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:

Henoch-Schonlein’s vasculitis

Systemic lupus erythematosus (SLE)

Poststreptococcal glomerulonephritis

Rocky Mountain spotted fever

Idiopathic thrombocytopenic purpura

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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?

Hysteroscopy

Ultrasound

Colposcopy

Cystoscopy

Hromohydrotubation

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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:

Absolute bed rest for 1 month

Complex therapy of gestosis for 2 days

Complex therapy of gestosis for 7 days

Caesarian section immediately

Labour stimulation after preparation

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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:

Delay of the part of placenta

Injury of cervix of the uterus

Hysterorrhexis

Atony of the uterus

Hypotonia of the uterus

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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:

Thrombophlebitis of veins of the pelvis

Infective contamination of the urinary system

Infectious hematoma

Apostasis of sutures after the episi-otomy

Metroendometritis

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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:

Apostasis of sutures after episiotomy

Infectious hematoma

Infectious contamination of the urinary system

Endometritis

Thrombophlebitis of veins of the pelvis

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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?

Presenting part is in the lower region of small pelvis

Duration of uterine contractions over 30 seconds

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:

Early discharge of the amniotic waters

The beginning of the 1st stage of labour

Pathological preterm labour

The end of the 1st stage of labour

Antenatal 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:

Magnitotherapy and vitamin therapy

Hormonotherapy and proteolytic enzymes

Antibacterial therapy and adaptogens

Lasertherapy and enzymotherapy

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 projection of pleural sinus

In the point of the greatest dullness on percussion

In the 7th intercostal space along the scapular line

In the 2nd intercostal space along the middle clavicular 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?

Pentaminum of 5% - 4,0 ml

Papaverine hydrochloride of 2% - 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

Painful movable induration

Bloody discharges from the nipple

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 calcium concentration in blood

-

Reduced magnesium concentration in blood

Increased sodium consentration in blood

Increased potassium concentration in blood

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

Maternal renal disease

Twin gestation

Anencephaly

Interventricular defect of the fetus

Hydatidiform mole

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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 nebulized cromolyn sodium

Prescribe nebulized metaproterenol

Prescribe intravenous corticosteroids

Administer supplemental oxygen

Prescribe intravenous aminophylline

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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

Obesity

Coarctation of the aorta

Theophylline toxicity

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 association

Coefficient of variation

Limit

Sigma

Amplitude

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

The Indirect method (Student)

Correlation ratio

Method of graduated correlation (Armler)

Method of grade correlation (Spirman)

The quadrate method (Pirson)

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

Atrial flutter

Ventricular fibrillation

Paroxysmal supraventricular tachycardia

Paroxysmal ventricular tachycardia

Atrial fibrillation

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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:

Colonic diverticulitis

Regional enteritis

Fish tapeworm infection

Pancreatitis

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

Tetralogy of Fallot

Coarctation of the aorta

Arterial septal defect

Ventricular septal defect

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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:

Cardiac transplant rejection

Pericardial effusion

Coronary artery disease

Hyperthyroidism

Amyloidosis

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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:

Aspiration

Pericarditis

Pulmonary thromboembolism

Acute myocardial infarction

Aortic dissection

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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:

III (c)

III (a)

I

II

III (b)

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

High serum K+

Elevated BUN

High serum Na+

Elevated hematocrit

Dilute urine

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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:

Torsion of the left testicle

Sigmoid diverticulitis

Retroperitoneal haemorrhage

Herpes zoster

Leftsided renal colic

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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

Regional MSEC

Specialized (traumatologic) MSEC

The head physician of a polyclinic

Interregional general 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 pancreatectomy

Sphincterotomy

Total pancreatectomy

Distal pancreaticojejunostomy

Lateral pancreaticojejunostomy

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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:

Tube duodenostomy

Nasogastric decompression and parenteral alimentation

Immediate exploration

Duodenojejunostomy

Retrocolic gastrojejunostomy

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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 rhonchi

Absence of rales

Hyperresonance over the right chest

Pleural friction rub on the left

Distant breath sounds on the right

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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

