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:

Systemic lupus erythematosus (SLE)

Henoch-Schonlein’s vasculitis

Rocky Mountain spotted fever

Idiopathic thrombocytopenic purpura

Poststreptococcal glomerulonephritis

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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?

Colposcopy

Ultrasound

Hysteroscopy

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:

Complex therapy of gestosis for 2 days

Absolute bed rest for 1 month

Labour stimulation after preparation

Caesarian section immediately

Complex therapy of gestosis for 7 days

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

Hypotonia of the uterus

Delay of the part of placenta

Atony of the uterus

Injury of cervix of the uterus

Hysterorrhexis

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

Apostasis of sutures after the episi-otomy

Metroendometritis

Infective contamination of the urinary system

Thrombophlebitis of veins of the pelvis

Infectious hematoma

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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:

Thrombophlebitis of veins of the pelvis

Infectious hematoma

Infectious contamination of the urinary system

Apostasis of sutures after episiotomy

Endometritis

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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?

Rupture of fetal bladder

Duration of uterine contractions over 30 seconds

Presenting part is in the lower region of small pelvis

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 end of the 1st stage of labour

Antenatal discharge of the amniotic waters

Pathological preterm labour

The beginning of the 1st stage of labour

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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

The patient does not require further care

Lasertherapy and enzymotherapy

Antibacterial therapy and adaptogens

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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 6th intercostal space along the posterior axillary line

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

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

Papaverine hydrochloride of 2% - 4,0 ml

Pentaminum of 5% - 4,0 ml

Droperidolum of 0,25% - 2,0 ml

Dibazolum of 1% - 6,0 ml

Hexenalum of 1% - 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?

Bloody discharges from the nipple

Pure discharges from the nipple

Skin induration with inverted nipple

Painful movable induration

Painless movable induration

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

Increased calcium concentration in blood

Increased sodium consentration in blood

Increased potassium concentration in blood

Reduced magnesium concentration in blood

-

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

Twin gestation

Maternal renal disease

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 intravenous aminophylline

Prescribe intravenous corticosteroids

Prescribe nebulized metaproterenol

Administer supplemental oxygen

Prescribe nebulized cromolyn sodium

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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:

Theophylline toxicity

Coarctation of the aorta

Chronic lung disease

Renal disease

Obesity

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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

Sigma

Limit

Amplitude

Coefficient of variation

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

Method of graduated correlation (Armler)

Method of grade correlation (Spirman)

Correlation ratio

The Indirect method (Student)

The quadrate method (Pirson)

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

Ventricular fibrillation

Paroxysmal ventricular tachycardia

Atrial fibrillation

Paroxysmal supraventricular tachycardia

Atrial flutter

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

Colonic diverticulitis

Fish tapeworm infection

Pancreatitis

Regional enteritis

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:

Ventricular septal defect

Patent ductus arteriosus

Arterial septal defect

Coarctation of the aorta

Tetralogy of Fallot

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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

Hyperthyroidism

Coronary artery disease

Amyloidosis

Pericardial effusion

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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:

Pericarditis

Aortic dissection

Pulmonary thromboembolism

Acute myocardial infarction

Aspiration

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

III (c)

III (b)

II

I

III (a)

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

Dilute urine

Elevated BUN

High serum K+

Elevated hematocrit

High serum Na+

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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

Herpes zoster

Leftsided renal colic

Retroperitoneal haemorrhage

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

Mammography

Thermography

Ultrasonography

Aspiration biopsy with cytology

Excision biopsy

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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?

The head physician of a polyclinic

Specialized (traumatologic) MSEC

DCC

Regional MSEC

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:

Total pancreatectomy

Distal pancreaticojejunostomy

Distal pancreatectomy

Lateral pancreaticojejunostomy

Sphincterotomy

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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:

Immediate exploration

Duodenojejunostomy

Nasogastric decompression and parenteral alimentation

Retrocolic gastrojejunostomy

Tube duodenostomy

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

Pleural friction rub on the left

Absence of rhonchi

Absence of rales

Distant breath sounds on the right

Hyperresonance over the right chest

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A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density -1,04 g/cm3, acidity - 210T, reductase probe - weak-positive. What way is the product to be used in?

