Step 2 - Medicine 2005

1 із 200

The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

Pregnant women

All children

Patients after operation

Patients after 60

Workers of industrial enterprises

2 із 200

A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, /a/pha-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud be carried out to establish diagnosis?

Coronarography

Esophageal electrocardiac stimulator

Myocardial scintigraphy

Test with dosed physical exercises

Stress-echocardiogram

3 із 200

The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis - she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?

Examination for HIV

Examination for fungi

Examination for neuropathology

Examination for trichomoniasis

Examination for gonorrhea

4 із 200

What methods of the collecting of the information is preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period?

Questioning

Statistical

Interviewing

Selecting of materials

A method of the directed selection

5 із 200

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

The linear diagram

The sector diagram

The curvilinear disgram

The radial diagram

The figured diagram

6 із 200

Define the basic registration document at the profound study of a case rate with temporary lost labor ability at the industrial enterprise:

A card of the personal account of a case rate

The sick-leave certificate

A ambulatory medical card

'The Report on reasons of a temporary lost labor ability'

The inpatient medical record

7 із 200

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

Thecal whitlow (ligament panaritium)

Articular (joint) panaritium

Paronychia

Subcutaneous panaritium

Bone panaritium

8 із 200

A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density- 1,04 g/cm3, acidity 210 C, reductase probe - weak positive. What way the product is to be used in? What would you advise?

Sell but inform customers about milk quality

Utilize technically

Write the product off for animal feeding

Annihilate the product

Sell without limitations

9 із 200

Patient with thyrotoxicosis is in the 2-beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature - 200C, relative humidity 45%, air movement velocity 0,3 m/s, light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the conditions.

Discomfortable microclimate

All conditions are OK

Poor lighting

Non-effective ventilation

High level of noise

10 із 200

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

Obesity

Schizophrenia

Uterine fibromyoma

Paradontosis

Common cold

11 із 200

A 9 y.o. girl has an average height and harmonic growth development. She was ill with acute respiratory infection for five times. Define the group of her health.

2nd group

5 th group

4 th group

1 st group

3 rd group

12 із 200

The child is 11 m.o. He suffers from nervous-arthritic diathesis. The increased synthesis of what acid is pathogenic at nervous-arthritic diathesis?

Uric acid

Hydrochloric acid

Acetic acid

Sulfuric acid

Phosphoric acid

13 із 200

A 35 y.o. woman was admitted to thoracic surgery department with fever up to 400 C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

Abscess of the lung

Pulmonary tuberculosis

Complication of liver echinococcosis

Actinomycosis of lungs

Bronchiectatic disease

14 із 200

A 52 y.o. man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply first?

Ultrasound dopplerography

CTof the brain

Cerebral angiography

MRI of the brain

Electroencephalography

15 із 200

A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP-100/70 mm Hg. On ECG: heart rate-200 bmp, ventricular complexes are wi- dened, deformed, location of segments ST and of wave T is discordant. The wave P is not changed, superimposes QRST, natural conformity between P and QRS is not present. What kind of arrhythmia is present?

Paroxismal ventricular tachycardia

Atrial flutter

Sinus tachycardia

Atrial tachycardia

Ventricular extrasystole

16 із 200

Ambulance was called to a 48 y.o. man. From the words of relatives he has had three episodes of lost consciousness and attacks during the day. On examination: the following fit is observed: patient is unconscious, fell on the floor, tonic and then clonic convuesions of trunk and extremities happened. The attack lasted for 4 minute, ended by involuntary urination. What type of attack was observed?

Major epileptic seizure

Absence

Episode of hysteria

Fainting

Vegetatic crisis

17 із 200

A 2 y.o. girl has been ill for 3 days. Today she has low-grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?

Rubella

Scarlet fever

Adenoviral infection

Measles

Pseudotuberculosis

18 із 200

Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, signs of increased intracranial pressure. What diagnosis can you make?

Adenoma of hypophysis

Optico - hiasmatic arachnoiditis

Tumor of pondo-cerebellar corner

Adrenal gland tumor

Encephalitis of truncus

19 із 200

A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t0- 390C, fever of irregular type. There is the area of darkening with a cavity in a center on X-ray film, with irregular contours and level of liquid. What disease is the question?

