Step 2 - Medicine 2008

An 8 year old child has low-grade fever, arthritis, colicky abdominal pain and a purpuric rash llocalized on the lower extremities. laboratory studies reveal a guaiac-positive stool, urinalysis with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most likely diagnosis is:

Idiopathic thrombocytopenic purpura

Rocky Mountain spotted fever

Henoch-Schonlein’s vasculitis

Poststreptococcal glomerulonephritis

Systemic lupus erythematosus (SLE)

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A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7x5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?

Ultrasound

Hysteroscopy

Hromohydrotubation

Colposcopy

Cystoscopy

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A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:

Complex therapy of gestosis for 2 days

Absolute bed rest for 1 month

Labour stimulation after preparation

Caesarian section immediately

Complex therapy of gestosis for 7 days

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A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s weight is 4080 gr. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the introduction of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:

Hypotonia of the uterus

Injury of cervix of the uterus

Delay of the part of placenta

Atony of the uterus

Hysterorrhexis

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On the first day after labour a woman had the rise of temperature up to 39°C. Rupture of fetal membranes took place 36 hours before labour. Examination of the bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of A group. The uterus body is soft, tender. Discharges are bloody, with admixtures of pus. Specify the most probable postnatal complication:

Infective contamination of the urinary system

Infectious hematoma

Metroendometritis

Apostasis of sutures after the episi-otomy

Thrombophlebitis of veins of the pelvis

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A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:

Endometritis

Apostasis of sutures after episiotomy

Infectious contamination of the urinary system

Thrombophlebitis of veins of the pelvis

Infectious hematoma

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A woman in her 39th week of pregnancy, the second labour, has regular birth activity. Uterine contractions take place every 3 minutes. What criteria describe the beginning of the II labor stage the most precisely?

Duration of uterine contractions over 30 seconds

Presenting part is in the lower region of small pelvis

Rupture of fetal bladder

Cervical dilatation by no less than 4 cm

Cervical smoothing over 90%

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A 24 years old primipara was hospitalised with complaints about discharge of the amniotic waters. The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed, light amniotic waters out of it. Point a correct component of the diagnosis:

Pathological preterm labour

The beginning of the 1st stage of labour

Antenatal discharge of the amniotic waters

The end of the 1st stage of labour

Early discharge of the amniotic waters

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A 29 year old patient underwent surgical treatment because of the benign serous epithelial tumour of an ovary. The postoperative period has elapsed without complications. What is it necessary to prescribe for the rehabilitational period:

Hormonotherapy and proteolytic enzymes

Antibacterial therapy and adaptogens

Lasertherapy and enzymotherapy

Magnitotherapy and vitamin therapy

The patient does not require further care

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A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture should be made in:

In the point of the greatest dullness on percussion

In the projection of pleural sinus

In the 2nd intercostal space along the middle clavicular line

In the 7th intercostal space along the scapular line

In the 6th intercostal space along the posterior axillary line

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A primagravida with pregnancy of 3738 weeks complains of headache, nausea, pain in epigastrium. Objective: the skin is acyanotic. Face is hydropic, there is short fibrillar twitching of blepharons, muscles of the face and the inferior extremities. The look is fixed. AP- 200/110 mm Hg; sphygmus of 92 bpm, intense. Respiration rate is 32/min. Heart activity is rhythmical. Appreciable edemata of the inferior extremities are present. Urine is cloudy. What medication should be administered?

Papaverine hydrochloride of 2% - 4,0 ml

Pentaminum of 5% - 4,0 ml

Dibazolum of 1% - 6,0 ml

Hexenalum of 1% - 2,0 ml

Droperidolum of 0,25% - 2,0 ml

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A 40 year old woman has changes of mammary gland. What are the most often symtomps that precede the malignizati-on?

Skin induration with inverted nipple

Pure discharges from the nipple

Bloody discharges from the nipple

Painful movable induration

Painless movable induration

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A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?

Increased sodium consentration in blood

Increased calcium concentration in blood

Increased potassium concentration in blood

Reduced magnesium concentration in blood

-

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An onset of severe preeclampsia at 16 weeks gestation might be caused by:

Interventricular defect of the fetus

Hydatidiform mole

Twin gestation

Anencephaly

Maternal renal disease

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A 9 year old girl with a history of intermittent wheezing for several years is brought to the pediatrician. The child has been taking no medications for some time. Physical examination reveals agitation and perioral cyanosis. Intercostal and suprasternal retractions are present. The breath sounds are quiet, and wheezing is audible bilaterally. The child is admitted to the hospital. Appropriate interventions might include all of the following EXCEPT:

Prescribe intravenous aminophylline

Prescribe nebulized cromolyn sodium

Administer supplemental oxygen

Prescribe intravenous corticosteroids

Prescribe nebulized metaproterenol

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Routine examination of an otherwise healthy child with a history of bronchial asthma reveals AP of 140/90 mm Hg. The most likely cause of the hypertension is:

Chronic lung disease

Theophylline toxicity

Obesity

Coarctation of the aorta

Renal disease

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The average body lenth of newborn boys is 50,9 cm at a sigma 1,66; and average mass - 3432 at a sigma 5,00. What criterion is necessary to compare degree of variability of these signs?

Coefficient of variation

Amplitude

Coefficient of association

Sigma

Limit

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What method is applied to establish rate of correlation between age of men and their mortality due to myocardial infarction?

Correlation ratio

The Indirect method (Student)

The quadrate method (Pirson)

Method of graduated correlation (Armler)

Method of grade correlation (Spirman)

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Adenosine triphosphate may be expected to convert which of the following arrhythmias to sinus rhythm?

Atrial fibrillation

Ventricular fibrillation

Paroxysmal supraventricular tachycardia

Paroxysmal ventricular tachycardia

Atrial flutter

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A 48 year old man complains of fati-que and shortness of breath. His Ht is 32%, and Hb - 103 g/l. Peripheral blood smear reveals macrocytosis. Serum vitamin Bi2 level is 90 pg/ml (normal is 170 to 940); serum folate level is 6 ng/ml (normal is 2 to 14). Possible causes to consider include all of the following EXCEPT:

Regional enteritis

Pancreatitis

Colonic diverticulitis

Fish tapeworm infection

Vegetarianism

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A 56 year old man complains of fatigue, dyspnea on exertion and palpitations. He has had a murmur since chi- ldhood. Examination reveals a lift at the left sternal border, split Si, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. Chest x-ray shows right ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial fibrillation with a right bundle branch block. The most likely diagnosis is:

Patent ductus arteriosus

Ventricular septal defect

Arterial septal defect

Tetralogy of Fallot

Coarctation of the aorta

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Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and <10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT:

Hyperthyroidism

Cardiac transplant rejection

Amyloidosis

Pericardial effusion

Coronary artery disease

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Five days after a total hip replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST — T wave changes. The most likely diagnosis is:

Pulmonary thromboembolism

Aortic dissection

Acute myocardial infarction

Pericarditis

Aspiration

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A child is 6 years old. Within one year of observation he had URI that lasted 8 days. Physical state is satisfactory. Specify hi health group:

II

III (a)

III (b)

III (c)

I

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Which of the following IS NOT TYPICAL for Addison’s disease?

