hystory: moderate arterial hypertension, the patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about intense headache that was suppressed by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is absent. AP-230/130 mm Hg, Ps- 50 bpm, BR- 12/min. What is your preliminary diagnosis?

Acute subdural hematoma

Disseminated sclerosis

Migraine

Myasthenia

Acute bacterial meningitis

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A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?

Cancer of esophagus

Diaphragmatic hernia

Myasthenia

Esophageal achalasia

Diffuse constriction of esophagus

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A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?

Cancer of esophagus

Esophagus achalasia

Gastroesophageal reflux

Esophagus candidosis

Myastenia

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A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, consciousness is confused. AP- 80/40 mm Hg. The palpitation of the fetus is not determined. In medical hystory there was a Cesarean section a year ago. Make a diagnosis:

Placental presentation

Hysterorrhesis

Premature expultion of the amniotic waters

Presentation of the cord

Abjointing of the mucous fuse from cervix of the uterus

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A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

Irritable bowels syndrome

Pseudomembranous colitis

Dispancreatism

Celiac disease

Crohn’s disease

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A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?

Varicosity of subcutaneous veins 10

Inguinal lymphadenopathy

Inguinal hernia

Ectopic testicle

Varicocele

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A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?

Torsion of the crus of the ovary tumour

Acute right-side adnexitis

Acute appendicitis

Apoplexy of the ovary

Broken tubal pregnancy

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Name a statistical observation unit for determination of blood sugar impact on the healing of wound’s surface in a postoperative period:

The patient who has a wound surface

An amount of blood sugar

The patient who was discharged on an after-care

Blood analysis

The patient in a postoperative period

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Choose a method of graphic representation of monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values, obtained for 5 last years:

The radial diagram

The figured diagram

The sector diagram

Curvilinear diagram

The linear diagram

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A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?

Subcutaneous panaritium

Paronychia

Bone panaritium

Articular (joint) panaritium

Thecal whitlow (ligament panaritium)

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An employee has been invalid for 6 months as a result of a hip fracture. Who has the right to authorize the issue of the medical sick-list for the last 2 months?

Head physician of the polyclinic

Deputy head physician on working capacity

DCC together with the head physician of a polyclinic

DCC

MSEC

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An employee had an abortion by medical indications on the 6.03.2001 and she stayed in a hospital till 1703.2001. What term is the medical sick-list issued for?

For 10 days

For 11 days

For 3 days

For 12 days

For 4 days

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A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density -1,04 g/cm3, acidity - 21°T, reductase probe - weak-positive. What way is the product to be used in?

Sell but inform customers about milk quality

Do the product away

Technical utilization

Sell without limitations

Discard for animal feeding

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Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature - 20° C, relative humidity -45%, air movement velocity - 0,3 m/s, light coefficient - 1/5, noise level - 30 dB. Do hygienic evaluation of the conditions meet the standards?

Non-effective ventilation

Discomfortable microclimate

High level of noise

Poor lighting

All conditions meet the requirements

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A 33 y.o. patient, works as a secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathology can result from this diet?

Schizophrenia

Uterine fibromyoma

Common cold

Obesity

Paradontosis

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A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjucti-va. The patient’s skin is dry, scales off, folliculitis signs of the face skin are present. What is the cause of this disease?

Biotin deficit

Folic acid deficit

Retinole deficit

Thiamine deficit

Napthtochynones deficit

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What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?

Draw up a statement about forensic medical examination

Conduct forensic medical examination by district forensic medicine expert

Utilisation copy of medical documents

Sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts

Conduct an inquiry by preliminary investigator of police department

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A 23 y.o. patient has a gunshot wound of his left arm.The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?

Aseptic dressing of the wound

Wound saturing

Primary surgical processing with a flowing suction

Wound saturing and drying

Wound drying with towel gauzes

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A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog’s bite. What surgical care would you provide to the patient?

Incomplete suturing of the wound

Cream bandage

Aseptic bandage

Complete suturing of the wound

Wound bathing with detergent water and antiseptic application

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A 37 y.o. patient complains of pain in the right arm which increases during motion, raised body temperature up to 39°C. In the right cubital fossa there is a trace of injection, hyperemia and thickening along the vein. Your diagnosis?

Phlebit

Inflammation of lymph

Abscess

Phlegmon

Erysipelas

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A 35 y.o. woman was admitted to thoracic surgery department with fever up to 40° C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

Bronchiectatic disease

Abscess of the lung

Pulmonary tuberculosis

Complication of liver echinococcosis

Actinomycosis of lungs

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A laboratory obtained a milk sample sent for analysis. Analysis gave the following data: color whitish, smell - has no pecularities, taste - typical for milk, density - 1,038, acidity - Turner’s 35 °, fat - 3,2%. What is the quality level of this milk?

The milk is of high quality

The milk is nominally qualified

The milk is falsificated

The milk is of poor quality

The milk is of reduced quality

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For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

Skin

Breast

Reproduction system organs

Lungs

Thyroid gland

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A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

Operation on thyroid gland

Krail’s operation

Operation on account of feochromocytoma

Subtotal resection of thyroid gland and fascicular resection of limphatic nodes

Vanach’s operation

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A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus, it was also wetting and itching. What test should not be used for diagnostics in this case?

Incision biopsy

Termography

Radioisotope diagnostics

Yaks’s reaction

Glass-print

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A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?

Introduction of permanent urethral catheter

Microwave thermotherapy of prostate

Trocar or open epicystostomy

Transuretral resection or prostatectomy

Placing of intraprostatic stent

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A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38,5°) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?

Acute rheumatic fever

Systemic lupus erythematosis

Reiter’s disease

Reactive arthritis

Juvenile rheumatoid arthritis

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A baby boy was born in time, it was his mother’s 1st pregnancy. The jaundice was revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level - 5 mcmol/L, Hb-150 g/L. Mother’s blood group - 0(I),Rh+, child’s blood group - A(II),Rh+. Make a diagnosis.

Hemolytic disease of newborn (Rh -incompatibility)

Hepatitis

Hemolytic disease of newborn (ABO incompatibility), icteric type

Jaundice due to conjugation disorder

Physiological jaundice

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Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?

Vegetatic crisis

Major epileptic seizure

Absence

Episode of hysteria

Fainting

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A 2 y.o. girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?

Pseudotuberculosis

Rubella

Measles

Adenoviral infection

Scarlet fever

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A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?

Encephalitis

Myelitis

Meningoencephalitis

Neurotoxic syndrome

Meningitis

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A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3,2 kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?

10

6

12

20

8

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A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog. In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial astma attacks?

Pollen

Dust

Chemical

Epidermal

Itch mite

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A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t0- 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.