Gangrene of lung

Tuberculosis

Pneumonia complicated by an abscess

Lobar pneumonia

Bronchiectatic illness

20 із 200

A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is greypale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood level of residual N2- 6,6 mmol/L, creatinine- 406 mmol/L. Day’s diuresis-2300 ml, nocturia. Specific density of urine is 1009, albumin- 0,9 g/L, WBC- 0-2 in f/vis. RBC.- single in f/vis., hyaline casts single in specimen. Your diagnosis?

Chronic nephritis with violation of kidney function

Stenosis of kidney artery

Feochromocitoma

Nephrotic syndrome

Hypertensive illness of the II degree

21 із 200

A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofi-beroscopy. Your diagnosis:

Ulcer of stomach, complicated with bleeding

Erosive gastritis

Acute myocardial infarction, abdominal form

Acute pleurisy

Ulcer of duodenum, complicated with bleeding

22 із 200

A 40 y.o. patient of rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathless and swelling of feet. On examination: t°- 39°C*, pulse is 100/min. As ucultation: diastolic murmur in the mitral area. Petechical lesion a round clavicle; spleen was palpable, tooth extraction one month ago.

Subacute bacteria endocarditis

Recurrence of rheumatic fever

Aortic stenosis

Mitral stenosis

Thrombocytopenia purpure

23 із 200

A patient with nosocomial pneumonia has signs of collapse. Which of the following pneumonia complication is the most likely to be accompanied with collapse?

Septic shock

Bronchial obstruction

Exudative pleuritis

Toxic hepatitis

Emphysema

24 із 200

A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. What can be diagnosed in this case?

Gastritis of type B

Menetrier’s disease

Gastritis of A type

Rigid antral gastritis

Reflux - gastritis

25 із 200

A 62 y.o. patient with DM-2. Diabetes is being compensated by diet and Manini-lum. Patient has to undergo an operation for inguinal hernia. What the tactics of hypoglycemic therapy should be used?

Prescribe fast-acting insulin

Prescribe guanyl guanidines

Continue with the current therapy

Prescribe long-acting insulin

Give Glurenorm in place of Maninilum

26 із 200

A 32 y.o. patient complains of severe weakness, tremor of extremities. On physical examination, there is loss of body weight, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps- 108 bpm. BP- 160/55 mm Hg. The rest is in norm. What can be diagnosed?

Diffuse toxic goitre of the 3rd degree, thyrotoxicosis of the average degree

Chronic autoimmune thyroiditis, hypertrophic type

Chronic fibrous thyroiditis

Diffuse euthyroid goitre of the 3rd degree

Toxiferous adenoma of the thyroid gland

27 із 200

A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the frist three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep.The most likelly cause is?

Rheumatoid vasculitis

Atlanto-axial sublaxation of cervical spine

Rheumatoid arthritis without complication

Sensory peripheral neuropathy

Carpal tunnel syndrome

28 із 200

A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

Addisonic crisis

Acute gastroenteritis

Pellagra

Meningoencephalitis

Scleroderma

29 із 200

An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?

Hypoglycemic coma

Hyperlactacidotic coma

Hyperosmolar coma

Hyperglycemic coma

Stroke

30 із 200

7 y.o. boy with chronic sinusitis and rercurent pulmonary infections has chest X-ray demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?

Kartagener syndrome

Cystic fibrosis (mucoviscidosis)

Bronchiolitis obliterans

o-antitrypsin deficiency

Laryngotracheomalacia

31 із 200

A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

Leptospirosis

Brucellosis

Salmonellosis

Yersiniosis

Trichinellosis

32 із 200

A 2,9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks’ gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the most likely diagnosis?

Esophageal atresia

Respiratory distress syndrome

Tracheal atresia

Choanal atresia

Laryngomalacia

33 із 200

Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level increasing up to 14 mmol/L. What is most appropriate for treatment of hyperbilirubinemia in this infant?

Exchange blood transfusion

Phototherapy

Intestinal sorbents

Infusion therapy

Phenobarbital

34 із 200

At term of a gestation of 40 weeks height of standing of a uterine fundus is less then assumed for the given term. The woman has given birth to the child in weight of 2500 g, a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor were fast. The cause of such state of the child were:

Chronic fetoplacental insufficiency

Delay of an intra-uterine fetation

Infection of a fetus

Prematurity

Placental detachment

35 із 200

A 42 y.o. man died in a road accident after the haemorrhage on the site, due to acute hemorrhagic anaemia. What minimum percentage volume of the total blood loss would result in death at acute haemorrhage?