Sell but inform customers about milk quality

Technical utilization

Do the product away

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

Draw up a statement about forensic medical examination

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

Utilisation copy of medical documents

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

Ectrodactyly

Ectromelia

Macrodactyly

Syndactyly

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

Chron’s disease

Tuberculosis of the intestine

Hirschprung’s disease

Peytz-Egers’s polyposis

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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

Hemostatic therapy

Intravenous administration of pituitrin

Administration of plasma

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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

R-scopy of abdominal cavity

Rectoromanoscopy

Laparoscopy

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

CT of the brain

MRI of the brain

Electroencephalography

Ultrasound dopplerography

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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?

US of fetus

A cardiophonography of fetus

Bacteriological examination of discharges from vagina

The test for tolerance to glucose

Determination of the contents of fetoproteinum

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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?

Tympanoplasty

Paracentesis of the drum

Cateterization of the Eustachian tube

Mastoidotomy

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?

In position of dorsal flexion of foot

In position of planter flexion of foot

At right angle with varus positioning of the foot

In position of supination

In position of pronation

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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 renal failure

Acute glomerylonephritis

Acute cystitis

Acute renal colic

Acute interstitial nephritis

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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 :

Respiratory failure of I degree

Respiratory failure of III degree

Myocarditis

Congenital heart malformation

Respiratory failure of II degree

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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?

Pseudotuberculosis

Measles

Scarlet fever

Rubella

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?

Rubella

Adenoviral infection

Measles

Pseudotuberculosis

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?

Chloramphenicol succinate and prednisone

Ampicillin and immunoglobulin

Penicillin and immunoglobulin

Chloramphenicol succinate and interferon

Penicillin and prednisone

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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?

Meningitis

Encephalitis

Myelitis

Meningoencephalitis

Neurotoxic syndrome

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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:

Septic endocarditis

Rheumatic endocarditis

Rheumatic pericarditis

Rheumatic pancarditis

Rheumatic myocarditis

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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:

Blood transfusion (conservative therapy)

Replacement blood transfusion (conservative therapy)

Antibiotics

Conservative therapy

Symptomatic therapy

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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?

15,0 kg

10,5 kg

9,0 kg

12,0 kg

11,0 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

1,0 months

3,0 months

4,0 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

Fats

Salt

Carbohydrates

Liquid

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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?

Puncture of the scrotum

Examination of the formation in Trendelenburg’s position

Palpation of the external inguinal ring

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

Diaphanoscopy

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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:

Ganglioneuroblastoma

Sarcoma of the vertebra

Ganglioneuroma

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?

Myocarditis

IHD. Unstable angina

Cardialgia due to spine problem

Myocardial dystrophy

IHD. Functional Class II angina

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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?

Hypothiazid

Clonidine

Dibazol

Nifedipin

Kapoten

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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 A

CHF- 1

CHF- 0

CHF- 2 B

CHF- 3

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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?

Phonocardiography

Chest X-ray

Ballistocardiogram

Echocardiography+Doppler-Echocardiography

ECG

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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

Exudative pleuritis

Toxic hepatitis

Bronchial obstruction

Emphysema

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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:

Liver cirrhosis

Cancer of the liver

Cancer of the head of pancreas

Gallstones

Viral hepatitis B

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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:

Menetrier’s gastritis

Gastritis of type B

Reflux-gastritis

Rigid antral gastritis

Gastritis of type A

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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?

Give Glurenorm instead of Maninilum

Continue with the current therapy

Prescribe guanyl guanidines

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?

Focal

Tuberculoma

Disseminated

Fibro-cavernous

Miliary

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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?

Lichen ruber planus

Vasculitis

Ritter’s disease

Psoriasis

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:

Pituitary

Frontal lobes

Corpus callosum

Hippocampus

Hypothalamus

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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:

Depressive stupor, bipolar disorder

Psychogenic stupor, stress disorder

Apathetic stupor, schizophrenia

Catatonic stupor, schizophrenia

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?

Irondeficiency anemia

Hemolytic anemia

Post-hemorrhagic anemia

Thalassaemia

B12-deficiency 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?