Aortic stenosis

Recurrence of rheumatic fever

Thrombocytopenia purpura

Mitral stenosis

Subacute bacteria endocarditis

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A 62 y.o. patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be used?

Prescribe long-acting insulin

Give Glurenorm in place of Maninilum

Continue with the current therapy

Prescribe fast-acting insulin

Prescribe guanyl guanidines

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A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria - 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:

DM 1st type, severe form, decompensation, allergic reaction to insulin

DM 2nd type, severe form, decompensation

DM 1st type, severe form, decompensation, insulin resistant

DM st type, severe form, subcompensation, Somoji phenomenon

DM 2nd type, moderate form, Zabrodi phenomenon

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A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus’ si- gn). What examination should be carried out first of all?

Wasserman test, IFT

T.pallidum Immobilization Test (TPI)

Consultation of neuropathist

Detection of the nasal mucous membrane for Micobacterium Leprae Hansen

CBC

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A triad of symptoms (“stearing spot' “terminal film' “blood dew”) have been revealed on examination of a patient. What disease should you think about?

Ritter’s disease

Psoriasis

Vasculitis

Lichen ruber planus

Seborrhea

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A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophi-le type. What pathology must be excluded first of all?

Atrophic gastritis

Hypoplastic anemia

Helminthic invasion

Lymphoprolipherative process

Duodenal ulcer

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A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?

Monitoring of the specific IgG IgM with the ELISA

Immunoglobulin injection

Cyclovin prescription

Fetus wastage

Interferon prescription

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A 32 y.o. woman has got the Laiel’s syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

Steroid immunosupressants

Non-steroid immunosupressants

Interferons

Specific immune modulators

Non-specific immune modulators

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A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38,50C, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?

Malignant tumors of large intestine

Nonspecific ulcerative colitis

Acute dysentery

Colibacillosis

Amebiasis

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The disease of a 21 y.o. patient began with raise of temperature up to 39, 00C, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor revealed: cytosis -1237 in 1 ml, including: 84% of neutrophils, 16% of lymphocytes. On bacterioscopy: gram-negative cocci are found in liquor. What is the most probable disease?

Meningococcal infection: serous meningitis

Secondary purulent meningitis

Infectious mononucleosis

Serous meningitis

Meningococcal infection: purulent meningitis

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The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is professional tactics of the doctor in this situation?

The urgent hospitalization in therapeutic department

The urgent hospitalization in surgical department

Treatment at home

To inject intravenously the ami-nocapronic acid

Treatment at a day time hospital

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A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?

-

Mitral comissurotomia

Prescription of anticoagulants

Prescription of venous vasodilatators

Conduction of current bicilino-prophilaxis

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A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?

35-50 %

25-30%

6-9 %

15-20 %

10-14 %

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A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP-95/60 mm Hg, Ps- 120/min, diuresis - 20 ml/h, HgB- 100 g/L, RBC- 2,1 * 1012/L. The patient needs introduction of :

Crystalloid and red blood cells

Crystalloid and 5% dextrose

Crystalloid and colloid

5 % dextrose and red blood cells

5 % dextrose and colloid

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A 58 y.o. man complained of severe inspiratory dyspnea and expectoration of frothy and bloodtinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, 'bubbli-ng'breathing, Ps- 30/min, BP- 230/130 mm Hg, bilateral rales. Choose medicines for treatment.

Theophylline, prednisolon

Albuterol, atropine, papaverine

Morphine, furosemide, nitroprusside sodium

Cordiamine, isoproterenol

Strophanthine, potassium chloride, plathyphylline

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A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP- 80/50 mm Hg, Ps- 120/min, irregular and weak pulse. What condition are these symptoms typical for?

Cardiogenic shock

Radicular syndrome

Acute right-side heart failure

Acute vascular insufficiency

Acute left-side heart failure

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A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn’t be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?

Angina pectoris of a new onset

Myocarditis

Stable angina pectoris of the III functional class

Unstable angina pectoris

Radiculitis

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A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with 'butterfly'look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR-88/min, BP- 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

Production of antibodies to doublestranded DNA

Production of antibodies to endothelial cells

Production of myocytes antibodies

Production of antimitochondrial antibodies

Production of myosin antibodies

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A 56 y.o. woman has an acute onset of fever up to 390C with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR-90/min, BP- 95/60 mm Hg, Ps- 26/min. There is dullness over the right lung. On X-ray: infiltrate in the right middle lobe of the lung en palpation. What is the diagnosis?

Acute lung abscess

Acute pleurisy

Hospital-acquired lobar pneumonia

Community-acquired lobar pneumonia with moderate severity

Community-acquired bronchopneumonia

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A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, discomfort during urination and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab examination: WBC-20 * 109/L; on urine analysis: protein -0,6g/L, leukocyturia, bacteriuria. Your preliminary diagnosis.

Acute cystitis

Exacerbation of chronic pyelonephritis

Acute pyelonephritis

Acute glomerulonephritis

Nephrolithiasis

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A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?

Chronic hepatitis

Chronic pancreatitis

Chronic cholangitis

Gallbladder stones

Cancer of the pancreas head

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A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.

Menetrier’s disease

Peptic ulcer of stomach

Chronic gastritis of type B

Chronic gastritis of type A

Chronic gastritis of type C

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A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC- 3,5 * 1012/L, C.I.- 0,7; ESR- 20 mm/h. Serum iron level was 8,7 mcmol/L. What treatment would you initiate?

Blood transfusion

Iron dextrin injections

Ferrous sulfate orally

Vitamin B12 intramuscularly

Packed RBCs transfusion

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A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?

Ischemic heart disease

Cardiomyopathy

Symptomatic hypertension

Essential hypertension, 1st stage

Essential hypertension, 2nd stage

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A 30 y.o. man complains of intense pain, skin reddening in the region of ankle joint, temperature rise up to 390C. He fell ill suddenly. In the past there were such onsets that lasted for 5-6 days and didn’t cause any residual changes of the joint. The skin over the joint is hyperemic, without distinct outlines and infiltrative bank at the periphery. What is the most probable diagnosis?

Gout

Infectional arthritis

Erysipelatous inflammation

Osteoarthrosis

Rheumatoid arthritis

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A 6 y.o. asthmatic child was taken to the emergency hospital because of severe coughing and wheezing for the last 24 hours. Physical examination reveals that the child is excitable, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, RR-60/min. Initial treatment may include the prescription of:

Subcutaneous epinephrine

Intravenous fluids in the first 2 h to compensate water deficiency

N-acetyl cysteine and cromolyn by inhalation

Parenteral gentamicyn

Parenteral phenobarbital

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A surgical department admitted a newborn boy with foamy discharges from nose and mouth, cyanosis attacks. X-ray examination: blind end of esophagus is at the level of the II thoracic vertebra, gastric air bubble is under the left cupula of diaphragm. What is the most probable diagnosis?