25-30%

15-20 %

35-50 %

6-9 %

10-14 %

36 із 200

What preparations are used for prevention of fungal infection?

Fluconozol, Orungol, Nisoral

Isoniazid, Ftibazid, Pyrazinamid

Captopril, Enalapril

Rubomycin, Bleomycin, Mytomycin C

Cytosar, Cormyctin, Lomycitin

37 із 200

What developes most often after accidental intake of Hydrochloric acid?

Cardiac insufficiency

Deylads’s syndrome

Cushing’s syndrome

Kutling’s syndrome

Acute pancreatitis

38 із 200

A woman, aged 40, primigravida, with infertility in the medical history, on the 42-43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish colour of amni-otic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are

Caesarean section

Fetal hypoxia treatment, in the II period - forceps delivery

Medication sleep, amniotomy, labour stimulation

Fetal hypoxia treatment, conservative delivery

Amniotomy, labour stimulation, fetal hypoxia treatment

39 із 200

30 y.o. woman, had mild trauma of 5th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of osteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5th finger of the left hand. What form of panaris has occurred in the patient?

Bony

Paronychia

Tendon type

Joints type

Hypodermic

40 із 200

A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of treatment is indicated to the patient?

Surgical drainage of the pleural cavity

Antiinflammation therapy

Thoracotomy

Symptomatic therapy

Pleural puncture

41 із 200

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

IgE

Circulating immunocomplexes

IgM

IgJ

IgA

42 із 200

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

Bubonic plague

Lymphogranulomatosis

Anthrax

Acute purulent lymphadenitis

Tularemia

43 із 200

A 17 y.o. patient complains of acute pain in the knee joint and t0- 380C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

Rheumatism, polyarthritis

Reactive polyarthritis

Rheumarthritis

Systemic lupus eritematodes

Infectious-allergic polyarthritis

44 із 200

A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be suspected?

Acute pancreatitis

Acute appendicitis

Perforated gastric ulcer

Acute enterocolitis

Renal colic

45 із 200

The girl is 12 y.o. Yesterday she was overcooled. Now she complains on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,80C. Pasternatsky symptom is negative. Urinalysis: protein- 0,033 g/L, WBC-20-25 in f/vis, RbC- 1-2 in f/vis. What diagnosis is most probable?

Acute cystitis

Urolithiasis

Acute glomerulonephritis

Dysmetabolic nephropathy

Acute pyelonephritis

46 із 200

The girl of 11 y.o. She is ill for 1 month. She has 'butterflytype rash on face (spots and papules), pain and swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC: Hb- 80 g/L, RBC- 2,9 * 1012/L, WBC- 15 * 109/L, ESR- 40 mm/hour. Urinalysis: protein- 0,33 g/L. What is the most probable diagnosis?

Systemic lupus erythematosus

Dermatomyositis

Periarteriitis nodosa

Acute rheumatic fever

Juvenile rheumatoid arthritis, systemic type

47 із 200

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

Fluorine intoxication

Manganese intoxication

Lead intoxication

Phosphorus intoxication

Mercury intoxication

48 із 200

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

Acute purulent maxillary sinusitis

Acute purulent sphenoiditis

-

Acute purulent ethmoiditis

Acute purulent frontitis

49 із 200

A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When should she be given maternity leave?

8 August

5 September

25 July

22 August

11 July

50 із 200

An infant aged 1 year on the third day of common cold at night developed inspiratory stridor, hoarse voice and barking cough. Physical examination revealed suprasternal and intercostal chest retractions. There is a bluish skin discoloration moistly seen over the upper lip. The respiratory rate is 52 per min and pulse- 122 bpm. The body temperature is 37,50C. What disease does the infant have?

Acute infectious croup due to viral laryngotracheitis

Acute epiglottitis

Acute laryngitis

Bronchopneumonia without complications

Acute bronchiolitis with respiratory distress

51 із 200

A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination reveals convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?

Encephalopathy due to hyperbilirubinemia

Skull injury

Spastic cerebral palsy

Hydrocephalus

Brain tumour

52 із 200

A 52 y.o. hard smoker patient complains of persistent cough with purulent sputum discharge especially in mornings, dyspnea provoked even by slight physi- cal exertion, wheezing chest, tahypnoe, general weakness. He considers himself to be ill during 12 years. The overwritten conditions appear 3-4 times per year usually after common cold and have tendency to progress. What disease do you think about first of all?