Leptospirosis

Malaria

Brucellosis

Sepsis

Typhoid fever

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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?

Meningitis

Relapse of viral hepatitis

Hepatic encephlopathy

Infectious-toxic shock

Cholangitis

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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?

Infectious mononucleosis

Adenoviral infection

Acute lymphoid leukosis

Diphtheria

Angina

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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

Haemolytic jaundice

Infectious hepatitis

Malignant biliary stricture

Carcinoma of the head of the pancreas

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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:

30-40%

15-20 %

25-30 %

10-15 %

20-25 %

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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:

Gastric lavage

Oxygen inhalation

Controlled respiration

Caffeine injection

Cordiamine injection

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

SGOT (ALT)

Alkaline phosphatase

WBCs

BUN

Sedimentation rates

‹ Назад

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

IVAB

IC

IIB

IIIA

IIA

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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

Acute pleuritis

Nosocomial lobar pneumonia

Community-acquired bronchopneumonia

Community-acquired lobar pneumonia of moderate severity

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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?

Myocarditis

Acute bronchitis

Pneumothorax

Pneumonia

Acute fibrinous pleuritis

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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?

Tetracyclines

Cephalosporines

Sulfonamides

Nonsteroidal anti-inflammatory drugs

Fluorchinolones

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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?

X-ray examination of the gastrointestinal tract

Ultrasound examination of the gallbladder

Liver function tests

Ultrasound study of the pancreas

Blood cell count

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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?

Penicillin OS

Ceftriaxone

Ciprofloxacine

Dipyridamole

Heparin

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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?

Mercury encephalopathy

Parkinson syndrome

Acute mercury intoxication

Chronic mercury intoxication

Neuroinfection

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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:

Clamydia trachomanis

Mycoplasma pneumoniae

Varicella

Pneumocystis carinii

Visceral larva migrans

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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 regurgitation

Aortic stenosis

Tricuspid stenosis

Mitral 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:

Prednisolone

Blood transfusion

Vinblastine

Myelosan

Cytosar

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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?

Megaloblastic anemia

Acute leukemia

Thrombocytopenia

Hemolytic anemia

Chronic leukemia

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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?

90-120 days after conception

18-45 days after conception

The first 7 days

10-14 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:

Subcutaneous hematoma

Early deep vein thrombosis

Cellulitis

Insect bite

Superficial venous 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

Thecal whitlow (ligament panaritium)

Bone panaritium

Paronychia

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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

Eustachian tube disfunction

Chronic secretory otitis media

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

Rhabdomyolysis

Acute glomerulonephritis

Calculi

Septicemia

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?

Left-sided pneumonia

Pulmonary infarction

Spontaneous left-sided pneumothorax

Pulmonary abscess

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:

Ulcerative colitis

Perforated Meckel’s diverticulum

Crohn’s disease of the terminal ileum

Acute ileitis

Ileocecal tuberculosis

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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?

Hashimoto’s thyroiditis

Suppurative thyroiditis

Papillary thyroid carcinoma

Subacute thyroiditis

Riedel’s 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?

Iodine

Zinc

Copper

Silicon

Selenium

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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?

Tularemia

Anthrax

Acute purulent lymphadenitis

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:

Mercury intoxication

Manganese intoxication

Phosphorus intoxication

Lead intoxication

Fluorine 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?

Verbal illusions

Acute hallucinosis

Delusion

Obsessional ideas

Confabulations

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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?

Peripheral cancer of lung

Atelectasis

Lung cyst

Lung abscess

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:

Syndrome of lactase deficiency

Chronic enterocolitis

Endocrine pancreatic insufficiency

Irritable bowels syndrome

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?

Huntington’s chorea

Alzheimer’s disease

Vascular dementia

Dissociative amnesia

Pick’s disease

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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:

Cryolysis of cervix of the uterus

Cervix ectomy

Specific treatment of Trichomonas colpitis

Diathermocoagulation of the cervix of the uterus

Treatment of specific colpitis and subsequent biopsy

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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

Overwork symptoms

Noise disease

Hypovitaminosis of B1

Caisson disease

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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?