Dilute urine

High serum K+

Elevated BUN

High serum Na+

Elevated hematocrit

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A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:

Sigmoid diverticulitis

Herpes zoster

Retroperitoneal haemorrhage

Leftsided renal colic

Torsion of the left testicle

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A 40 year old woman has a selfdetected hard breast mass. The procedure of choice for confirming the diagnosis is:

Thermography

Mammography

Aspiration biopsy with cytology

Excision biopsy

Ultrasonography

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A 38 year old man was admitted to a hospital from his working place on July 19 because of hip fracture. He was invalid till November 19. Requires prolongation of treatment. Who decides on the issue of further temporary invalidity?

DCC

Interregional general MSEC

The head physician of a polyclinic

Regional MSEC

Specialized (traumatologic) MSEC

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During investigation for chronic, severe, epigastric pain, a 40 year old alcoholic man is found to have multiple areas of narrowing alternating with dilatation ('chain of lakes'appearance) of the main pancreatic duct. The operation of choice is:

Distal pancreaticojejunostomy

Lateral pancreaticojejunostomy

Distal pancreatectomy

Sphincterotomy

Total pancreatectomy

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The treatment of choice for duodenal obstruction caused by secondary duodenal hematoma that developed a few days after blunt abdominal injury is:

Nasogastric decompression and parenteral alimentation

Duodenojejunostomy

Immediate exploration

Retrocolic gastrojejunostomy

Tube duodenostomy

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A 25 year old man has a sudden onset of chest pain on the right and dyspnea. His trachea is deviated to the left. All of the following would be anticipated EXCEPT:

Absence of rales

Pleural friction rub on the left

Distant breath sounds on the right

Absence of rhonchi

Hyperresonance over the right chest

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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 - 210T, reductase probe - weak-positive. What way is the product to be used in?

Sell without limitations

Discard for animal feeding

Technical utilization

Do the product away

Sell but inform customers about milk quality

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

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

Conduct forensic medical examination by district forensic medicine expert

Draw up a statement about forensic medical examination

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If a child has adherent fingers on his right hand, then what will be your diagnosis?

Syndactyly

Ectrodactyly

Macrodactyly

Ectromelia

Polydactyly

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A 16 year old patient with complaints of frequent pain in the abdomen was diagnosed with melanoma, examination revealed also pigmentation of the mucosa and skin, polyp in the stomach and large intestine. It is know that the patient’s mother has an analogous pigmentation and has been often treated for anemia. What disease is suspected?

Adolescent polyposis

Peytz-Egers’s polyposis

Chron’s disease

Hirschprung’s disease

Tuberculosis of the intestine

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A 41 year old patient was admitted to the intensive care unit with haemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding?

Introduction of obturator nasogastric tube

Operation

Administration of plasma

Intravenous administration of pituitrin

Hemostatic therapy

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It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?

Digital examination of rectum

Rectoromanoscopy

Laparoscopy

R-scopy of abdominal cavity

Percussion and auscultation of stomach

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A 52 year old man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detected murmur. What diagnostic method is to be applied in the first place?

Cerebral angiography

MRI of the brain

Ultrasound dopplerography

CT of the brain

Electroencephalography

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A 34 year old woman in the 10th week of gestation (the second pregnancy) consulted a doctor of antenatal clinic in order to be registered there. In the previous pregnancy hydramnion was observed, the child’s birth weight was 4086 g. What examination method should be applied in the first place?

Determination of the contents of fetoproteinum

US of fetus

The test for tolerance to glucose

Bacteriological examination of discharges from vagina

A cardiophonography of fetus

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A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowi-ng of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic +actions at the second stage of mastoiditis?

Mastoidotomy

Tympanoplasty

Paracentesis of the drum

Cateterization of the Eustachian tube

Radical operation on the middle ear

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A 22 year old patient was admitted to trauma center with complaints of pain in the left ankle joint that was getting worse during moving and weight bearing. On the clinical examination it was found that the patient had the closed fracture of medial malleolus without displacement. In which position should the foot be fixed in plaster cast?

At right angle with varus positioning of the foot

In position of pronation

In position of planter flexion of foot

In position of supination

In position of dorsal flexion of foot

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A patient with acute respiratory viral infection (3rd day of disease) complains of pain in lumbar region, nausea, dysuria, oliguria. Urinalysis - hematuria (100-200 RBC in eyeshot spot), specific gravity -1002. The blood creatinin level is 0,18 mi-llimole/l, potassium level - 6,4 millimole/l. Make the diagnosis:

Acute glomerylonephritis

Acute cystitis

Acute renal failure

Acute interstitial nephritis

Acute renal colic

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A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate - 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration / pulse ratio is 1:2 . The heart dullness under normal size. Such signs characterise :

Myocarditis

Respiratory failure of II degree

Respiratory failure of I degree

Respiratory failure of III degree

Congenital heart malformation

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A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is your diagnosis?

Scarlet fever

Rubella

Measles

Pseudotuberculosis

Allergic rash

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A 2 year old 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

Adenoviral infection

Rubella

Measles

Scarlet fever

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A 3 year old boy fell ill abruptly: fever up to 39oC, weakness, vomi-tng. Haemorrhagic rash of various size appeared on his lower limbs in 5 hours. Meningococcemia with infective - toxic shock of the 1 degree was diagnosed. What medications should be administered?

Ampicillin and immunoglobulin

Penicillin and immunoglobulin

Chloramphenicol succinate and prednisone

Penicillin and prednisone

Chloramphenicol succinate and interferon

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A 7 year old 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

Meningitis

Neurotoxic syndrome

Myelitis

Meningoencephalitis

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A 14 year old patient complains of chest pain, temperature up to 38,5oC, breathlessness. He had acute tonsillitis 2 weeks ago. He is in grave condition. The skin is pale. Heart borders are dilated, heart sounds are quiet. Above total heart area you can hear pericardium friction sound. Electrocardiogram: the descent of QRS voltage, the inversion T. The liver is enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 - 1260, C-reactive protein +++. Your diagnosis:

Rheumatic endocarditis

Septic endocarditis

Rheumatic myocarditis

Rheumatic pancarditis

Rheumatic pericarditis

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A woman born a child. It was her fith pregnancy but the first delivery. Mother’s blood group is A(II)Rh-, newborn’s -A(II)Rh+. The level of indirect bilirubin in umbilical blood was 58 micromole/l, hemoglobin -140 g/l, RBC- 3,8 • 1012/l. In 2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type, Rhincompatibility) was diagnosed. Choose the therapeutic tactics:

Symptomatic therapy

Blood transfusion (conservative therapy)

Replacement blood transfusion (conservative therapy)

Conservative therapy

Antibiotics

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A mother consulted a pediatrician about her son. Her son was born with body mass of 3 kg and length of 48 cm. He’s 1 year old now. What is the required normal mass?