Esophagus atresia without a fistula

Esophagus atresia, tracheo-esophageal fistula

Paraesophageal hernia

Bronchoesophageal fistula

Total esophagus atresia

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A 30 y.o. man complains of sharp pain in the right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 m, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

Acute purulent otitis media

Chronic secretory otitis media

Chronic purulent otitis media

Acute mastoiditis

Eustachian tube disfunction

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A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months after acquiring aquarium fish rhinitis, conjunctivitis, itching in the nose developed. Level of what immunologic index should be defined in this case?

IgM

IgE

IgA

IgJ

Circulating immunocomplexes

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A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of bloody discharges. In her medical history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USD showed a placental presentation. The uterus is in normotonus, the fetus position is transversal (Ist position). The heartbeats is clear, rhythmical, 140 bpm. What is the further tactics of the pregnant woman care?

Stimulate the delivery by intravenous introduction of oxytocin

To perform the hemotransfusion and to prolong the pregnancy

To perform a delivery by means of Cesareansection

To keep the intensity of hemorrhage under observation and after the bleeding is controlled to prolong the pregnancy

To introduct the drugs to increase the blood coagulation and continue observation

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Studying of pulmonary tuberculosis incidence provided data about patients’ socioeconomic living conditions and bad habits. What method allows to estimate the impact of these factors on tuberculosis incidence?

Calculation of reliability coefficient

Standardized index calculation

Calculation of regression coefficient

Calculation of correspondence index

Calculation of correlation coefficient

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A 15 y.o. girl was examined. Her medi- cal history registers gradual onset of fever, malaise, loss of weight. There was nothing typical about the kind of fever which has been present for more than 7-10 days and changed quickly. Physical examination didn’t give evident results. What is the only most important examination for excluding miliary tuberculosis?

Liver or bone marrow biopsy

Tuberculin skin testing

Chest X-ray

Bronchoscopy

Sputum smear and culture of m. tuberculosis

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A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white coating. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin is erythematous and glistering over the lymphatic nodes. What is the most probable diagnosis?

Tularemia

Anthrax

Lymphogranulomatosis

Acute purulent lymphadenitis

Bubonic plague

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A 17 y.o. patient complains of acute pain in the knee joint and t0- 38°C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

Rheumatism, polyarthritis

Systemic lupus erythematodes

Infectious-allergic polyarthritis

Reactive polyarthritis 6- Rheumatoid arthritis

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A girl is 12 y.o. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8°C. Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in f/vis, RBC-1-2 in f/vis. What diagnosis is the most probable?

Urolithiasis

Acute glomerulonephritis

Acute pyelonephritis

Acute cystitis

Dysmetabolic nephropathy

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A 56 y.o. patient has worked at the aluminium plant over 20 years. Within 3 last years he has got loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

Manganese intoxication

Mercury intoxication

Lead intoxication

Fluorine intoxication

Phosphorus intoxication

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A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37,50C. The patient has been ill for a week and associates her illness with common cold. There are a pain and tenderness on palpation of her left cheek. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudate is seen in the middle meatus in maxillary. What is the most probable diagnosis?

Acute purulent ethmoiditis

Acute purulent maxillary sinusitis

-

Acute purulent frontitis

Acute purulent sphenoiditis

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Condition of a parturient woman has been good for 2 hours after live birth: uterus is thick, globe-shaped, its bottom is at the level of umbilicus, bleeding is absent. The clamp put on the umbilical cord remains at the same level, when the woman takes a deep breath or she is being pressed over the symphysis with the verge of hand, the umbilical cord drows into the vagina. Bloody discharges from the sexual tracts are absent. What is the doctor’s further tactics?

To introduct oxitocine intravenously

To apply Crede’s method

To apply Abduladze method

To do curettage of uterine cavity

To do manual removal of afterbirth

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A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle weakness, weight loss, diarrhea, frequent urination. Objectively: hyperpigmentation of skin, gums, internal surface of cheeks. AP- 90/58 mm Hg. Blood count: RBC- 3,1 * 1012/L, Hb95 g/L, C.I.- 0,92; leukocytes - 9,4 * 109/L, eosinophils - 7, segmentonuclear leukocytes - 45, stab neutrophils - 1, lymphocytes - 40, monocytes - 7, Na+-115 mmol/L, K+- 7,3 mmol/L. What is the preliminary diagnosis?

Primary hyperaldosteronism

Primary adrenocortical insufficiency

Congenital adrenocortical hyperplasia

Pheochromocytoma

Diabetes insipidus

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A 52 y.o. hard smoker complains of persistent cough with purulent sputum discharge especially in the mornings, dyspnea provoked even by slight physical exercises, wheezing chest, tachypnoe, general weakness. He considers himself to be ill for 12 years. The foresaid presentations appear 3-4 times per year usually after a common cold and have tendency to progress. What disease do you think about first of all?

Mucoviscidosis (cystic fibrosis)

Bronchial asthma

Chronic obstructive lung disease

Aspergillosis

Bronchoectatic disease

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3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

Pyelonephritis

Renal amyloidosis

Cystitis

Intestinal nephritis

Glomerulonephritis

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47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin -160 mkmol/L, direct -110 mkmol/L, AST- 2.1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol9.2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

Primary liver cancer

Chronic viral hepatitis B

Acute viral hepatitis B

Alcoholic liver cirrhosis

Primary biliary liver cirrhosis

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In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingooophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. What diagnostic method will you start from the workup in this case of sterility?

Diagnostic scraping out of the uterine cavity

Ultra sound investigation

Hormone investigation

Hysteroscopia

Hysterosalpingography

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A patient has undergone an operation on account of perforated ulcer of stomach, terminal phase of diffuse peritonitis and endotoxic shock. In the postoperative period he is prescribed artificial pulmonary ventilation with 60% oxygen inhalation. Blood gases: Pa02- 7078 mm Hg, hypoxemy doesn’t ecrease, CVP (central venous pressure) - 150180 mm of water column, AP90 /60 mm Hg (against the backgound of taking big doses of dopamine). Radiogram shows diffuse pulmonary infiltration. What cause the refractory arterial hypoxemia?

Respiratory distress syndrome

Pulmonary edema

Pneumothorax

Mendelson’s syndrome

Bilateral pneumonia

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According to results of medical and pedagogical observation during the gymnastics lesson in the 9th grade there was plotted a phisiological curve characterized by gradual increasing of pulse rate during the opening part of lesson, 80% increase during the main part; the curve has 4 waves. How can the lesson’s structure be assessed?