Sell but inform customers about milk quality

Sell without limitations

Discard for animal feeding

Do the product away

Technical utilization

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

Draw up a statement about forensic medical examination

Conduct forensic medical examination by district forensic medicine expert

Conduct an inquiry by preliminary investigator of police department

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

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

Syndactyly

Macrodactyly

Ectromelia

Polydactyly

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

Chron’s disease

Adolescent polyposis

Hirschprung’s disease

Peytz-Egers’s polyposis

Tuberculosis of the intestine

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

Intravenous administration of pituitrin

Administration of plasma

Hemostatic therapy

Introduction of obturator nasogastric tube

Operation

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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?

Laparoscopy

Digital examination of rectum

Rectoromanoscopy

R-scopy of abdominal cavity

Percussion and auscultation of stomach

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

Ultrasound dopplerography

CT of the brain

Electroencephalography

Cerebral angiography

MRI of the brain

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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

The test for tolerance to glucose

Bacteriological examination of discharges from vagina

A cardiophonography of fetus

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?

Cateterization of the Eustachian tube

Radical operation on the middle ear

Paracentesis of the drum

Mastoidotomy

Tympanoplasty

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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 pronation

In position of dorsal flexion of foot

In position of supination

In position of planter flexion of foot

At right angle with varus positioning of the foot

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

Acute renal failure

Acute glomerylonephritis

Acute interstitial nephritis

Acute renal colic

Acute cystitis

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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 :

Congenital heart malformation

Respiratory failure of III degree

Myocarditis

Respiratory failure of II degree

Respiratory failure of I 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

Allergic rash

Scarlet fever

Rubella

Measles

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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

Scarlet fever

Measles

Adenoviral infection

Pseudotuberculosis

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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?

Penicillin and prednisone

Chloramphenicol succinate and interferon

Penicillin and immunoglobulin

Ampicillin and immunoglobulin

Chloramphenicol succinate 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?

Meningoencephalitis

Myelitis

Meningitis

Neurotoxic syndrome

Encephalitis

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

Rheumatic endocarditis

Rheumatic pericarditis

Rheumatic pancarditis

Rheumatic myocarditis

Septic endocarditis

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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:

Conservative therapy

Replacement blood transfusion (conservative therapy)

Symptomatic therapy

Antibiotics

Blood transfusion (conservative 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

11,0 kg

9,0 kg

12,0 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)?

1,5 months

4,0 months

1,0 months

3,0 months

2,0 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

Salt

Fats

Liquid

Carbohydrates

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

Examination of the formation in Trendelenburg’s position

Diaphanoscopy

Puncture of the scrotum

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

Palpation of the external inguinal ring

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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

Ganglioneuroma

Sympatogonioma

Sympatoblastoma

Sarcoma of the vertebra

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

Cardialgia due to spine problem

IHD. Functional Class II angina

IHD. Unstable angina

Myocarditis

Myocardial dystrophy

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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

Nifedipin

Kapoten

Dibazol

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

CHF- 2 B

CHF- 3

CHF- 1

CHF- 2 A

CHF- 0

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

ECG

Phonocardiography

Echocardiography+Doppler-Echocardiography

Ballistocardiogram

Chest X-ray

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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?

Bronchial obstruction

Septic shock

Toxic hepatitis

Emphysema

Exudative pleuritis

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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

Viral hepatitis B

Cancer of the head of pancreas

Gallstones

Cancer of the liver

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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:

Reflux-gastritis

Rigid antral gastritis

Gastritis of type A

Gastritis of type B

Menetrier’s gastritis

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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?

Prescribe guanyl guanidines

Give Glurenorm instead of Maninilum

Prescribe fast-acting insulin

Prescribe long-acting insulin

Continue with the current therapy

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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?

Disseminated

Tuberculoma

Fibro-cavernous

Miliary

Focal

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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?

Seborrhea

Ritter’s disease

Lichen ruber planus

Psoriasis

Vasculitis

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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:

Hypothalamus

Corpus callosum

Hippocampus

Pituitary

Frontal lobes

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

Catatonic stupor, schizophrenia

Apathetic stupor, schizophrenia

Depressive stupor, bipolar disorder

Psychogenic stupor, stress disorder

Dissociative stupor, dissociative psychosis

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

Irondeficiency anemia

Post-hemorrhagic anemia

Hemolytic anemia

B12-deficiency anemia

Thalassaemia

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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?