12,0 kg

11,0 kg

9,0 kg

15,0 kg

10,5 kg

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A 2 month old healthy infant with good appetite is given artificial feeding since he turned 1 month old. When is it recommended to start the corrective feeding (fruit juice)?

2,0 months

4,0 months

3,0 months

1,0 months

1,5 months

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A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?

Proteins

Carbohydrates

Salt

Liquid

Fats

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Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?

Examination of the formation in Trendelenburg’s position

Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)

Diaphanoscopy

Palpation of the external inguinal ring

Puncture of the scrotum

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A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:

Ganglioneuroma

Ganglioneuroblastoma

Sarcoma of the vertebra

Sympatoblastoma

Sympatogonioma

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A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?

Cardialgia due to spine problem

IHD. Unstable angina

IHD. Functional Class II angina

Myocardial dystrophy

Myocarditis

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A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?

Clonidine

Kapoten

Nifedipin

Hypothiazid

Dibazol

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A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps - 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?

CHF- 2 B

CHF- 2 A

CHF- 0

CHF- 3

CHF- 1

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A patient, aged 49, complains of fever of 37,5oC, heart pain, dyspnea. Si is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur can be auscultated. What is the most efficient examination for valvular disorder assessment?

ECG

Phonocardiography

Chest X-ray

Ballistocardiogram

Echocardiography+Doppler-Echocardiography

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A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied by collapse?

Septic shock

Bronchial obstruction

Exudative pleuritis

Emphysema

Toxic hepatitis

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A patient, aged 48, complains of heaviness in the right hypochondrium, itching of the skin. Repeatedly he had been treated in infectious diseases hospital because of icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall veins, protruding navel, spleen enlargement. Diagnosis is:

Viral hepatitis B

Cancer of the head of pancreas

Liver cirrhosis

Cancer of the liver

Gallstones

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A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. Diagnosis is:

Gastritis of type A

Reflux-gastritis

Rigid antral gastritis

Menetrier’s gastritis

Gastritis of type B

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

Continue with the current therapy

Prescribe guanyl guanidines

Give Glurenorm instead of Maninilum

Prescribe fast-acting insulin

Prescribe long-acting insulin

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Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?

Tuberculoma

Focal

Miliary

Disseminated

Fibro-cavernous

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

Vasculitis

Ritter’s disease

Psoriasis

Lichen ruber planus

Seborrhea

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A female 28 years old patient became depressed, her mood is melancholic; this state is accompanied by hypobulia, hypokinesia, slow speed of thinking. Her attitude towards her past, present and future is pessimistic. The pathogenetic mechanism of this state is supposed to involve dysfunction in the:

Corpus callosum

Pituitary

Hippocampus

Hypothalamus

Frontal lobes

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The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stays in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:

Catatonic stupor, schizophrenia

Depressive stupor, bipolar disorder

Apathetic stupor, schizophrenia

Psychogenic stupor, stress disorder

Dissociative stupor, dissociative psychosis

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A 50 year old patient has been admitted to the clinics with atrophic gastritis. Blood count: erythrocytes -3,8 • 1012/l, Hb - 68 g/l, c.i. - 1, macroanisocytosis, poikilocytosis. There is megaloblastic type of haemopoesis. A number of leukocytes, reticulocytes and thrombocytes is lreduced. Which pathology is suspected?

B12-deficiency anemia

Irondeficiency anemia

Post-hemorrhagic anemia

Thalassaemia

Hemolytic anemia

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A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39,0oC, headache, weakness, constipation on the 9th day of the disease. On examination : single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?

Malaria

Leptospirosis

Typhoid fever

Sepsis

Brucellosis

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A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, acholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?

Cholangitis

Hepatic encephlopathy

Meningitis

Infectious-toxic shock

Relapse of viral hepatitis

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An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In blood: leukocytosis, atypical lymphocytes 15 %. What is the most probable diagnosis?

Adenoviral infection

Diphtheria

Angina

Acute lymphoid leukosis

Infectious mononucleosis

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A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:

Metastatic disease of liver

Malignant biliary stricture

Carcinoma of the head of the pancreas

Infectious hepatitis

Haemolytic jaundice

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A 33 year old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP - 60/30 mm Hg, Ps - 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb - 80 g/l, red blood cell count - 2,5 • 1012/l. The reduction of blood volume averages:

15-20 %

20-25 %

10-15 %

25-30 %

30-40%

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A 19 year old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:

Oxygen inhalation

Gastric lavage

Caffeine injection

Controlled respiration

Cordiamine injection

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A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:

BUN

Sedimentation rates

SGOT (ALT)

Alkaline phosphatase

WBCs

‹ Назад

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An endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage:

IIIA

IC

IVAB

IIA

IIB

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A 56 year old woman has an acute onset of fever up to 39°C 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, RR-26/min. There is dullness over the right lung on percussion. On X-ray: infiltrate in the right middle lobe of the lung. What is the diagnosis?

Acute lung abscess

Community-acquired bronchopneumonia

Community-acquired lobar pneumonia of moderate severity

Acute pleuritis

Nosocomial lobar pneumonia

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A 26 year old man was admitted to the hospital because of stabbing back pain on inspiration and dyspnea. Examination results: BT of 37°C, Ps of 24/min, HR of 92/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard on both expiration and inspiration in the left inferior lateral part of the chest. What is the most likely diagnosis?

Acute fibrinous pleuritis

Myocarditis

Pneumonia

Acute bronchitis

Pneumothorax

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A 34 year old woman fell ill 3 months ago after cold exposure. She complained of pain in her hand and knee joints, morning stiffness and fever up to 38oC. Interphalangeal, metacarpophalangeal and knee joints are swollen, hot, with reduced ranges of motions; ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you recommend the patient?

Fluorchinolones

Tetracyclines

Cephalosporines

Sulfonamides

Nonsteroidal anti-inflammatory drugs

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A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has been suffering from for a year. Last week the attacks repeated every day and became more painful. What diagnostic study would you recommend?

Ultrasound examination of the gallbladder

Blood cell count

X-ray examination of the gastrointestinal tract

Ultrasound study of the pancreas

Liver function tests

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A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?

Heparin

Penicillin OS

Dipyridamole

Ceftriaxone

Ciprofloxacine

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A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?

Parkinson syndrome

Mercury encephalopathy

Neuroinfection

Chronic mercury intoxication

Acute mercury intoxication

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A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical examination reveals tachypnea, bilateral inspiratory crackles and single expiratory wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no history of fever. White blood cell count is 15 • 109/l, with 28% of eosinophils. The most likely cause of this child’s symptoms is:

Varicella

Visceral larva migrans

Clamydia trachomanis

Pneumocystis carinii

Mycoplasma pneumoniae

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A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

Tricuspid stenosis

Mitral stenosis

Tricuspid regurgitation

Aortic stenosis

Mitral regurgitation

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A 60 year old man complains of fever, significant weight loss, bone and joint pain, bleeding gums. Examination revealed paleness, lymphadenopathy, hepato- and splenomegaly. CBC: WBC - 270 • 109/l with 13% lymphocytes, 1% monocytes, 21% basophiles, 29% neutrophils, 9 % blasts, 12% promyelocytes, 12% myelocytes, 2% metamyelocytes, 1% eosinophils. ESR -22 mm/h. Name the drug for treatment:

Vinblastine

Blood transfusion

Cytosar

Myelosan

Prednisolone

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A 54 year old woman complains of increasing fatigue and easy bruising of 3 weeks’ duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. Blood count: RBC- 2,5 • 1012//; Hb - 73 g/l; Ht - 20%; PLT- 23 • 109//; and WBC-162 • 109// with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?