Chronic obstructive lung disease

Bronchial asthma

Aspergillosis

Bronchoectatic disease

Mucoviscidosis (cystic fibrosis)

53 із 200

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

Glomerulonephritis

Pyelonephritis

Intestinal nephritis

Cystitis

Renal amyloidosis

54 із 200

47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct -110 mkmol/L, AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT- 1,8 mmol/L, alkaline phosphotase- 4,6 mmol/L per hour, cholesterol- 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

Primary biliary liver cirrhosis

Chronic viral hepatitis B

Primary liver cancer

Acute viral hepatitis B

Alcoholic liver cirrhosis

55 із 200

The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:

Jaundice

Cholangitis conditioned by the presence of stones in the bile tract

Empyema of the gall-bladder

Gall-bladder perforation

Emphysematous gall-bladder

56 із 200

The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

Paget’s disease

Hyperparathyoid dystrophy

Chronic osteomyelitis

Mottled disease (marble disease)

Myeloma

57 із 200

The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached 1,5% of her bodywei-ght. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP- 75/50 mm Hg. What is the further treatment?

Uterine extirpation

Supravaginal uterine amputation

Inner glomal artery ligation

Uterine vessels ligation

Putting clamps on the uterine cervix

58 із 200

A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36,60C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?

Inevitable abortion

Incomplete abortion

Incipient abortion

Complete abortion

Disfunctional bleeding

59 із 200

18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has suddenly appeared unconscious at home. The patient had no menses within last 3 months. On examination: pale skin, the pulse- 110 bpm, BP- 80/60 mm Hg. The Schyotkin’s sign is positive. Hb- 76 g/L. The vaginal examination: the uterus is a little bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct size. The posterior fornix of the vagina is tendern and overhangs inside. What is the most probable diagnosis?

Impaired extrauterine pregnancy

Ovarian apoplexy

Twist of cystoma of right uterine adnexa

Acute appendicitis

Acute salpingoophoritis

60 із 200

A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical hospital with complains of pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?

Placental presentation

Uterine rupture

Threatened premature labor

Incipient abortion

Premature placental separation

61 із 200

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

Hysterosalpingography

Diagnostic scraping out of the uterine cavity

Hysteroscopia

Hormone investigation

Ultra sound investigation

62 із 200

A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38,40C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through out. What disease should a doctor consider first of all?

Carbuncle

Skin abscess

Furuncle

Carbuncle associated with anthrax

Acute skin cellulitis

63 із 200

A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement What kind of penetrative chest wound complications has developed in patient?

Pericardium tamponade

Massive hemothorax

Open pneumothorax

Closed pneumothorax

Valve-likes pneumothorax

64 із 200

A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

Corrosive esophagitis and stricture

Esophageal diverticula

Cardiac achalasia

Cardiac insufficiency

Esophagitis

65 із 200

An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?

Issued regardless of company’s ownership

Issued a medical certificate of a free form

Issued only on condition of payment guarantee by the company’s proprietor

Issued a medical certificate of a set form

Issued only to empties of state-owned companies

66 із 200

A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?

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

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

The head of department

Working ability expertise committee

Deputy head physician on the working ability expertise

67 із 200

A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?

Use of neutral creams to protect skin

Systematic skin disinfection

Systematic use of local corticosteroids

Avoidance of skin insolation

Frequent skin washing with detergents

68 із 200

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

Subarachnoid hemorrhages

Subdural hemorrhages

Haemorrhages in ventricles of brain

Small hemorrhages in brain tissue

Periventricular hemorrhages

69 із 200

A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joint’s pain. On examination: excited, t0- 390C, Ps- 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

Influenza with cerebral edema manifestations

Influenza, typical disease duration

Respiratory syncytial virus

Parainfluenza

Adenovirus infection

70 із 200

A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, STsegment is sharply elevated in II, III aVF leads. What is the most likely disorder?

Cardiogenic shock

Cardiac tamponade

Disquamative aortic aneurizm

Pulmonary artery thromboembolia

Cardiac asthma

71 із 200

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

The right to the protection of the patient’s interests

The right to the free choice

The right to the information

The right to be heard

The right to the protection from incompetence

72 із 200

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

Artesian well water

Spring water

Water from melted snow

Rain water

River water

73 із 200

The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?