Sepsis

Brucellosis

Leptospirosis

Malaria

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?

Relapse of viral hepatitis

Meningitis

Cholangitis

Infectious-toxic shock

Hepatic encephlopathy

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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?

Acute lymphoid leukosis

Infectious mononucleosis

Adenoviral infection

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:

Infectious hepatitis

Carcinoma of the head of the pancreas

Malignant biliary stricture

Haemolytic jaundice

Metastatic disease of liver

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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:

25-30 %

10-15 %

20-25 %

30-40%

15-20 %

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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:

Controlled respiration

Oxygen inhalation

Caffeine injection

Gastric lavage

Cordiamine injection

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

Sedimentation rates

WBCs

Alkaline phosphatase

BUN

SGOT (ALT)

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

IVAB

IIA

IC

IIB

IIIA

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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?

Nosocomial lobar pneumonia

Acute lung abscess

Acute pleuritis

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?

Acute fibrinous pleuritis

Pneumonia

Myocarditis

Pneumothorax

Acute bronchitis

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

Fluorchinolones

Cephalosporines

Sulfonamides

Tetracyclines

Nonsteroidal anti-inflammatory drugs

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

Blood cell count

Liver function tests

X-ray examination of the gastrointestinal tract

Ultrasound examination of the gallbladder

Ultrasound study of the pancreas

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

Heparin

Penicillin OS

Ceftriaxone

Ciprofloxacine

Dipyridamole

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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

Chronic mercury intoxication

Neuroinfection

Acute mercury intoxication

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

Clamydia trachomanis

Varicella

Visceral larva migrans

Pneumocystis carinii

Mycoplasma pneumoniae

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

Mitral stenosis

Aortic stenosis

Tricuspid regurgitation

Tricuspid 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:

Cytosar

Blood transfusion

Prednisolone

Vinblastine

Myelosan

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

Hemolytic anemia

Megaloblastic anemia

Chronic leukemia

Thrombocytopenia

Acute 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?

18-45 days after conception

10-14 days after conception

90-120 days after conception

The first 7 days

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:

Early deep vein thrombosis

Cellulitis

Superficial venous thrombosis

Insect bite

Subcutaneous hematoma

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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?

Subcutaneous panaritium

Thecal whitlow (ligament panaritium)

Bone panaritium

Articular (joint) 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

Eustachian tube disfunction

Acute mastoiditis

Chronic purulent otitis media

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:

Calculi

Acute glomerulonephritis

Septicemia

Rhabdomyolysis

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

Pleuritis

Pulmonary abscess

Spontaneous left-sided pneumothorax

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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:

Acute ileitis

Ileocecal tuberculosis

Ulcerative colitis

Crohn’s disease of the terminal ileum

Perforated Meckel’s diverticulum

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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?

Riedel’s thyroiditis

Subacute thyroiditis

Suppurative thyroiditis

Papillary thyroid carcinoma

Hashimoto’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?

Selenium

Silicon

Iodine

Zinc

Copper

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

Acute purulent lymphadenitis

Bubonic plague

Tularemia

Lymphogranulomatosis

Anthrax

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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:

Fluorine intoxication

Lead intoxication

Mercury intoxication

Phosphorus intoxication

Manganese 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

Delusion

Acute hallucinosis

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?

Atelectasis

Peripheral cancer of lung

Lung cyst

Cenral cancer of lung

Lung abscess

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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:

Exocrine pancreatic insufficiency

Endocrine pancreatic insufficiency

Chronic enterocolitis

Syndrome of lactase deficiency

Irritable bowels syndrome

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

Pick’s disease

Alzheimer’s disease

Dissociative amnesia

Vascular dementia

Huntington’s chorea

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

Cervix ectomy

Treatment of specific colpitis and subsequent biopsy

Specific treatment of Trichomonas colpitis

Cryolysis of cervix of the uterus

Diathermocoagulation of the cervix of the uterus

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

Vibration disease

Hypovitaminosis of B1

Noise disease

Caisson disease

Overwork symptoms

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

Liver biopsy

Abdominal ultrasound

Spleen biopsy

Sternal puncture

Coagulogram

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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 B incompatibility

Antigen A 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?