Exercise stress is excesive

Long interval between exercises

The lesson’s structure is correct

Exercise stress is adequate

Exercise stress is insufficient

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A patient is 16 y.o. In the last year his behaviour has gradually changed: he secluded himself, was not interested in communication with friends, in learning. He became indifferent towards relatives, motivelessly rude, was speaking or laughing to himself. He answers the questions formally correctly, laconically. Considers himself to be absolutely healthy but a little tired, says, he’s thinking about writing a book 'Projection of humanity on the plane of Universe'. He always has a copybook with which is full of a great many of the same daggers. What is the most

Depressive disorder

Schizoid personality disorder

Autistic personality disorder

Schizophrenia

Pick’s disease

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A worker was temporarily off work because of illness for l6 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list of this patient?

Deputy head physician on the working ability expertise

The doctor in charge of the case together with the head of department

Working ability expertise committee

The head of department

The doctor in charge of the case with the permission of the head of department

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The results of a separate diagnostic curettage of the mucous of the uterus’ cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium - the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?

Surgical treatment and hormonotherapy

Surgical treatment and radial therapy

-

Surgical treatment + chemotherapy

Radial therapy

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A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary - a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?

Anti-inflammatory therapy

Dispensary observation of the patient

Prescription of an estrogen-gestogen complex for 3 months with repeated examination

Operative treatment

Chemotherapeutic treatment

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A 40 y.o. patient complains of yellowi- sh discharges from the vagina. Bimanual examination: no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum test. Your tactics:

Specific treatment of Trichomonas colpitis

Treatment of specific colpitis and with the subsequent biopsy

Cryolysis of cervix of the uterus

Cervix ectomy

Diathermocoagulation of the cervix of the uterus

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A full-term new-born suffered from ante- and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial hemorrhage in this case?

Periventricular hemorrhages

Small hemorrhages in brain tissue

Subdural hemorrhages

Subarachnoid hemorrhages

Hemorrhages in ventricles of brain

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A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?

Discoordinated labor activity

Pathological preliminary period

Normal labor activity

Primary uterine inertia

Secondary uterine inertia

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A patient at a doctor complains of temperature rise up to 38, 20C, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a coneshaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?

In-patient treatment with common regimen

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First out-patient treatment, then outpatient treatment

In-patient treatment with bed rest

Out-patient treatment

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A 15 y.o. boy was twice attacked by bees, as a result he had severe anaphylactic shock. What is the most effective prophylaxis method?

Desensibilisation by means of bee venom extract

Prescription of corticosteroids for summer

Long-term prophylactic treatment with antihistamines

Limitation of outside staying during summer months

Protective clothing

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A healthy 75 y.o. woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 mmol/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

Decrease of carbohydrates consumption

Decrease of saturated fats consumption

Increase of cellulose consumption

Any dietary changes are necessary

Decrease of cholesterol consumption

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In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of patients should be observed. Which of these rights are the most significant?

The right to be heard

The right to the information

The right to the protection from incompetence

The right to the protection of the patient’s interests

The right to the free choice

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A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around eyes and over knee joints. HR- 120/min, heart sounds are weak. Blood count: leukocytes - 12 * 109/L, ESR- 40 mm/h. What is the

Rheumathoid arthritis

Atopic dermatitis

Systemic lupus erythematosus

Dermatomyositis

Reactive polyarthritis

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A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitaryepidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field

River water

Spring water

Artesian well water

Rain water

Water from melted snow

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A district doctor was commisioned with a task to work out a plan of treatment-and-prophylaxis actions for the population of his district. What actions of secendary prophylaxis must he include into this plan?

Rehabilitation actions

Improvement of population’s living conditions

Disease prevention

Prevention of disease complications

Elimination of disease causes

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A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37, 2°C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

Right-side chronic mastitis

Premenstrual syndrome

Right-side acute mastitis

Tuberculosis of the right mammary gland

Cancer of the right mammary gland

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A 20 y.o. patient was admitted to the hospital with complaints of having skin and sclera icteritiousness, dark urine, single vomiting, appetite loss, body temperature rise up to 380C for 2 days. Three weeks ago he went in for fishing and shared his dishes with friends. Objectively: the patient is flabby, t0- 36,80C, skin and scleras are icteritious, liver sticks from under the costal margin by 3 cm, it is sensi- tive; spleen isn’t palpable. Urine is dark, stool is partly acholic. What is the most probable diagnosis?

Infectious mononucleosis

Intestinal yersiniosis

Hemolytic anemia

Leptospirosis

Virus A hepatitis

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A full-term newborn child has a diagnosis Rh-factor hemolytic disease of newborn. Bilirubin rate is critical. The child’s blood group is B(III), his mother’s blood group - A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

Blood group B(III), Rh (-)

Blood group A(II), Rh (-)

Blood group O(I), Rh (-)

Blood group A(II), Rh (+)

Blood group B(III), Rh (+)

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At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patient’s treatment. What index of hospital work can be calculated based upon this data?

Average duration of patients presence in the hospital

Average annual bed occupancy

Bed resources of the hospital

Bed turnover

Average bed idle time

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A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney’s functioning is satisfactory. What is the most probable diagnosis?

Subcapsular kidney’s rupture

Multiple kidney’s ruptures

Paranephral hematoma

Kidney’s abruption

Kidney’s contusion

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A 3 y.o. child with weight deficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 mmol/L. What is the most probable diagnosis?

Recurrent bronchitis

Bronchial asthma

Pulmonary hypoplasia

Mucoviscidosis (cystic fibrosis)

Bronchiectasis

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A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Hb- 70 g/L, RBC- 2, 3 * 1012/L, Ht-20. What is the most probable diagnosis?

Polycyst ovarian syndrome

Hormonoproductive ovary tumor

Werlholf’s disease

Noncomplete spontaneous abortion

Juvenile bleeding, posthemorrhagic anemia

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A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insulinotherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2 nd (insulin-independent) types of diabetes?

Glycemia examination on an empty stomach

Fructosamine estimation

Glucose-tolerant test

Determination of insular cells antibodies

Estimation of glucolized blood hemoglobin

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A 43 y.o. patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenoutic papillitis 0,5 cm long has been revealed. What is the best way of treatment?

To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

To perform choledochoduodenostomy

To perform transduodenal papillosphincterotomy

To perform external choledoch drainage

To perform endocsopic papillosphincterotomy

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A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria - 7,1 g/L, protein content in the daily urine - 4,2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9,2 mmol/L). What variant of glomerulonephritis is the most probable?