A baby dead at the age up to 12 months

A baby dead at birth

A baby dead at the age up to 1 months

A baby dead at the age up to 6 days

A baby dead at the age over 28 days

74 із 200

Chief district pediatrician has to carry out analysis of infant mortality rate. What should he take as a unit of the observation?

Child death case at the age up to 1 year

Child death case during first 7 days of life

Child death case at the age up to the first month

Child death case after 28 days of life

Child death case on labor

75 із 200

A 43 y.o. patient complains of mass and, pain in the right breast, elevation of temperature to 37,20C during 3 last months. Condition worsens before the menstruation. On examination : edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

Right side chronic mastitis

Cancer of right mammary gland

Right side acute mastitis

Tuberculosis of right mammary gland

Premenstrual syndrome

76 із 200

A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

Ancylosing spondyloarthritis

Spread osteochondrosis of the vertebral column

Spondyloarthropatia on the background of Reiter’s disease

Tuberculous spondylitis

Psoriatic spondyloarthropatia

77 із 200

A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers’ skin - greyish warts. Factory’s sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?

Thorax roentgenography

Bronchoalveolar lavage

Bronchoscopy

Blood gases examination

Spirography

78 із 200

Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics for the last 5 years. What statistical values can help in calculations of diseases level dissamination?

Relative values

Average values

Absolute values

Standart values

Dynamic row

79 із 200

A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?

Echocardiography

Coronarography

X-ray

Sphygmography

Phonocardiography

80 із 200

A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t0- 38, 20C, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?

Measles

Adenovirus infection

Rubella

Scarlet fever

Enterovirus exanthema

81 із 200

There were registered 500 cases of urolithiasis per 10000 inhabitants. What kind of statictical indices is presented?

Prevalence rate

Correlation coefficient

Incidence rate

Index of visualization

Index of compliance

82 із 200

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

Bed turnover

Average bed idle time

Average annual bed occupacy

Bed resources of the hospital

Average duration of patients presence in the hospital

83 із 200

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

Kidney’s contusion

Subcapsular kidney’s rupture

Kidney’s abruption

Multile kidney’s ruptures

Paranephral hematoma

84 із 200

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

Mucoviscidosis (cystic fibrosis)

Bronchial asthma

Pulmonary hypoplasia

Recurrent bronchitis

Bronchiectasis

85 із 200

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

Juvenale bleeding, posthemorrhagic anemia

Werlholf’s disease

Hormonoproductive ovary tumor

Polycyst ovarian syndrome

Noncomplete spontaneous abortion

86 із 200

A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks Xray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia di-aphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?

Right shin osteomielitis

Right shin syphilis

Right shin trauma

Right shin tuberculosis

Bone cyst of tibia

87 із 200

A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6x8 cm. In blood: alkaline phosphatase - 2,0 mmol/(hour*L), general bilirubin - 60 mkmol/L, cholesterol - 8,0 mmol/L. What is the leading syndrome in the patient?

Cholestatic

Asthenic

Cytolytic

Mesenchymal inflammatory

Liver-cells insufficiency

88 із 200

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

To perform endocsopic papillosphincterotomy

To perform choledochoduodenostomy

To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

To perform external choledoch drain

-

89 із 200

A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrom during first days of the disease. What is the role of angiotesin II in the pathogenesis?

Intensifies production and secretion of aldosterone

Increases heart output

Increases renine level

Increases erythropoetin production

Infibits deppresive action of prostaglandins

90 із 200

On physiologic-sanitary examination of railway department work it was revealed that loaders work is of III degree of difficulty. They unload vagons with sand, manually break coagulated mass by shovel and shift it. What criteria was used to evaluate work of loaders?

Maximun load weigh which is shifted

Time of active activities, % to the shift duration

Time of passive observation, % to the shift duration

Intellectual efforts

Value of static loading for the shift

91 із 200

A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?

Esophagogastroduodenoscopy with biopsy

pH-metry

Ureatic test

Stomach X-ray

Ultrasound examination of abdomen

92 із 200

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

Chronic lympholeucosis

Acute leucosis

Lymphogranulomatosis

Chronic myeloleucosis

Tuberculous lymphadenitis

93 із 200

Examination of placenta, which has just been born, reveals defect 2x3 cm in size. There is no bleeding. What tactics is the most reasonable?