Salmonellosis, gastrointestinal form

Botulism

Yersiniosis

Leptospirosis

Lambliasis

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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?

0,2%

0,05%

0,3%

0,1%

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

Fat share is insufficient

Nutrient content complies with the recommended shares of energy value

Carbohydrate share is excessive

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

Decrease of saturated fats consumption

Decrease of carbohydrates consumption

Increase of cellulose consumption

Any dietary changes are necessary

Decrease of cholesterol consumption

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

Benzidine

Asbestos

Nickel carbonyl

Arsenic

Vinyl chloride

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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

Iron deficit in blood serum, bone marrow and depot

Disturbed hemostasis

Inherited insufficiency of plasm factors of blood coagulation

Deficit of the VIII factor of blood coagulation

Generation of antithrombocytic antibodies

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

Increased pulse pressure

Increased pulmonary blood flow

Normal pressure gradient across the pulmonary valve

Normal oxygen tension (PaO2) in the left ventricle

Increased pressure in the right ventricle

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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 be heard

The right to the protection of the patient’s interests

The right to the protection from incompetence

The right to the information

The right to the free choice

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

River water

Rain water

Artesian well water

Melt snow 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?

Cholera

Intestinal amebiasis

Escherichiosis

Salmonellosis

Acute dysentery

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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 duration of patients’ presence in the hospital

Bed turnover

Average bed idle time

Average annual bed occupancy

Bed resources of the hospital

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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?

Mucoviscidosis (cystic fibrosis)

Bronchiectasis

Recurrent bronchitis

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

Juvenile bleeding, posthemorrhagic anemia

Incomplete spontaneous abortion

Polycyst ovarian syndrome

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 endocsopic papillosphincterotomy

To perform transduodenal papillosphincterotomy

To perform external choledoch drainage

To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

To perform choledochoduodenostomy

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

Finger’s pseudofurunculosis

Phlegmon of newborn

Exfoliative dermatitis

Mycotic erythema

Impetigo neonatorum

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

Correlation

-

Intensive

Extensive

Visualization

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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?

Allergic dermatitis

Dermatitis simplex

Toxicoallergic dermatitis

Microbial eczema

Localized neurodermatitis

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

Autoantibody production

Chelicobacterial infection

Dietary allergy

Disorder of gastric motor activity

Reduced prostaglandin synthesis

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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 fat consumption

Restriction of protein consumption

Consumption of higher amounts of liquid

Diet with high content of 'alkaline' dishes

Restriction of carbohydrate consumption

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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

Dilatation cardiomyopathy

Myocarditis

Stenocardia

Myocardium infarction

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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?

Infantile eczema

Milk crust

Gneiss

Pseudofurunculosis

Strophulus

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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 bilirubin

Blood creatinine

Fibrinogen

Blood sodium

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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?

Corglicone

Aminophylline

Amysyl

No-shpa

Obsidan

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

Alpha-hemolytic streptococcus

Pyogenic streptococcus

Staphylococcus aureus

Saprophytic staphylococcus

(3-hemolytic streptococcus

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

Parenteral disintoxication

Parenteral introduction of polyvalent antibotulinic serum

Parenteral introduction of antitetanus serum

Parenteral introduction of antibiotics

Gastric lavage

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

Cryoprecipitate

Dried plasma

Fresh frozen blood

Fresh frozen plasma

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?

Chlamydiosis

Candydomycosis

Trichomoniasis

Chronic gonorrhea

Recent acute ascending gonorrhea

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

Ultrasonic examination

Palpation of mammary glands and pressing-out of colostrum

Bimanual vaginal examination

Speculum examination

Roentgenography of small pelvis organs

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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:

Corresponding to the age

150 g less than necessary

Paratrophy of the I grade

Hypotrophy of the I grade

Hypotrophy of the II grade

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

Fibrous adenoma of the left mammary gland

Lactational mastitis

Phlegmon of mammary gland

Breast cancer

Lacteal cyst with suppuration

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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

Myxedema

Systemic lupus erythematosus

Dermatomyositis

Rheumatoid arthritis

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

Acute viral myocarditis

Idiopathic myocarditis

Myocardiopathy

Neurocirculatory dystonia

Acute allergic infectious myocarditis

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

Iron deficit

Erythrocyte hemolysis

Hemogenesis immaturity

B12 deficit

Infectious process

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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?