Hemolytic anemia

Chronic leukemia

Acute leukemia

Thrombocytopenia

Megaloblastic anemia

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The highest risk of congenital anomalies probably occurs when human embryos or fetuses are exposed to ionizing radiation. At what stage of gestational period does it occur?

10-14 days after conception

18-45 days after conception

The first 7 days

90-120 days after conception

The third trimester

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A 28 year old woman was admitted to the emergency room with a slightly reddened, painful 'knot'8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. The most likely diagnosis is:

Cellulitis

Subcutaneous hematoma

Superficial venous thrombosis

Insect bite

Early deep vein thrombosis

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A 25 year old patient complains of pain in the I finger on his 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?

Articular (joint) panaritium

Subcutaneous panaritium

Paronychia

Bone panaritium

Thecal whitlow (ligament panaritium)

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A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 mm, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

Acute purulent otitis media

Chronic purulent otitis media

Acute mastoiditis

Chronic secretory otitis media

Eustachian tube disfunction

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Among the following causes of acute renal failure, the one that would be classified as 'postrenal'is:

Rhabdomyolysis

Septicemia

Calculi

Acute glomerulonephritis

Cardiac failure

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A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?

Spontaneous left-sided pneumothorax

Left-sided pneumonia

Pulmonary abscess

Pulmonary infarction

Pleuritis

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During an operation for presumed appendicitis the appendix was found to be normal; however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayishwhite exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:

Crohn’s disease of the terminal ileum

Ulcerative colitis

Ileocecal tuberculosis

Perforated Meckel’s diverticulum

Acute ileitis

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A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid enlargement complains of 10 pound weight gain and fatigue. What is the most probable diagnosis?

Papillary thyroid carcinoma

Riedel’s thyroiditis

Hashimoto’s thyroiditis

Subacute thyroiditis

Suppurative thyroiditis

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A severely traumatized patient who has been receiving prolonged parenteral alimentation develops diarrhea, mental depression, alopecia and perioral and periorbital dermatitis. Administration of which of the following trace elements is most likely to reverse these complications?

Selenium

Iodine

Zinc

Copper

Silicon

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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 deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?

Acute purulent lymphadenitis

Anthrax

Tularemia

Lymphogranulomatosis

Bubonic plague

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A 56 year old patient has worked at the aluminium plant over 20 years. Within 3 last years he has been experiencing loosening of teeth, bone and joint pains, piercing pains in heart region, vomiting. The provisional diagnosis is:

Phosphorus intoxication

Manganese intoxication

Fluorine intoxication

Lead intoxication

Mercury intoxication

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An excited patient constantly tries to look into the next room because he is sure of his friends’ presence. He claims to hear his friends and other people talking although no-one is there. He tries to persuade his doctor that people in the next room are disputing about 'his punishment', repeats aloud phrases he has allegedly heard from the next room. What state is it?

Acute hallucinosis

Confabulations

Delusion

Obsessional ideas

Verbal illusions

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Survey radiograph of chest of a 62 year old smoker who often suffers from 'pneumonias'showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed devi- ation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?

Atelectasis

Lung abscess

Lung cyst

Peripheral cancer of lung

Cenral cancer of lung

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A 68 year old patient has been suffering from chronic pancreatitis for 35 years. During the last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested food), progressing weight loss. Change of symptom set is caused by joining of:

Irritable bowels syndrome

Endocrine pancreatic insufficiency

Syndrome of lactase deficiency

Chronic enterocolitis

Exocrine pancreatic insufficiency

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A 60 year old patient has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining about amotivati-onal bad mood, problems with attention concentration; she forgets to close the entrance door, cannot recall events of the last day. Computer tomography shows areas of postinfarction changes in the cortical postfrontal regions. What is the most probable diagnosis?

Pick’s disease

Vascular dementia

Dissociative amnesia

Alzheimer’s disease

Huntington’s chorea

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A 40 year old patient complains of yellowish discharges from the vagina. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:

Treatment of specific colpitis and subsequent biopsy

Cryolysis of cervix of the uterus

Diathermocoagulation of the cervix of the uterus

Cervix ectomy

Specific treatment of Trichomonas colpitis

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A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

Vibration disease

Hypovitaminosis of B1

Caisson disease

Noise disease

Overwork symptoms

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A 25 year old patient complains about weakness, dizziness, appearance of haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1,0 • 1012/l, Hb- 37 g/l, colour index - 0,9, leukocytes - 1,2 • 109/l, thrombocytes - 42 • 109/l. What diagnostic method will be the most effective?

Coagulogram

Abdominal ultrasound

Sternal puncture

Spleen biopsy

Liver biopsy

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A 28 year old woman had the second labour and born a girl with manifestations of anemia and progressing jaundice. The child’s weight was 3 400 g, the length was 52 cm. The woman’s blood group is B (III) Rh-, the father’s blood group is A (III) Rh+, the child’s blood group is B ( III) Rh+. What is the cause of anemia?

Antigen AB incompatibility

Antigen A incompatibility

Rhesus incompatibility

Antigen B incompatibility

Intrauterine infection

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A 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, mydriatic pupils, difficult diglutition, bradycardia, constipation. What is the diagnosis?

Salmonellosis, gastrointestinal form

Yersiniosis

Lambliasis

Botulism

Leptospirosis

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Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as maximum permissible?

0,1%

0,05%

0,15%

0,3%

0,2%

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Study of actual diet of an adult revealed the following: proteins make up 16% of energy value of daily ration, fats - 25%, carbohydrates - 59%. Evaluate compliance of protein, fat and carbohydrate share in the energy value of daily ration with the recommended shares of these nutrients?

Carbohydrate share is insufficicent

Nutrient content complies with the recommended shares of energy value

Fat share is insufficient

Carbohydrate share is insufficient, there is excess of proteins

Carbohydrate share is excessive

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A healthy 75 year old 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 millimol/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 saturated fats consumption

Any dietary changes are necessary

Decrease of carbohydrates consumption

Increase of cellulose consumption

Decrease of cholesterol consumption

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Periodical survey of a worker of a chemicals plant revealed a malignant neoplasm on the urinary bladder. This occupational disease was the most probably caused by contact with the following industrial poison:

Benzidine

Arsenic

Nickel carbonyl

Vinyl chloride

Asbestos

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A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was diagnosed

Generation of antithrombocytic antibodies

Inherited insufficiency of plasm factors of blood coagulation

Deficit of the VIII factor of blood coagulation

Iron deficit in blood serum, bone marrow and depot

Disturbed hemostasis

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A child with tetralogy of Fallot is most likely to exhibit:

Increased pressure in the right ventricle

Increased pulse pressure

Normal oxygen tension (PaO2) in the left ventricle

Normal pressure gradient across the pulmonary valve

Increased pulmonary blood flow

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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 is the most significant?