Manual uretus cavity revision

Parturient supervision

Administration of uterotonic medicines

External uterus massage

Instrumental uterus cavity revision

94 із 200

A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?

To place suture on the uterus cervix

To interrupt pregnancy

To perform amniocentesis

To administer tocolytic therapy

To administer hormonal treatment

95 із 200

A district pediarician has carried out infant mortality rate analysis in his area. What data has been used?

Mortality of children under 1 y.o. structured by age, sex, causes

Mortality of district newborn

Mortality of district adolescents

Hospital mortality of children, structured by age

Mortality of children under 1 y.o., natimortality

96 із 200

A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.

To decrease thyroxine dosage

To administer betablockers

To add mercasolil to the treatment

To increase thyroxine dosage

To administer sedatives

97 із 200

Body temperature of a 12 y.o. girl increased up to 39—40°C in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Nikolsky syndrome is positive. What is the most probable diagnosis?

Acute epidermical necrolysis

Pemphigus vulgaris

Polymorphic exudative erythema

Duhring’s disease

Bullous dermatitis

98 із 200

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

Right-sided direct inguinal hernia

Right-sided oblique inguinal hernia

Varicose veins of the right hip

Right-sided femoral hernia

Lipoma of the right inguinal area

99 із 200

A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. AP- 180/100 mm Hg. Speeln is 4 cm below the rib arch edge. What is the most probable diagnosis?

Erythremia

Allergic dermatitis

Essential hypertension

Systemic sclerodermia

Dermatomyositis

100 із 200

A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?

Syndrome of fermentative dyspepsia

Dyskinesia syndrome

Syndrome of fatty dyspepsia

Malabsorption syndrome

Syndrome of decayed dyspepsia

101 із 200

In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

Immunization of the population

Hospitalization of patients

Disinfection in disease focus

Detection of carriers

Early diagnostics

102 із 200

A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal ( rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

Anovular menstrual cycle

Immunologic infertility

Genital endometriosis

Abnormalities in genital development

Chronic adnexitis

103 із 200

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

Cancer of cervix of the uterus

Nascent fibroid

Polypus of the cervis of the uterus

Cervical pregnancy

Leukoplakia

104 із 200

A local doctor has to prepare a report about the health condition of the population of his region. What medical indexes of population health condition should he use?

Morbidity, disabilities, demographic, physical development

Social welfare, satisfaction of life quality

Way of life, genetic, pollution

Average treatment duration, complications

Average longevity

105 із 200

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

Harmonious

Disharmonious

Below the average

Markedly disharmonious

Excessive

106 із 200

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

Obsidan

Euphyline

Amisyl

No-shpa

Corglicone

107 із 200

A woman complains of high temperature to 380C, mild pain in the throat during 3 days. On examinati- on: angle lymphatic nodes of the jaw are 3 cm enlarged, palatinel tonsils are enlarged and coated with grey plaque which spreads to the uvula and frontal palatinel arches. What is the most probable diagnosis?

Larynx dyphtheria

Vincent’s angina

Oropharyngeal candidosis

Infectious mononucleosis

Agranulocytosis

108 із 200

A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and localized between scapulas. In a day temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

Perforation of esophagus with mediasti-nitis

Aspirative pneumonia

Pulmonary atelectasis

Esophageal hemorrhage

Obstruction of esophagus

109 із 200

A child from the first noncomplicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3th day appeared changes of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces- golden-yellow. Mother’s blood group is A(II)Rh-, child-A(II)Rh+. On the third day child’s Hb is 200 g/L, RBC- 6,1 * 1012/L, bilirubin in blood - 58 mk mol/L due to unconjugated bilirubin, Ht- 0,57 What is the child’s jaundice explanation?

Brain delivery trauma

Hemolytic disease of newborn

Bile ducts atresia

Physiologic jaundice

Fetal hepatitis

110 із 200

A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator N°8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?

Probing of uterus cavity

Metrosalpingography

Laparoscopy

Ultrasound examination

Bimanual examination

111 із 200

A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39,50C. He had a respiratory disease 1,5 week ago. On examination: temperature- 38,50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?