Menarche

Juvenile hemorrhage

Werlhof’s disease

Endometrium cancer

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

Accelerated ESR

Leukocytosis

Carditis

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

Time of the room insolation

Depth of study room

Natural light coefficient

Presence of mixed (superolateral) light

Light coefficient

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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

Asthenic syndrome

Depressive syndrome

Obsessive 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?

Dysentery

Amebiasis

Nonspecific ulcerative colitis

Salmonellosis

Yersiniosis

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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?

Purulent meningitis

Serous viral meningitis

Serous tuberculous meningitis

Subarachnoid haemorrhage

Brain tumour

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

EEG

Computer tomography

Lumbar puncture

Examination of eye fundus

Ultrasonic dopplerography

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

Contrast roentgenoscopy

Intragastral pH-metry

Esophagogastroduodenoscopy

Biochemical blood analysis

Fractional examination of gastric juice

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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

Hypokaliemia

Hypocalciemia

Hyperhydratation

Hyperkaliemia

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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 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

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

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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?

Hemicrania (migraine)

Facial neuritis

Brain tumour

Ischemic stroke

Trigeminus neuralgia

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

Microbial eczema

Contact allergic dermatitis

Contact dermatitis simplex

Herpes zoster

Herpetiform Duhring’s dermatosis

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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?

Plane of pelvic inlet

Over the pelvic inlet

Wide pelvic plane

Plane of pelvic outlet

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

Action of bacterial exotoxin

Allergic

Bacteriemia

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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:

Sialic acids

Ceruloplasmin

Antibodies to the native DNA

y-globulins

Creatine phosphokinase

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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 change point of introduction

To reduce insulin dose

To apply periodically other types of insulin

To limit fats in the boy’s diet

To administer antioxidants

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

Sputum test for secondary flora

Cerebrospinal puncture

Puncture of cervical lymph node

Complete blood count

Roentgenological examination of lungs

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

Kreon

Linex

Vikasolum

Motilium

Sulfosalasine

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

Increase of catecholamine concentration

Increase of vasopressin secretion

Increase of aldosterone level in blood

Increase of thyroxine secretion

Increase of plasma renin activity

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

Aerophagia

Pylorostenosis

Acute gastroenteritis

Pylorospasm

Esophageal atresia

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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?

Acute lacunar tonsillitis

Paratonsillitis

Chronic pharyngitis

Chronic tonsillitis

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 thrombosis of right veins

Lymphedema of lower right extremity

Acute thrombophlebitis of superficial veins

Parkes-Weber syndrome

Postthrombophlebitic syndrome, varicose form

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

Mycosis

Furuncle

Streptococcal impetigo

Herpes zoster

Hydradenitis

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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?

Hemiparesis

Distal right-sided obstetric paralysis

Tetraparesis

Total right-sided obstetric paralysis

Proximal 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?

Boiled meat

Potatoes

Cabbage

Tinned food

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 limit physical work

To go in for weightlifting

To improve health at the Black sea coast

To administer protein-and-carbohydrate diet

To administer protein-and-vitamin diet

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

Thrombocytic mass

Native erythrocytic mass

Erythrocytic suspension

Stored blood

Washed erythrocytes

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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 traumatologist

A doctor of any speciality

A laboratory physician

An anaesthesilogist

A surgeon

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

Wilcoxon’s t-criterion

Sign criterion

Student’s coefficient (t)

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?

Patient’s examination room

Manipulation room

Nursing room

Doctor’s consulting room

Bathroom unit

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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?