Hematuric

Nephritic

Nephrotic

Mixed

Isolated urinary

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A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- 35 * 109/L, lymphocytes - 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

Chronic lympholeucosis

Chronic myeloleucosis

Acute leucosis

Tuberculous lymphadenitis

Lymphogranulomatosis

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Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

By means of the sacral approach

Through the postoperative wound

Through the obturator foramen

Through the anterior abdominal wall

Through the rectum

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Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic is the most reasonable?

Prescription of uterotonic medicines

External uterus massage

Instrumental uterus cavity revision

Manual uretus cavity revision

Parturient supervision

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A 3 y.o. girl has had a temperature rise up to 380C, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn’t reveal any changes over her lungs. Percussion sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?

Bilateral microfocal pneumonia

Acute simple bronchitis

Recurrent bronchitis, acute condition

Acute obstructive bronchitis

Acute simple tracheitis

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A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39 — 40 oC. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky’s symptom is positive. What is the most probable diagnosis?

Pemphigus vulgaris

Acute epidermal necrolisis

Polymorphous exudative erythema

Duhring’s disease

Bullous dermatitis

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A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, is positioned near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

Varicose veins of the right hip

Right-sided femoral hernia

Lipoma of the right inguinal area

Right-sided direct inguinal hernia

Right-sided oblique inguinal hernia

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A 54 y.o. patient has been sufferi- ng from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria - 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of a2- and q-globulins, ESR- 50 mm/h. What is the most probable diagnosis?

Chronic glomerulonephritis

Secondary renal amyloidosis

Myelomatosis

Systemic lupus erythematosus

Acute glomerulonephritis

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A mineshaft is situated on the territory of homestead land, it is 20 m away from the house, 10 m- from the toilet and 15 m - from the neighbour’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of

10 m

15 m

25 m

30 m

20 m

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A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

Cervical pregnancy

Cancer of cervix of the uterus

Polypus of the cervis of the uterus

Nascent fibroid

Leukoplakia

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A boy, aged 9, was examined: height -127 cm (-0,36), weight - 28,2 kg (+0,96), chest circumference - 64,9 cm (+0,66), lung vital capacity - 1520 ml (-0,16). What is the complex assessment of the child’s physical development?

Below the average

Harmonious

Excessive

Disharmonious

Apparently disharmonious

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A 14 y.o. child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for atack reduction?

No-shpa

Amisyl

Euphyline

Corglicone

Obsidan

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A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC- 2, 7 * 1012/L, Hb- 88 g/L, WBC-5,6 * 109/L, ESR- 15 mm/h. What is the most probable reason of bilirubin level change?

Decrease of unconjugated bilirubin

Increase of unconjugated and conjugated bilirubin

Increase of unconjugated bilirubin

Decrease of conjugated bilirubin

Increase of conjugated bilirubin

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A 28 y.o. woman consulted a doctor about edematic face, moderate legs edemata; occasionally her urine has colour of 'meat slops'. When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36,80C, Ps- 68/min, rhythmic. AP- 170/110 mm Hg. What urine changes are the most probable?

Proteinuria, hematuria, cylindrouria

Decrease of relative density, proteinuria

Increase of relative density, hematuria, bacteriuria

Decrease of relative density, proteinuria, some urinary sediment

Erythrocyturia and urinozuria

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A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?

Distal tourniquet

Heightened position of extremity, compressive sterile bandage

Z-shaped stitch on the raptured varicose node

Proximal turniquet

Troyanov-Trendelenburg operation

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It is determined that 30 of a 100 women with risk factor had preterm labor, and of a 100 women without risk factor 5 women had preterm labor. What method of statistic data processing should the doctor use in order to estimate reliability of differences between the compared groups?

Standardization method

Average computing

Student’s criterion calculation

Correlation analysis

Relative numbers calculation

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A patient was admitted to the hospital with complaints of occasional pains at the bottom of abdomen that get worse during menses, weakness, indisposition, nervousness, some dark bloody discharges from vagina on the day before and the day after menses. Bimanual examination results: body of womb is enlarged, appendages cannot be determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries, peritoneum of rectouterine pouches and pararectal fat are covered with 'cyanotic spots'. What is the most probable diagnosis?

Ovarian cystoma

Polycystic ovaries

Widespread form of endometriosis

Chronic salpingitis

Genital organs tuberculosis

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A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegar’s dilator N° 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

Metrosalpingography

Bimanual examination

Uterine probing

US examination

Laparoscopy

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A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He suffers from hemophilia B-type. What antihemophilic medicine should be included in pre- and postoperative treatment plan?

Cryoprecipitate

Native plasma

Dried plasma

Fresh frozen plasma

Fresh frozen blood

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A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fith day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 410C, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

Measles

Leptospirosis

Typhoid fever

Epidemic typhus

Delirium alcoholicum

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An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37,5°C, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal examination with mirrors: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened; fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most probable?

Candydomycosis

Trichomoniasis

Chlamydiosis

Chronic gonorrhea

Recent acute ascending gonorrhea

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A 28 y.o. patient complains of pain in legs during walking, chill of feet and toes. He has been ill for a year. Objectively: leg skin is pale, cool; turgor is decreased, hypotrichosis. Femoral and popliteal artery pulsation is weak, it is palpable on the foot arteries only after nitroglycerine test. Rheographic index is <1. What is the most probable diagnosis?

Obliterating aterosclerosis

Chronic thrombophlebitis

Buerger’s disease

Obliterating endarteritis

Raynaud’s disease

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A 2 m.o. child was delivered in time with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:

Hypotrophy of the II grade

Paratrophy of the I grade

Hypotrophy of the I grade

150 g less than necessary

Corresponding to the age

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A woman consulted a doctor on the 14th day after labor about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 390C, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

Phlegmon of mammary gland

Fibrous adenoma of the left mammary gland

Lactational mastitis

Lacteal cyst with suppuration

Breast cancer

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A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical hystory: acute pancreatitis. Body temperature is 38, 20C. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner’s and HubergritsSkulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?

Acute cholecystitis

Chronic pancreatitis

Cancer of pancreas

Acute cholangitis

Chronic cholecystitis

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A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly 'snored'. There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?

Saphar’s triple airway maneuver

Precardiac stroke

ECG record

Electric defibrillation

Intracardiac introduction of adrenalin with atropine

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A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37,50C. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the most probable?

Constriction of joint space, subchondral osteosclerosis

Constriction of joint space, usura

Epiphysis osteolysis

Cysts in subchondral bone

Multiple marginal osteophytes

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8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region - 3,0x1,0 cm, neck muscles rigidity, Ps- 58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?