The right to the information

The right to be heard

The right to the protection of the patient’s interests

The right to the free choice

The right to the protection from incompetence

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

River water

Artesian well water

Melt snow water

Spring water

Rain water

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A man in grave condition was delivered to the admission ward of a hospital on the 2nd day of illness. Examination revealed body temperature of 36,1oC, sharpened features of face, dry skin that makes a fold, aphonia, convulsive twitching of some muscle groups. Acrocyanosis is present. Heart sounds are muffled, Ps is 102 bpm, AP is 50/20 mm Hg. Abdomen is soft, drawn-in, painless. Anuria is presnt. Stool is liquid in form of rice water. What is the most probable diagnosis?

Acute dysentery

Cholera

Salmonellosis

Escherichiosis

Intestinal amebiasis

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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 patients’ treatment. What index of hospital work can be calculated on the base of this data?

Bed resources of the hospital

Average bed idle time

Average duration of patients’ presence in the hospital

Average annual bed occupancy

Bed turnover

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A 3 year old 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 millimol/l. What is the most probable diagnosis?

Bronchiectasis

Recurrent bronchitis

Pulmonary hypoplasia

Bronchial asthma

Mucoviscidosis (cystic fibrosis)

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A 14 year old 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?

Hormonoproductive ovary tumor

Werlholf’s disease

Incomplete spontaneous abortion

Juvenile bleeding, posthemorrhagic anemia

Polycyst ovarian syndrome

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A 43 year old 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. Stenosing papillitis 0,5 cm long has been revealed. What is the best way of treatment?

To perform choledochoduodenostomy

To perform transduodenal papillosphincterotomy

To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

To perform external choledoch drainage

To perform endocsopic papillosphincterotomy

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A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky’s symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?

Finger’s pseudofurunculosis

Phlegmon of newborn

Exfoliative dermatitis

Impetigo neonatorum

Mycotic erythema

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An outpatient hospital made record of 11600 diseases within one year. Among them influenza and ARD make up 5800, circulatory system diseases - 3480, digestion diseases - 1300, other diseases - 1020. What relative index can be calculated according this data?

Correlation

Intensive

Visualization

Extensive

-

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A 35 year old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent 'Lotos'. The patient has been using it for a month. She hasn’t suffered from dermatological diseases before. What is the most probable diagnosis?

Dermatitis simplex

Microbial eczema

Allergic dermatitis

Toxicoallergic dermatitis

Localized neurodermatitis

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A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

Disorder of gastric motor activity

Chelicobacterial infection

Autoantibody production

Reduced prostaglandin synthesis

Dietary allergy

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A 48 year old woman complains about weakness, weight loss, appetite loss, headache. The patient had acute glomerulonephritis when she was young. She has been suffering from arterial hypertension since she was 25. She didn’t undergo systematic treatment, consulted a doctor rarely. Examination revealed signs of chronic renal insufficiency of the I stage ( creatinine - 0,43 millimole/l). What dietary recommendations are the most reasonable?

Restriction of protein consumption

Restriction of carbohydrate consumption

Restriction of fat consumption

Diet with high content of 'alkaline' dishes

Consumption of higher amounts of liquid

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A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38 oC. She had influenza a week ago. Objectively: Ps -100 bpm, dropped-beat pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?

Myocardium infarction

Stenocardia

Exudative pericarditis

Dilatation cardiomyopathy

Myocarditis

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Examination of a 4 month old child revealed some lemon-yellow squamae with fatty crusts on the scalp. What is the most probable diagnosis?

Pseudofurunculosis

Gneiss

Strophulus

Milk crust

Infantile eczema

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A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages. The patient had acute glomerulonephritis at the age of 15 . Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, pallor of skin and mucous membranes. What chemestry test has the greatest diagnostic importance in this case?

Uric acid

Fibrinogen

Blood creatinine

Blood sodium

Blood bilirubin

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

Amysyl

Obsidan

Aminophylline

No-shpa

Corglicone

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A 23 year old man complains about face edemata, headache, dizziness, reduced urination, change of urine colour (dark-red). These presentations appeared after pharyngitis. Objectively: face edemata, pale skin, temperature -37,4oC; heart rate - 86/min, AP - 170/110 mm Hg. Heart sounds are muffled, the II sound is accentuated above aorta. What etiological factor is probable in this case?

Alpha-hemolytic streptococcus

Staphylococcus aureus

Pyogenic streptococcus

Saprophytic staphylococcus

(3-hemolytic streptococcus

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A 12 year old girl complains about abrupt weakness, nausea, dizziness, vision impairment. The day before she ate home-made stockfish, beef. Examination revealed skin pallor, a scratch on the left knee, dryness of mucous membranes of oral pharynx, bilateral ptosis, mydriatic pupils. The girl is unable to read a simple text (mist over the eyes). What therapy

Parenteral introduction of antitetanus serum

Gastric lavage

Parenteral introduction of antibiotics

Parenteral disintoxication

Parenteral introduction of polyvalent antibotulinic serum

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A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and postoperative treatment plan?

Cryoprecipitate

Fresh frozen blood

Native plasma

Fresh frozen plasma

Dried plasma

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An 18 year old woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37,5oC, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal and speculum examination results: 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?

Recent acute ascending gonorrhea

Candydomycosis

Trichomoniasis

Chlamydiosis

Chronic gonorrhea

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A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasn’t applied any contraceptives. What method should be applied in order to specify her diagnosis?

Bimanual vaginal examination

Roentgenography of small pelvis organs

Palpation of mammary glands and pressing-out of colostrum

Speculum examination

Ultrasonic examination

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A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:

150 g less than necessary

Paratrophy of the I grade

Corresponding to the age

Hypotrophy of the I grade

Hypotrophy of the II grade

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A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

Lacteal cyst with suppuration

Breast cancer

Lactational mastitis

Phlegmon of mammary gland

Fibrous adenoma of the left mammary gland

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A 32 year old patient complai- ns about pain in small joints of her hands, paresthesia at the tips of fingers, weakness, difficult diglutition. She has been suffering from this for 13 years. Objectively: face amimia, shortening of nail bones, skin indurations in the area of shoulder girdle are present. Roentgenological examination of lungs revealed basal pneumosclerosis. Fibrogastroscopy revealed esophagus constriction in its cardial part. Blood count: leukocytes 9,8 • 109/l, ESR - 22 mm/h, y-globulin - 22%. What is the most probable diagnosis?

Rheumatoid arthritis

Dermatomyositis

Systemic lupus erythematosus

Myxedema

Systemic scleroderma

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A 30 year old woman ill with influenza felt palpitation and dull cardiac pain during moderate physical exercise. Objectively: Ps - 96 bpm, AP - 100/60 mm Hg. The first sound is quiet above the apex, soft systolic murmur is present. What complication is indicated by these clinical presentations?