Erysipelatous inflammation

Infectious arthritis

Osteoarthritis

Gout

Rheumatoid 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 insulin

To administer glibenclamid

To administer repaglinide

To administer dietotherapy

To administer metformin

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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 regression coefficient

Calculation of dynamic indices

Calculation of conformity coefficient

Calculation of correlation coefficient

Calculation of coefficient of difference validity

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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 force

Systematicness

Increase of influence intensity

Autodefense increase

Increase of resistance

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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?

Treatment at a health resort

Conservative treatment in a surgical department

Conservative treatment in the therapeutic hospital

Operation in a surgical department

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?

Heparin

Prednisolone

Furosemide

Seduxen

Adrenalin

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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 short-acting insulin

Intravenous infusion of neohaemodesum along with glutamic acid

Introduction of long-acting insulin

Intravenous infusion of sodium chloride saline

Intravenous infusion of glucose along with insulin

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

August’s psychrometer

Assmann psychrometer

Alcohol thermometer

Thermograph

Mercury thermometer

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

Phosphate diabetes

Anemia

Spasmophilia

Chondrodystrophy

Rachitis

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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 uterine contracting agents

Urine drainage, cold on the lower abdomen

Introduction of hemostatic medications

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?

Examination of evoked potentials

Electroencephalography

Skull roentgenogram

Echoencephalography

Computer tomogram

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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?

Lung abscess

Lung gangrene

Multiple bronchiectasis

Chronic pneumonia

Pleura empyema

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

Aortal insufficiency

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 rub feet with snow

To put feet into hot water

To administer cardiac medications

To apply an alcohol compress

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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

Lymphangitis

Tetanus

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?

Takayasu’s disease

Thoracal outlet syndrome

Occlusion of the left subclavicular artery, steal syndrome

Occlusion of brachiocephalic trunk

Raynaud’s 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?

Hypertensive angioneuropathy

Thrombosis of central vein of retina

Embolism of central artery of retina

Hypertensive angiopathy

Diabetic retinopathy

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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?

Premenstrual syndrome

Stein-Leventhal syndrome

Morgagni-Stewart syndrome

Algodismenorrhea

Sheehan’s 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?

Stein-Leventhal syndrome

Shereshevsky-Turner’s syndrome

Sheehan’s syndrome

Homological blood syndrome

Vegetovascular dystonia

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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

Gangrene of the IV toe on the right foot

Haematoma

Erysipelas

Fracture of the IV toe on the right foot

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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?

Kyphosis

Normal

Corrected

Lordosis

Round-shouldered

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

In critical care wards

In radiological wards

In burns wards

In infectious wards for adults

In infectious wards for children

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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 (+)

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 (+) and 2 statistic talons signed (-)

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

‹ Назад

Далі ›

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

Pie diagram

Radial diagram

Linear diagram

Bar diagram

Histogram

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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?

Closed-chest cardiac massage

Defibrillation

Restoration of airway patency

Mouth-to-mouth ventilation

Precordial thump

‹ Назад

Далі ›

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

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

Alimentary constitutional obesity of the I stage, abdominal type

Alimentary constitutional obesity of the II stage, abdominal type

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

Alimentary constitutional obesity of the III stage, gynoid type

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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

Postpartum metroendometritis

Lactostasis

Remnants of placental tissue after labour

Physiological course of postpartum period

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Далі ›

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

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

Left-sided thoracotomy, closure of esophagus and mediastinum wound

Endoscopic closure of esophagus wound, drainage

Left-sided thoracotomy, closure of esophagus wound

Buelau’s drainage of pleural cavity, antibacterial therapy

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Далі ›

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

^-adrenoceptor blocker

Diuretic

Dihydropyridine calcium antagonist

Adenosine pyrophosphate inhibitor

3-adrenoceptor blocker

‹ Назад

Далі ›

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

Polycystic ovaries

Ovarian cystoma

Menstrual irregularity

Chronic oophoritis

Bilateral ovarian tumours

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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?

Wilm’s tumour

Gastrointestinal haemorrhage

Ileocecal invagination

Helminthic invasion

Pylorostenosis

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Далі ›

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

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

III physiological sound

Atrial gallop rhythm

Protodiastolic gallop rhythm

IV physiological sound

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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?

Analgin

Diclofenac

Aspirin

Novocaine

Spasmalgon

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