Intensification of convulsions

Anisocoria

Wounds

Intracranial hemorrhage

Unconsciousness

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A girl, aged 13, consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

Juvenile hemorrhage

Haemophilia

Endometrium cancer

Menarche

Werlhof’s disease

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A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?

Sanitary certificate

Medical certificate

Exchange card

Appointment card for hospitalization

Individual prenatal record

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In course of observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

Presence of mixed (upper-lateral) light

Light coefficient

Natural light coefficient

Depth of study room

Time of the room insolation

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A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of conti-nious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

Phobic syndrome

Depressive syndrome

Asthenic syndrome

Paranoid syndrome

Obsessive syndrome

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200 patients suffering from essential hypertension were examined in order to obtain data about patients’ arterial pressure and age. What statistic value should be applied in order to measure relation between these characteristics?

Correlation coefficient

Sygmal deviation

Representation error

Coefficient of variation

Student’s coefficient

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A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood count: leukocytes - 2, 2 * 109/L. What disease can be suspected?

Chroniosepsis

Tuberculosis

Infectionous mononucleosis

HIV-infection

Lymphogranulomatosis

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A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?

Kidneys

Lungs

Heart

Gastrointestinal tract

Skin and joints

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A 2 month old child who was born with body weight 5100 g has jaundice, hoarse cry, umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are of normal color. In anamnesis: delayed falling-away of umbilical rest. Blood count: Hb- 120 g/L, RBC- 4,5 * 1012/L, ESR- 3 mm/h. General level of serum bilirubin - 28 mcmol/L, unconjugated bilirubin - 20 mcmol/L, conjugated bilirubin - 8 mcmol/L. What disease would you think about first of all?

Congenital hepatitis

Cytomegalovirus infection

Hemolitic anemia

Congenital thyreoid deficiency

Conjugated jaundice

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The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?

Glucocorticoids

Cardiac glycosides

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A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation - gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?

Acute suprarenal insufficiency

Chronic renal insufficiency

Glomerulosclerosis

Antibiotic combination is optimal and absolutely safe

Acute renal insufficiency

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A 60 y.o. patient complains of having passing reduction of strength in his left extremities for a month. Some time later he has got persistent weakness of extremities in the mornings. Objectively: AP-140/90 mm Hg, conscious, central paresis of the VII and XII pair of left-side cranial nerves, central hemiparesis and hemi-hyperesthesia also on the left side. What medicines should be chosen for the differentiated treatment of the patient?

Hemostatics

Hypotensive

Corticosteroids

Anticoagulants

Diuretics

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A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exercises. He has had it for 1 year. On examination: heart borders are enlargement to the left side, sounds are muffled, Ps- 76 bpm, rhythmic, AP-155/80 mm Hg, ECG: the left type, the rest signs are normal. What additional examination is necessary to confirm the diagnosis?

Transaminases of blood

Veloergometry

General blood count

Echocardiography

Lipoprotein test

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A 70 y.o. patient complains of weakness, dizziness, short periods of loss of consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP- 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?

Bradysystolic form of the atrial fibrillation

I degree atrioventricular heart block

Complete block of the left branch of His bundle

III degree atrioventricular heart block

Sinus bradycardia

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A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right lung suddenly felt pain after coughing in the right half of thorax, he got heavy breathing, cyanosis. What complication is the most probable?

Myocardial infarction

Infarction-pneumonia

Esophagus perforation

Pyopneumothorax

Exudative pleurisy

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Fluorography of a 45 y.o. man revealed some foci of small intensity with nondistinct outlines on the top of his right lung. The patient doesn’t feel worse. He has been smoking for many years. Objectively: vesicular resonance over lungs, respiration is vesicular, rales are absent. Blood count is not changed. What is the most probable diagnosis?

Focal pulmonary tuberculosis

Disseminated pulmonary tuberculosis

Peripheral cancer of lung

Eosinophilic pneumonia

Bronchiolitis

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An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 390C, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0,5 cm, t0380C. Blood count: Hb- 98g/L, RBC-2,9 * 1012/L, leukocytes - 32 * 109/L, stab neutrophils 0 %, segmental leukocytes - 28%, monocytes - 2%, lymphocytes -39%, blasts - 31%, reticulocytes - 31%, thrombocytes - 120* 109/L, ESR- 36 mm/h. What form of leukosis does the patient have?

Undifferentiated leukosis

Acute lymphoblastic leukosis

Acute myeloblastic leukosis

Chronic myeloleukosis

Chronic lympholeukosis

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A mother of a 5 y.o. girl consulted a doctor about doughter’s involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition, intellectual development is good, the girl can read and explains common situations quite adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithi-asis. What type of diathesis is the most probable in the child’s case?

Allergic diathesis

Urine acid diathesis

Gouty diathesis

Exudative diathesis

Lymphohypoplastic diathesis

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After manual reposition and application of plaster splint a patient with fractures of forearm bones had an edema of hand and fingers, he felt pain and lack of sensitivity. What tactics should the doctor choose?

To repeat reposition

It’s a natural phenomena, the edema will dissipate in a day

To prescribe analgetics and diuretics

To remove the plaster

To cut the bandage that fastens the splint

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A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?

Hypocalcemia

Hypokaliemia

Hypernatremia

Hyperkaliemia

Hyperhydratation

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A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?

Bechterew’s disease

Reiter’s disease

Osteoarthritis

Rheumatic arthritis

Psoriatic arthritis

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A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft, there are no symptoms of peritenium irritation, 'splashing sounds'in epigastrium. Defecation once in 3 days. What complication corresponds with the patient’s state and described clinical presentations?

Concealed ulcer perforation

Ulcer penetration

Ulcerative pyloric stenosis

Chronic pancreatitis

Stomach cancer

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An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/l; RBC- 3, 2 * 1012/L; C.I.-0,95; thromb.- 20 * 109/L. The sedimentation time according to Lee White is 5'; hemorrhagia duration according to Duke is 8', 'pinch and tourniquet' test is positive. What is the most probable diagnosis?

Idiopathic thrombocytopenic purpura

Hemophilia

Marchiafava-Micheli’s disease

Hemorrhagic diathesis

Iron deficiency anemia

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A 46 y.o. patient complains of skin itch, sweating, especially at night, body temperature rise up to 38, 6°C. Objectively: chest skin has marks of scratching, supraclavicular lymph nodes are as big as a pigeon egg, they are not matted together with skin. What test is the most reasonable?

Common blood count

Immunogram

Whole protein and protein fractions

Plan radiography of thorax

Punction of an enlarged lymph node

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A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. An echinococcus liver affection is suspected. What type of examination will be the most informative in this case?

USI examination

Angiography

Liver scanning

Biochemical laboratory analysis

Plan radiography of abdominal cavity

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A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?