Acute viral myocarditis

Idiopathic myocarditis

Myocardiopathy

Acute allergic infectious myocarditis

Neurocirculatory dystonia

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A 5 month old boy was born prematurely, he didn’t suffer from any disease at the infant age and later on. Examination at an outpatient’s hospital revealed paleness of skin, sleepiness. Blood count: Hb - 95 g/l, erythrocytes - 3,5 • 1012/l, reticulocytes - 9%o, colour index - 0,7, osmotic stability of erythrocytes - 0,44-0,33%, serum iron - 4,9 micromole/l. What is the most probable cause of anemia?

Iron deficit

Erythrocyte hemolysis

Infectious process

B12 deficit

Hemogenesis immaturity

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A 13 year old girl 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

Werlhof’s disease

Haemophilia

Menarche

Endometrium cancer

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An 8 year old girl complains about joint pain, temperature rise up to 38oC, dyspnea. Objectively: the left cardiac border is deviated by 2,5 cm to the left, tachycardia, systolic murmur on the apex and in the V point are present. Blood count: leukocytes - 20,0 • 109/l, ESR - 18 mm/h. What sign gives the most substantial proof for rheumatism diagnosis?

Carditis

Fever

Accelerated ESR

Arthralgia

Leukocytosis

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During inspection of sanitary conditions of studying at a 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?

Time of the room insolation

Natural light coefficient

Depth of study room

Light coefficient

Presence of mixed (superolateral) light

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A 70 year old man is suffering from coronary heart disease. His mood is evidently depressed, anxious. As a result of continious 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?

Asthenic syndrome

Obsessive syndrome

Depressive syndrome

Phobic syndrome

Paranoid syndrome

‹ Назад

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A 37 year old farmer complains about general weakness, spastic pain in the lower parts of his abdomen, mainly in the left iliac area, frequent defecations up to 18 times a day, feces contain admixtures of mucus and blood. The illness began abruptly 3 days ago with chill, fever, headache. General condition is moderately severe, body temperature is 37,8oC. Sigmoid colon is spasmed and painful. What is the most probable diagnosis?

Yersiniosis

Dysentery

Nonspecific ulcerative colitis

Salmonellosis

Amebiasis

‹ Назад

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A 3 year old child fell acutely ill, body temperature rose up to 39,5oC, the child became inert, there appeared recurrent vomiting, headache. Examination revealed positive meningeal symptoms, after this lumbal puncture was performed. Spinal fluid is turbid, runs out under pressure, protein concentration is 1,8 g/l; Pandy reaction is +++, sugar concentration is 2,2 millimole/l, chloride concentration - 123 millimole/l, cytosis is 2, 35 • 109 (80% of neutrophils, 20 % of lymphocytes). What is the most probable diagnosis?

Subarachnoid haemorrhage

Serous viral meningitis

Serous tuberculous meningitis

Purulent meningitis

Brain tumour

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A 39 year old patient suffering from hypertension felt suddenly intense headache in the region of occiput; there appeared recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps - 88 bpm, AP - 205/100 mm Hg, painfulness of occipital points, rigidity of occipital muscles are present. Kernig’s symptom is bilaterally positive. Subarachnoid haemorrhage is also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?

Ultrasonic dopplerography

Computer tomography

EEG

Examination of eye fundus

Lumbar puncture

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A 10 year old girl complains about abdominal pain that is arising and getting worse after eating rough or spicy food. She complains also about sour eructation, heartburn, frequent constipations, headache, irritability. She has been suffering from this for 12 months. Objectively: the girl’s diet is adequate. Tongue is moist with white deposit at the root. Abdomen is soft, painful in its epigastric part. What study method will help to make a diagnosis?

Contrast roentgenoscopy

Fractional examination of gastric juice

Esophagogastroduodenoscopy

Biochemical blood analysis

Intragastral pH-metry

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A 35 year old patient who suffers from chronic glomerulonephritis and has been hemodialysisdependent for the last three years developed intermissions of heart activity, hypotension, progressing weakness, dyspnea. ECG showed bradycardia, atrioventricular block type I, high pointed waves T. The day before the flagrant violation of diet took place. What is the most probable cause of these changes?

Hyperkaliemia

Hypocalciemia

Hypokaliemia

Hypernatriemia

Hyperhydratation

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A 34 year old coal miner who has been in service for 10 years was discharged from an occupational disease clinic after examination and treatment. He was diagnosed with the I stage of anthracosilicosis, peribronchitis, 0 stage of respiratory failure. What expert decision should be taken about his working capacity?

He should stay on the sick-list to consolidate treatment results

He should be referred to the local medical expert comission for determination of his disability group for the period of re-training

He should be given medical certificate for the further out-patient treatment

He should be referred to the local medical expert comission for determination of percentage of working capacity loss

He can continue working as coal miner provided that sanitary and hygienic conditions are observed

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A 52 year old woman complains about face distortion. It appeared 2 days ago after supercooling. Objectively: body temperature is 38, 2oC. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn’t close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes - 10 • 109/l, ESR - 20 mm/h. What is the most probable diagnosis?

Facial neuritis

Brain tumour

Ischemic stroke

Hemicrania (migraine)

Trigeminus neuralgia

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A patient complained about general weakness, fever, painful rash on his trunk skin . He has been suffering from this for 3 days. Objectively: lateral surface of trunk on the left is hyperemic and edematic, there are some groups of vesicles with serous and haemorrhagic contents. What is the most probable diagnosis?

Contact allergic dermatitis

Microbial eczema

Herpes zoster

Herpetiform Duhring’s dermatosis

Contact dermatitis simplex

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Internal obstetric examination of a parturient woman revealed that the sacrum hollow was totally occupied with fetus head, ischiadic spines couldn’t be detected. Sagittal suture is in the straight diameter, occipital fontanel is directed towards symphysis. In what plane of small pelvis is the presenting part of the fetus?

Over the pelvic inlet

Plane of pelvic outlet

Narrow pelvic plane

Plane of pelvic inlet

Wide pelvic plane

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A 24 year old patient complains about general weakness, dizziness, body temperature rise up to 37,5oC, sore throat, neck edema, enlargement of submaxillary lymph nodes. Objectively: mucous membrane of oropharynx is edematic and cyanotic, tonsils are enlarged and covered with films that spread beyond the tonsils and cannot be easily removed. What is the leading mechanism of this illness’ development?

Accumulation of suboxidated products

Bacteriemia

Allergic

Action of bacterial endotoxin

Action of bacterial exotoxin

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A 38 year old man complains about mild pain and muscle weakness of shoulder and pelvic girdles and back that has been progressing for the last 3 weeks. He has also significant problems with getting up, going up and down the stairs and shaving. It is suspected that the patient is suffering from dermatomyosi-tis. Blood count: Hb - 114 g/l, leukocytes - 10,8 • 109/l, eosin - 9%, ESR - 22 mm/h, C-reactive protein (++). Change of the following laboratory factor will be of the greatest diagnostic importance:

y-globulins

Antibodies to the native DNA

Creatine phosphokinase

Ceruloplasmin

Sialic acids

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A 9 year old boy has been suffering from diabetes mellitus for a year. He gets insulin injections ( humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day. Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures should be taken in order to prevent lipodystrophy?