Sternal puncture

Abdominal ultrasound

Coagulogram

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?

Intrauterine infection

Rhesus incompatibility

Antigen AB incompatibility

Antigen A incompatibility

Antigen B incompatibility

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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?

Botulism

Leptospirosis

Lambliasis

Salmonellosis, gastrointestinal form

Yersiniosis

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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%

0,2%

0,05%

0,3%

0,15%

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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 insufficient, there is excess of proteins

Carbohydrate share is insufficicent

Carbohydrate share is excessive

Fat share is insufficient

Nutrient content complies with the recommended shares of energy value

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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

Decrease of cholesterol consumption

Any dietary changes are necessary

Decrease of carbohydrates consumption

Increase of cellulose 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:

Arsenic

Asbestos

Benzidine

Vinyl chloride

Nickel carbonyl

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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

Inherited insufficiency of plasm factors of blood coagulation

Iron deficit in blood serum, bone marrow and depot

Generation of antithrombocytic antibodies

Disturbed hemostasis

Deficit of the VIII factor of blood coagulation

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

Increased pulse pressure

Increased pressure in the right ventricle

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 the protection from incompetence

The right to the protection of the patient’s interests

The right to the free choice

The right to be heard

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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:

Melt snow water

River water

Rain water

Artesian well water

Spring 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?

Escherichiosis

Cholera

Intestinal amebiasis

Acute dysentery

Salmonellosis

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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?

Average bed idle time

Bed resources of the hospital

Bed turnover

Average duration of patients’ presence in the hospital

Average annual bed occupancy

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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?

Recurrent bronchitis

Mucoviscidosis (cystic fibrosis)

Bronchiectasis

Pulmonary hypoplasia

Bronchial asthma

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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?

Werlholf’s disease

Incomplete spontaneous abortion

Polycyst ovarian syndrome

Juvenile bleeding, posthemorrhagic anemia

Hormonoproductive ovary tumor

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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 external choledoch drainage

To perform transduodenal papillosphincterotomy

To perform endocsopic papillosphincterotomy

To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

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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?

Mycotic erythema

Impetigo neonatorum

Phlegmon of newborn

Exfoliative dermatitis

Finger’s pseudofurunculosis

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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

-

Visualization

Extensive

Intensive

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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?

Localized neurodermatitis

Allergic dermatitis

Dermatitis simplex

Microbial eczema

Toxicoallergic dermatitis

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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

Reduced prostaglandin synthesis

Autoantibody production

Chelicobacterial infection

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 fat consumption

Consumption of higher amounts of liquid

Restriction of carbohydrate consumption

Diet with high content of 'alkaline' dishes

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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?

Exudative pericarditis

Stenocardia

Dilatation cardiomyopathy

Myocardium infarction

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?

Strophulus

Gneiss

Infantile eczema

Pseudofurunculosis

Milk crust

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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

Blood sodium

Fibrinogen

Blood creatinine

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?

No-shpa

Aminophylline

Obsidan

Amysyl

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?

Staphylococcus aureus

Saprophytic staphylococcus

Alpha-hemolytic streptococcus

Pyogenic streptococcus

(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 antibiotics

Gastric lavage

Parenteral disintoxication

Parenteral introduction of polyvalent antibotulinic serum

Parenteral introduction of antitetanus 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?

Dried plasma

Fresh frozen plasma

Cryoprecipitate

Fresh frozen blood

Native 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

Chronic gonorrhea

Chlamydiosis

Candydomycosis

Trichomoniasis

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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?

Palpation of mammary glands and pressing-out of colostrum

Bimanual vaginal examination

Roentgenography of small pelvis organs

Ultrasonic examination

Speculum 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:

Paratrophy of the I grade

Hypotrophy of the II grade

Hypotrophy of the I grade

Corresponding to the age

150 g less than necessary

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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?

Phlegmon of mammary gland

Fibrous adenoma of the left mammary gland

Lacteal cyst with suppuration

Breast cancer

Lactational mastitis

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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?