Expectant management

Vacuum extraction of fetus

Perineum protection

Episiotomy

Perineotomy

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A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?

Kidney dystopy

Varicocele

Necrotic papillitis

Tuberculosis of urinary bladder

Cancer of kidney

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A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38,50C, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?

Chickenpox

Anthrax, dermal form

Erysipelas, hemorrhagic form

Crus phlegmon

Herpetic infection

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A 1,5 y.o. child fell seriously ill: chill, body temperature rise up to 40,10C, then rapid dropping to 36, 20C, skin is covered with voluminous hemorrhagic rash and purple cyanotic spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis, fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission stage?

Penicillin

Sulfamonometoxin

Soluble Levomycetine succinate

Lincomycin

Gentamycin

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A 41 y.o. patient complains of acute pain in the right side of the thorax and sudden progress of dyspnea following the lifting of a heavy object. The patient’s condition is grave: lips and mucous membranes are cyanotic, BR- 28/min, Ps-122 bpm., AP- 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S2 sound is accentuated above pulmonary artery. What is the main urgent measure on the prehospital stage?

Oxygen inhalation

Epinephrine introduction

Euphilline introduction

Call for cardiologic team

Air aspiration from the pleural cavity

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A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney, presumably it belongs to the adrenal gland. What laboratory test will allow to make a more precise diagnosis?

Estimation of glomerular filtration rate

Estimation of catecholamine and vani-llylmandelic acid excretion with urine

Estimation of renin content in blood

Estimation of thyroxin and thyrotropic hormon in blood

Estimation of insulin and C-peptide content in blood

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A 48 y.o. farmer was admitted to the hospital with complaints of headache, nausea, vomiting, cough with sputum, breath shortage, weak sight, sweating, salivation. He was cultivated the garden with phosphoorganic pesticides. Blood count: RBC- 4,1 * 1012/L, Hb- 136 g/L, C.I.- 0,9, leukocytes - 13,0 * 109/L, ESR- 17 mm/h. His diagnosis is acute intoxication with phosphoorganic pesticides. What is the most important diagnostic criterion for this pathology?

Leukocytosis

Anemia

Low level of choline esterase

Reticulocytosis

Thrombocytopenia

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A 74 y.o. female patient complains of pain, abdominal distension, nausea. She suffers from heart ichemia, post-infarction and atherosclerotic cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion in abdominal cavity, one of the bowel loops is dark-blue. What is the most probable diagnosis?

Erysipelas

Acute intestinal obstruction

Volvulus

Mesenterial vessels thrombosis

Ichemic abdominal syndrome

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A 30 y.o. woman is in her second labor that has been lasting for 14 hours. Fetal heartbeats are muffled, arrhythmic, 100/min. Vaginal examination results: cervical dilatation is complete, fetal head is close to the exit of small pelvis. Sagittal suture has the direct diameter, small crown is close to the pubis. What is the further tactics of labor management?

Craniodermal forceps

Use of cavity forceps

Labor stimulation by means of oxitocine

Cesarean section

Use of obstetrical forceps

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A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has got fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

Psychotherapeutic conversation

Out-patient treatment

Admission to the mental hospital

Admission to the neurological department

Strict supervision at home

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A 63 y.o. woman complains of moti- veless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature - 37,50C, BR- 20/min, Ps-96/min, AP-110/75 mm Hg. On palpation in epigastrium - pain and muscle tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a diagnosis?

Endoscopy

Cytologic

Radiography

Stomach content examination

Coprology

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A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, jaundice. What examination may account for the worsening of the patient’s condition?

Estimation of cholesterol esters

Estimation of serum ammonia

Estimation of o-fetoprotein content

Estimation of alkaline phosphatase level

Estimation of alanine aminotransferase and aspartate aminotransferase

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A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, then there were seropurulent vesicles for about 1cm large. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?

Ritter’s dermatitis

Vesiculopustulosis

Newborn pemphigus

Pseudofurunculosis

Sepsis

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A 41 y.o. woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC-9,8* 109/L, RBC- 3,0 *1012/L, sedimentation rate - 52 mm/hour. What medication provides pathogenetic treatment of this patient?

Motilium

Sulfasalasine

Linex

Kreon

Vikasolum

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A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples, increasing AP up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?

Increasing of aldosterone level in blood

Increasing of catecholamines concentration

Increasing of vasopressin excretion

Increasing of thyroxine excretion

Increasing of plasma renin activity

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A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

Pylorospasm

Aerophagia

Esophageal atresia

Acute gastroenteritis

Pylorostenosis

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A 32 y.o. woman has been suffering for 5 months from pain in lumbar region, low grade fever, frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field of sight, bacteriuria. Blood analysis: leukocytosis, increased ESR. What is the most probable diagnosis?

Acute pyelonephritis

Acute glomerulonephritis

Chronic pyelonephritis

Urolithiasis

Chronic glomerulonephritis

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A 2 y.o. boy was admitted to the hospital with weight loss, unstable feces, anorexia, following the semolina’s introduction (since 5 months). The child is adynamic, flabby, his skin is pale and dry, subcutaneous fat layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the most probable cause of the disease?

Mucoviscidosis (cystic fibrosis)

Celiakia (celiac disease)

Disaccharidase insufficiency

Chronic enteritis

Intestinal dysbacteriosis

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A child with chronic cardialtis, cardial insufficiency IIA that is being treated with digoxin has got progressing bradycardia, nausea, vomiting. dizziness, sleep disorders. ECG results: extrasystole, PQ-0,18. What is the most probable cause of this condition?

Cardiac glucosides overdose or intolerance

Hypokaliemia

Atrioventricular heart block of the I degree

Acute enteric infection

Pulmonary edema

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Examination of a hanged man’s corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31,0oC. What is the prescription of death coming?

1-2 hours

8-10 hours

10-18 hours

6-7 hours

16-24 hours

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In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?

Acquired oblique inguinal hernia

Obturator hernia

Femoral hernia

Congenital oblique inguinal hernia

Direct inguinal hernia

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Vaginal inspection of a parturient woman revealed: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for examination. The fetus has cephalic presentation. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?

Cervix dilatation stage

Prodromal stage

Stage of fetus expulsion

Preliminary stage

Placental stage

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Ambulace brought to the hospital a patient with acute respiratory viral infection. The illness began suddenly with temperature rise up to 39,90C. He complains of headache in frontotemporal lobes, pain in eyeballs, aching of the whole body, nose stuffiness, sore throat, dry cough. At home he had a nasal hemorrhage twice. What type of acute respiratory viral infection is it?