To apply periodically other types of insulin

To change point of introduction

To limit fats in the boy’s diet

To reduce insulin dose

To administer antioxidants

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A 25 year old pediatrician fell ill a week ago: body temperature rose up to 37,6oC, there appeared a slight swelling on his neck. His illness was diagnosed as ARD, cervical lymphadenitis. Treatment course included erythromycin, hot compress on the neck. In course of treatment body tempearture rose up to 39oC, there appeared headache, repeated vomiting, meningeal syndrome. What studies are necessary for the final diagnosis?

Complete blood count

Puncture of cervical lymph node

Cerebrospinal puncture

Sputum test for secondary flora

Roentgenological examination of lungs

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A 41 year old 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, ESR - 52 mm/hour. What medication provides pathogenetic treatment of this patient?

Vikasolum

Motilium

Linex

Kreon

Sulfosalasine

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

Increase of plasma renin activity

Increase of aldosterone level in blood

Increase of thyroxine secretion

Increase of catecholamine concentration

Increase of vasopressin secretion

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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?

Esophageal atresia

Aerophagia

Acute gastroenteritis

Pylorospasm

Pylorostenosis

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Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?

Chronic tonsillitis

Tonsillar tumour

Acute lacunar tonsillitis

Paratonsillitis

Chronic pharyngitis

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A 43 year old patient had rightsided deep vein thrombosis of iliofemoral segment 3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right extremity. Objectively: moderate edema of shin, brown induration of skin in the lower third of shin, varix dilatation of superficial shin veins are present. What is the most probable diagnosis?

Acute thrombosis of right veins

Acute thrombophlebitis of superficial veins

Postthrombophlebitic syndrome, varicose form

Lymphedema of lower right extremity

Parkes-Weber syndrome

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A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?

Mycosis

Hydradenitis

Furuncle

Herpes zoster

Streptococcal impetigo

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A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in the arm is absent. 'Scarf'symptom is positive. What is the most probable diagnosis?

Tetraparesis

Distal right-sided obstetric paralysis

Total right-sided obstetric paralysis

Proximal right-sided obstetric paralysis

Hemiparesis

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An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?

Cabbage

Pasteurized milk

Potatoes

Tinned food

Boiled meat

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A 42 year old metalworker has been working at the turning machine for production of heavy large-size parts for 5 years. His work requires using of hand and pedal levers that involves considerable physical force. What means for osteoarthrosis prevention should be recommended?

To go in for weightlifting

To administer protein-and-vitamin diet

To limit physical work

To improve health at the Black sea coast

To administer protein-and-carbohydrate diet

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A 30 year old patient undergoes treatment because of Werlhof’s disease. Objectively: the patient is pale, there are petechial haemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2,8 • 1012/l, Hb - 90 g/l, Ht -0,38, thrombocytes - 30 • 109/l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?

Native erythrocytic mass

Stored blood

Erythrocytic suspension

Washed erythrocytes

Thrombocytic mass

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A 19 year old boy was admitted to a 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 specify the patient’s blood group and rhesus compatibility?

An anaesthesilogist

A laboratory physician

A doctor of any speciality

A traumatologist

A surgeon

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Clinical and statistical study was devoted to the effect of a new pharmacological medication upon the patients with coronary heart disease. What parametric criterion (coefficient) can be used for estimation of results validity?

Student’s coefficient (t)

Sign criterion

Kolmogorov-Smirnov’s criterion

Wilcoxon’s t-criterion

Conformity coefficient

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It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?

Bathroom unit

Patient’s examination room

Manipulation room

Doctor’s consulting room

Nursing room

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A 30 year old man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39oC. There was an 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 and ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?

Rheumatoid arthritis

Osteoarthritis

Gout

Erysipelatous inflammation

Infectious arthritis

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Preventive examination of a 55 year old patient revealed diabetes mellitus. The patient hasn’t received treatment for it. Objectively: height is 170 cm, weight is 106 kg, skin humidity is normal. Ps is 76 bpm, rhythmic, left border of relative heart dullness is deviated by 1 cm to the left from the middle clavicular line, heart sounds are quiet, AP is 140/80 mm Hg. Glycemia on an empty stomach is 6,9 millimole/l. Glucose rate in the daily urine is 0,5%, diuresis makes up 2,5 l. What treatment tactics should be chosen?

To administer glibenclamid

To administer insulin

To administer dietotherapy

To administer metformin

To administer repaglinide

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Далі ›

The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of popultaion. What statistic method should be chosen?

Calculation of dynamic indices

Calculation of correlation coefficient

Calculation of coefficient of difference validity

Calculation of conformity coefficient

Calculation of regression coefficient

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In order to improve organism tolerance of boarding-school pupils a doctor developed a program. The program is based upon the following principles: graduality, consistency, individuality, coomplexity. What of the main principles of organism tempering wasn’t taken into account?

Increase of resistance

Increase of influence intensity

Autodefense increase

Increase of influence force

Systematicness

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A patient complains about pyrosis and permanent pain behind his breastbone. When he bends forward after eating there appears regurgitation. Roentgenological examination revealed extrasaccular cardiofunctional hernia of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux-esophagitis. What is the necessary tretment tactics?

Operation in a surgical department

Treatment at a health resort

Conservative treatment in a surgical department

Conservative treatment in an outpatients’ clinic

Conservative treatment in the therapeutic hospital

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15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested symptoms of Quincke’s edema. What medication should be applied for emergency aid?

Heparin

Furosemide

Seduxen

Adrenalin

Prednisolone

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During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul’s respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?

Introduction of long-acting insulin

Intravenous infusion of glucose along with insulin

Intravenous infusion of sodium chloride saline

Intravenous infusion of neohaemodesum along with glutamic acid

Intravenous infusion of short-acting insulin

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In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:

August’s psychrometer

Mercury thermometer

Assmann psychrometer

Thermograph

Alcohol thermometer

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A 3 month old child has occiput alopecia, anxious sleep, excessive sweating. What disease might be suspected?

Chondrodystrophy

Rachitis

Spasmophilia

Phosphate diabetes

Anemia

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

Manual exploration of the uterine cavity

Urine drainage, cold on the lower abdomen

Introduction of uterine contracting agents

Introduction of hemostatic medications

External massage of uterus

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A 7 year old boy has periods of loss of attention that last 10-15 seconds and occur several times a day. During these periods he stands still in one position, doesn’t answer the questions or react when he is called by his name. Neurological examination revealed no changes. What diagnostic method should be applied to specify his diagnosis?

Echoencephalography

Examination of evoked potentials

Electroencephalography

Computer tomogram

Skull roentgenogram

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A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of 'meat slops'. Objectively: the patient’s condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?