Systemic scleroderma

Systemic lupus erythematosus

Rheumatoid arthritis

Dermatomyositis

Myxedema

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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 allergic infectious myocarditis

Acute viral myocarditis

Neurocirculatory dystonia

Idiopathic myocarditis

Myocardiopathy

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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

B12 deficit

Infectious process

Hemogenesis immaturity

Erythrocyte hemolysis

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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

Menarche

Endometrium cancer

Werlhof’s disease

Haemophilia

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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?

Fever

Arthralgia

Leukocytosis

Carditis

Accelerated ESR

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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?

Light coefficient

Time of the room insolation

Natural light coefficient

Presence of mixed (superolateral) light

Depth of study room

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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?

Paranoid syndrome

Depressive syndrome

Obsessive syndrome

Asthenic syndrome

Phobic 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?

Amebiasis

Dysentery

Salmonellosis

Yersiniosis

Nonspecific ulcerative colitis

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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

Brain tumour

Purulent meningitis

Serous tuberculous meningitis

Serous viral meningitis

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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?

Computer tomography

Examination of eye fundus

Lumbar puncture

Ultrasonic dopplerography

EEG

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Далі ›

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?

Esophagogastroduodenoscopy

Intragastral pH-metry

Fractional examination of gastric juice

Contrast roentgenoscopy

Biochemical blood analysis

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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?

Hypernatriemia

Hyperkaliemia

Hyperhydratation

Hypocalciemia

Hypokaliemia

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

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

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

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

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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?

Ischemic stroke

Hemicrania (migraine)

Trigeminus neuralgia

Facial neuritis

Brain tumour

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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?

Herpetiform Duhring’s dermatosis

Contact allergic dermatitis

Contact dermatitis simplex

Microbial eczema

Herpes zoster

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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

Wide pelvic plane

Plane of pelvic inlet

Narrow 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?

Action of bacterial endotoxin

Accumulation of suboxidated products

Bacteriemia

Allergic

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:

Creatine phosphokinase

Ceruloplasmin

y-globulins

Sialic acids

Antibodies to the native DNA

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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 reduce insulin dose

To administer antioxidants

To limit fats in the boy’s diet

To change point of introduction

To apply periodically other types of insulin

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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?

Roentgenological examination of lungs

Sputum test for secondary flora

Cerebrospinal puncture

Complete blood count

Puncture of cervical lymph node

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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?

Kreon

Linex

Sulfosalasine

Motilium

Vikasolum

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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 vasopressin secretion

Increase of thyroxine secretion

Increase of plasma renin activity

Increase of catecholamine concentration

Increase of aldosterone level in blood

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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?

Aerophagia

Esophageal atresia

Pylorospasm

Acute gastroenteritis

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

Paratonsillitis

Acute lacunar tonsillitis

Chronic pharyngitis

Tonsillar tumour

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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 thrombophlebitis of superficial veins

Acute thrombosis of right 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?

Furuncle

Herpes zoster

Hydradenitis

Streptococcal impetigo

Mycosis

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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

Hemiparesis

Total right-sided obstetric paralysis

Proximal right-sided obstetric paralysis

Distal right-sided obstetric paralysis

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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?

Potatoes

Tinned food

Boiled meat

Cabbage

Pasteurized milk

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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-carbohydrate diet

To administer protein-and-vitamin diet

To improve health at the Black sea coast

To limit physical work

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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?

Thrombocytic mass

Native erythrocytic mass

Washed erythrocytes

Erythrocytic suspension

Stored blood

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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?

A laboratory physician

A traumatologist

An anaesthesilogist

A surgeon

A doctor of any speciality

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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?

Wilcoxon’s t-criterion

Student’s coefficient (t)

Sign criterion

Kolmogorov-Smirnov’s 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?

Doctor’s consulting room

Patient’s examination room

Nursing room

Bathroom unit

Manipulation 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?