Enterovirus infection

RS-infection

Adenoviral infection

Influenza

Parainfluenza

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A 52 y.o. patient complains of dyspnea caused even by moderate physical activity, cough with hardly secreted sputum. He has been ill for 12 years. Objectively: BR- 26/min. Lung examination: tympanitis, diminished vesicular breathing with prolonged expiration, disseminated dry rales. In the past he was taking only theopecym or ami-nophylline inravenously. Prescribe him the basic treatment after the exacerbation is suppressed:

Aminophylline

Inhacort

Alupent

Tilade

Atrovent

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Plan radiography of the patient’s abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?

Cancer of large intestine

Price’s disease

Meteorism

Perforative ulcer

Intestinal obstruction

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A patient of a somatic hospital has got psychomotor agitation as a result of high fever: he tried to run about the department; thought that some water was running down the walls, he pretended to see rats and cockroaches on the floor. Claimed he were in a hostel, recognized his 'aquaintances'. After introduction of sedative drugs he fell asleep. In the morni- ng he remembered this condition. What psychopathologic syndrome is it?

Maniacal syndrome

Twilight disorder of consciousness

Hallucinatory paranoid syndrome

Delirium

Oneiric syndrome

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Далі ›

A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. Ap is falling rapidly, it is necessary to perform hemotransfusion. Who can determine the patient’s blood group and rhesus compatibility?

An anaesthesilogist

A surgeon

A traumatologist

A doctor of any speciality

A laboratory physician

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A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin - striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?

Shichan’s syndrome

Stein-Levental’s syndrome

Turner’s syndrome

Itsenko-Cushing syndrome

Babinski-Froehlich syndrome

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A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 390C. There was acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?

Osteoarthritis

Gout

Erysipelatous inflammation

Rheumatoid arthritis

Infectional arthritis

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Далі ›

A 5 y.o. girl was by accident closed in a dark room for several minutes. When the door was opened, the child was standing motionless in the middle of the room staring at one point, her face had a look of terror, she didn’t respond to any stimuli. 40 minutes after her state changed into crying. On the next day she could remember nothing of this incident. What is the most probable mechanism of this reaction?

Conditioned reflex

Endogenically organic

Exogenously organic

Psychogenic

Endogenic

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A 42 y.o. patient was admitted 3 hours after a trauma with evident subcutaneous emphysema of the upper part of his body, dyspnea, tachycardia 120/min. X-ray examination revealed no pneumothorax, significant dilatation of mediastinum to the both sides. What emergency care is needed?

Pleural cavity punction

Toracoscopy

Pleural cavity drainage

Toracotomy

Drainage of anterior mediastinum

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Далі ›

An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanine aminotransferase activity is 2,2 mcmol/L. How can this condition be estimated?

Recurrance of viral hepatitis type B

Development of liver cirrhosis

Residual effects of old viral hepatitis type B

Biliary dyskinesia

Development of chronic hepatitis

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A 2,5 m.o. child has got muscle hypotony, sweating, occipital alopecia. Along with massage and therapeutic exercises the child was prescribed vitamin ','

1000 IU every day

What dosage and frequency are correct?

500 IU every other day

3000 IU every day 6- 500 IU every day

1000 IU every other day

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After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterus is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations and raptures. What action is nesessary?

Manual exploration of the uterine cavity

Urine drainage, cold on the lower abdomen

Use of uterine contracting agents

External massage of uterus

Use of hemostatic medications

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A 25 y.o. patient complains of body temperature rise up to 370C, pain at the bottom of her abdomen and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an artificial abortion. Objectibely: cervix of uterus is clean, uterus is a little bit enlarged in size, painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are sanguinopurulent. What is the most probable diagnosis?

Postabortion uterus perforation

Parametritis

Postabortion endometritis

Pelvic peritonitis

Hematometra

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A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months. Objectively: t0- 37, 30C, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?

Bronchoectatic disease

Macrofocal pneumonia

Focal pulmonary tuberculosis

Cancer of lung

Exudative pleuritis

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People who live in the radiation polluted regions are recommended to include pectins into their dietary intake for the radioactive nuclides washout. What products are the main source of pectins?

Macaroni

Bread

Milk

Meat

Fruit and vegetebles

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A 25 y.o. pregnant woman in her 34th week was taken to the maternity house in grave condition. She complains of headache, visual impairment, nausea. Objectively: solid edemata, AP- 170/130 mm Hg. Suddenly there appeared fibrillary tremor of face muscles, tonic and clonic convulsions, breathing came to a stop. After 1,5 minute the breathing recovered, there appeared some bloody spume from her mouth. In urine: protein - 3,5 g/L. What is the most probable diagnosis?

Cerebral edema

Eclampsia

Cerebral hemorrhage

Epilepsy

Stomach ulcer

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The Transcarpathian region is characterized by constant high (over 80%) air moisture. Population of this region feels an intense cold in winter when the temperature is temperately low. What way of heat emission becomes more active?

Evaporation

Irradiation

Conduction

Radiation

Convection

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A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2,5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?

Supravaginal amputation of uterus without appendages

Conservative treatment of bleeding

Diagnostic curettage of uterine cavity

Hysterectomy

TORCH-infection test

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An 18 y.o. patient complains of painfulness and swelling of mammary glands, headaches, irritability, edemata of lower extremities. These symptoms have been present since the begin of menarche, appear 3-4 days before regular menstruation. Gynecological examination revealed no pathology. What is the most probable diagnosis?

Renal disease

Premenstrual syndrome

Mastopathy

Disease of cardiovascular system

Neurasthenia

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A 15 y.o. patient has a developmental lag, occasionally he has skin yellowing. Objectively: spleen is 16x12x10 cm, cholecystolithiasis, skin ulcer of the lower third of left crus. Blood count: RBC- 3,0 * 1012/L, Hb- 90 g/L, C.I.-1,0; microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, unconjugated - 38 mcmol/L. What therapy will be the most appropriate?

Omentohepatopexy

Spleen transplantation

Splenectomy

Portacaval shunt

Omentosplenopexy

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In a city with population 400000 people 5600 fatal cases were recorded, including 3300 cases because of blood circulation diseases, 730 - because of tumors. What index will allow to characterize mortality from blood circulation diseases in this city?

Correlation index

Visuality index

Intensive index

Extensive index

Relative intensity index

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During the medical examination a port crane operator complained of dizziness, nausea, sense of pressure against tympanic membranes, tremor, dyspnoea, cough. He works aloft, the work is connected with emotional stress. Workers are affected by vibration (general and local), noise, ultrasound, microclimate that warms in summer and cools in winter. What factor are the worker’s complaints connected with?

Noise

Altitude work

Intensity of work

Vibration

Infrasound

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