Multiple bronchiectasis

Chronic pneumonia

Lung abscess

Lung gangrene

Pleura empyema

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A 15 year old patient suffers from headache, nasal haemorrhages, sense of lower extremity coldness. Objectively: muscles of shoulder girdle are developed, lower extremities are hypotrophied. Pulsation on the pedal and femoral arteries is sharply dampened. AP is 150/90 mm Hg, 90/60 on the legs. Systolic murmur can be auscultated above carotid arteries. What is the most probable diagnosis?

Aortal insufficiency

Aortal stenosis

Aorta coarctation

Aorta aneurism

Coarctation of pulmonary artery

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A patient with frostbite of both feet was delivered to the admission ward. What actions should be taken?

To apply an alcohol compress

To administer cardiac medications

To apply a bandage, to introduce vasodilating medications

To put feet into hot water

To rub feet with snow

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A patient has a stab wound on his right foot. On the fourth day after injury the patient’s body temperature rose up to 38oC, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?

Lymphadenitis

Tetanus

Phlegmon

Lymphangitis

Erysipelas

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A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?

Occlusion of the left subclavicular artery, steal syndrome

Occlusion of brachiocephalic trunk

Thoracal outlet syndrome

Takayasu’s disease

Raynaud’s syndrome

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Далі ›

A 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0,02 excentri-cally, eye fundus has haemorrhages of different forms and sizes ( 'squashed tomato'symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis?

Thrombosis of central vein of retina

Hypertensive angiopathy

Embolism of central artery of retina

Hypertensive angioneuropathy

Diabetic retinopathy

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Далі ›

A 28 year old patient complained about prolongation of intermenstrual periods up to 2 months, hirsutism. Gynaecological examination revealed that the ovaries were enlarged, painless, compact, uterus had no peculari-ties. Pelvic ultrasound revealed that the ovaries were 4-5 cm in diameter and had multiple enlarged follicles on periphery. Roentgenography of skull base showed that sellar region was dilated. What is the most probable diagnosis?

Sheehan’s syndrome

Premenstrual syndrome

Morgagni-Stewart syndrome

Algodismenorrhea

Stein-Leventhal syndrome

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A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has been having amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?

Homological blood syndrome

Stein-Leventhal syndrome

Sheehan’s syndrome

Vegetovascular dystonia

Shereshevsky-Turner’s syndrome

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A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes melli-tus for 15 years, doesn’t receive regular treatment. What complication of diabetes mellitus is it?

Haematoma

Fracture of the IV toe on the right foot

Gangrene of the IV toe on the right foot

Erysipelas

Panaritium

‹ Назад

Далі ›

Preventive examination of an 11 year old boy helped to determine his habitus type. It was established that the child’s shoulders were deviated and brought forward, with forward flexion of head, the thorax was flattened, abdomen was convex. The child’s backbone had signs of deepened cervical and lumbar curvatures. What habitus is it?

Kyphosis

Corrected

Lordosis

Normal

Round-shouldered

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During hygienic examination of a hospital it was established that the area for each bed in a double ward was: in the infectious department for children - 7 m2, in the infectious department for adults -8 m2, in the burns department - 9 m2, in the radiological department -10 m2, in the critical care department - 13 m2. In which wards the area for each bed doesn’t correspond with hygienic requirements?

In critical care wards

In infectious wards for adults

In burns wards

In infectious wards for children

In radiological wards

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A 2 year old child has been ill with acute respiratory viral infection of upper thrice a year - in February, in April and in December. How should these occurences be recorded?

It is necessary to fill in 1 statistic talon signed (+) and 2 statistic talons signed (-)

It is necessary to fill in 1 statistic talon signed (+)

It is necessary to fill in 1 statistic talon signed (-)

It is necessary to fill in 3 statistic talons signed (-)

It is necessary to fill in 3 statistic talons signed (+)

‹ Назад

Далі ›

Researchers studied disease incidence of influenza and acute respiratory viral infection within the last 5 years. What kind of graphic presentation should be used for the best visualization of this data?

Pie diagram

Bar diagram

Radial diagram

Histogram

Linear diagram

‹ Назад

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A 55 year old patient felt suddenly sick in a hospital corridor, he was immediately examined by a doctor. Examination revealed that the patient’s skin was pale, autonomous respiration was absent, pulse on carotid arteries couldn’t be felt, pupils were mydriatic. What action should be taken at the beginning of cardiac resuscitation?

Precordial thump

Restoration of airway patency

Mouth-to-mouth ventilation

Defibrillation

Closed-chest cardiac massage

‹ Назад

Далі ›

A 24 year old patient complained about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type, body weight index is 33,2 kg/m2, waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most probable diagnosis?

Alimentary constitutional obesity of the I stage, abdominal type

Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type

Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type

Alimentary constitutional obesity of the III stage, gynoid type

Alimentary constitutional obesity of the II stage, abdominal type

‹ Назад

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A parturient woman is 27 year old, it was her second labour, delivery was at term, normal course. On the 3rd day of postpartum period body temperature is 36,8oC, Ps - 72/min, AP 120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is the most probable diagnosis?

Postpartum metroendometritis

Physiological course of postpartum period

Lactostasis

Remnants of placental tissue after labour

Subinvolution of uterus

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Далі ›

Esophagus wall of a 72 year old patient with severe concomitant pathology was injured during urgent fi-broesophagogastroscopy. This resulted in progressing of acute respiratory failure and collapse of the left lung. What aid should be rendered?

Left-sided thoracotomy, closure of esophagus wound

Buelau’s drainage of pleural cavity, antibacterial therapy

Left-sided thoracotomy, closure of esophagus and mediastinum wound

Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy

Endoscopic closure of esophagus wound, drainage

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Далі ›

A 46 year old woman who has been suffering from hypertension for 5 years was diagnosed with hypertensive crisis. She complains about palpitation, sense of head pulsation; heart rate is 100/min, AP is 190/100 mm Hg (haemodynamics is of hyperkinetic type). What medication should be the medication of choice?

^-adrenoceptor blocker

Adenosine pyrophosphate inhibitor

Dihydropyridine calcium antagonist

3-adrenoceptor blocker

Diuretic

‹ Назад

Далі ›

A 30 year old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4 x5x5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?

Polycystic ovaries

Bilateral ovarian tumours

Menstrual irregularity

Chronic oophoritis

Ovarian cystoma

‹ Назад

Далі ›

A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 23 minutes, there was also one-time vomiting. Objectively: the child’s condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor’s finger was stained with blood. What is the most probable diagnosis?

Gastrointestinal haemorrhage

Wilm’s tumour

Ileocecal invagination

Pylorostenosis

Helminthic invasion

‹ Назад

Далі ›

During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?

Fout-ta-ta-rou (reduplication of the 2nd sound)

Protodiastolic gallop rhythm

III physiological sound

IV physiological sound

Atrial gallop rhythm

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A 52 year old patient with disseminated vertebral osteochondrosis lifted a significant load that resulted in lumbar pain and pain along the sciatic nerve. Objectively: positive Lasegue’s sign on the left, reduced Achilles reflex. What drug would be the most effective from the pathogenetic point of view?

Diclofenac

Novocaine

Aspirin

Spasmalgon

Analgin

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