Gout

Osteoarthritis

Erysipelatous inflammation

Rheumatoid arthritis

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 repaglinide

To administer insulin

To administer glibenclamid

To administer metformin

To administer dietotherapy

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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 coefficient of difference validity

Calculation of regression coefficient

Calculation of conformity coefficient

Calculation of dynamic indices

Calculation of correlation 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 influence intensity

Systematicness

Increase of resistance

Increase of influence force

Autodefense increase

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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?

Conservative treatment in the therapeutic hospital

Conservative treatment in a surgical department

Operation in a surgical department

Treatment at a health resort

Conservative treatment in an outpatients’ clinic

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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?

Furosemide

Prednisolone

Adrenalin

Seduxen

Heparin

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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?

Intravenous infusion of glucose along with insulin

Intravenous infusion of short-acting insulin

Intravenous infusion of sodium chloride saline

Introduction of long-acting insulin

Intravenous infusion of neohaemodesum along with glutamic acid

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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

Alcohol thermometer

Thermograph

Assmann psychrometer

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

Spasmophilia

Anemia

Rachitis

Chondrodystrophy

Phosphate diabetes

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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?

Introduction of hemostatic medications

Introduction of uterine contracting agents

Urine drainage, cold on the lower abdomen

Manual exploration of the uterine cavity

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

Computer tomogram

Electroencephalography

Skull roentgenogram

Examination of evoked potentials

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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?

Chronic pneumonia

Lung abscess

Pleura empyema

Multiple bronchiectasis

Lung gangrene

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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

Aorta coarctation

Aortal stenosis

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 a bandage, to introduce vasodilating medications

To administer cardiac medications

To put feet into hot water

To apply an alcohol compress

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

Erysipelas

Tetanus

Lymphangitis

Phlegmon

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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 brachiocephalic trunk

Takayasu’s disease

Occlusion of the left subclavicular artery, steal syndrome

Raynaud’s syndrome

Thoracal outlet syndrome

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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?

Embolism of central artery of retina

Hypertensive angioneuropathy

Diabetic retinopathy

Hypertensive angiopathy

Thrombosis of central vein of retina

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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?

Stein-Leventhal syndrome

Algodismenorrhea

Sheehan’s syndrome

Morgagni-Stewart syndrome

Premenstrual 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?

Sheehan’s syndrome

Vegetovascular dystonia

Stein-Leventhal syndrome

Shereshevsky-Turner’s syndrome

Homological blood 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?

Panaritium

Haematoma

Fracture of the IV toe on the right foot

Gangrene of the IV toe on the right foot

Erysipelas

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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?

Lordosis

Kyphosis

Round-shouldered

Corrected

Normal

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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 radiological wards

In infectious wards for children

In infectious wards for adults

In burns wards

In critical care wards

‹ Назад

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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 3 statistic talons signed (+)

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

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

‹ Назад

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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

Histogram

Radial diagram

Bar diagram

Linear diagram

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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

Closed-chest cardiac massage

Mouth-to-mouth ventilation

Restoration of airway patency

Defibrillation

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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 II stage, gynoid type

Alimentary constitutional obesity of the III stage, gynoid type

Alimentary constitutional obesity of the II stage, abdominal type

Hypothalamic Itsenko-Cushing obesity of the I 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?

Subinvolution of uterus

Lactostasis

Remnants of placental tissue after labour

Physiological course of postpartum period

Postpartum metroendometritis

‹ Назад

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?

Endoscopic closure of esophagus wound, drainage

Left-sided thoracotomy, closure of esophagus wound

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

Buelau’s drainage of pleural cavity, antibacterial therapy

Left-sided thoracotomy, closure of esophagus and mediastinum wound

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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?

Dihydropyridine calcium antagonist

Adenosine pyrophosphate inhibitor

^-adrenoceptor blocker

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?

Menstrual irregularity

Chronic oophoritis

Polycystic ovaries

Ovarian cystoma

Bilateral ovarian tumours

‹ 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?

Ileocecal invagination

Pylorostenosis

Wilm’s tumour

Helminthic invasion

Gastrointestinal haemorrhage

‹ Назад

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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?

Protodiastolic gallop rhythm

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

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?

Spasmalgon

Novocaine

Aspirin

Analgin

Diclofenac

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