Antistreptolysine-0

1- antitrypsine

Creatinkinase

Rheumatic factor

Seromucoid

112 із 200

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

Fresh frosen plasma

Fresh frosen blood

Cryoprecipitate

Dried plasma

Native plasma

113 із 200

A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

Punction and drainage of pleural cavity

Pneumoectomy

Decortication of pleura

Thoracoplasty

Lobectomy

114 із 200

A 28 y.o. homeless male was admitted to the hospital because of initial diagnosis 'influenza'. Roseolo-petechiae rash has appeared on the trunk and internal surfaces of the limbs on the fifth day. Temperature is 410C, euphoria, face and sclera’s hyperemia, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

Typhus

Leptospirosis

Measles

Alcogolic delirium

Abdominal typhoid

115 із 200

A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient’s condition is grave. Body temperature - 38, 90C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

Peritonsillar abscess

Pharyngeal tumour

Vincent’s disease

Phlegmonous tonsillitis

Diphtheria

116 із 200

In a 65 y.o. female patient a tumor 13x8 cm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On ausculation: systolic murmur. What is the most probable diagnosis?

Abdominal aortic aneurism

Stomach tumor

Mitral insufficiency

Arterio-venous aneurism

Tricuspid valve insufficiency

117 із 200

A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

Trichomonas colpitic

Gonorrhea

Vagina candidomicosis

Chlamydiosis

Bacterial vaginosis

118 із 200

A 18 y.o. woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,50C, considerable mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina examination the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

Recent acute ascending gonorrhea

Chronic gonorrhea

Candydomycosis

Trichomoniasis

Chlamydiosis

119 із 200

A 30 y.o. male patient complains of itching of the skin which intensifies in the evening. He has been ill for 1,5 months. On examination: there is rash with paired papules covered with bloody crusts on the abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand. There are traces of line scratches. What additional investigations are necessary to make diagnosis?

Examination of rash elements scrape

Serologic blood examination

Examination for helmints

Blood glucose

Determination of dermographism

120 із 200

A child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0,45. What is the most probable diagnosis?

Edematous-hemorrhagic syndrome

Pulmonary edema

Disseminated intravascular clotting syndrome

Hyaline membrane disease

Congenital pneumonia

121 із 200

A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil- 2%; eosinophil-5%. There is a urate crystales in urine, erythrocyte- 2-3 in the field of vision. What is the preliminary diagnosis?

Chronic myeloleucosis

Lymphogranulomatosis

Hepar cirrhosis

Leukemoid reaction

Urolithiasis

122 із 200

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

Corresponding to the age

Paratrophy of I grade

150 g less than necessary

Hypotrophy of II grade

Hypotrophy of I grade

123 із 200

A 2 m.o. breast-fed child suffers from cheek skin hyperemia, sporadic papulous elements on the skin of the chest and back following the apple juice introduction. The child is restless. What is the initial pediatritian’s tactics?

Clarify mother’s diet and exlude obligate allergens

Apply ointment with corticosteroids to affected skin areas

Refer to prescribe dermathologist

Administer general ultraviolet irradiation

Treat with claritine

124 із 200

A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

Perforative ulcer

Right-sided renal colic

Acute cholecystitis

Acute appendicitis

Acute bowel obstruction

125 із 200

On the 5-th day of the respiratory disease a 24 y.o. man has developed progressive headaches systemic dizziness, feeling of seeing double, paresis of mimic muscles on the right, choking while swallowing. Acute viral encephalitis has been diagnosed. What is the main direction of urgent therapy?

Zovirax

Hemodesis

Glucocorticoids

Ceftriaxon

Lasix

126 із 200

A 65 y.o. woman complains of complicated mouth opening following foot trauma 10 days ago. Next day she ate with difficulties, there were muscles tension of back, the back of the head and abdomen. On the third day there was tension of all muscle groups, generalized convulsions every 10-15 min. What is the most probable diagnosis?

Tetanus

Tetania

Epilepsy

Hemorrhagic stroke

Meningoencephalitis

127 із 200

A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP-180/20 mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, S2 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor’s tactics should be?

Cardiosurgeon consultation

Dispensary observation

Administration of therapeutic treatment

Exemption from physical exercises

Continuation of investigation

128 із 200

A 35 y.o. woman is suspected of aplastic anemia. The bone marrow puncti-on has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

Replacement of marrow elements with adipose tissue

Presence of blast cells

Replacement of marrow elements with fibrous tissue

Absolute lymphocytosis

Prevalence of megaloblasts

129 із 200

A girl, aged 13, consults 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

Endometrium cancer

Haemophilia

Juvenile haemorrhage

Werlhof’s disease

130 із 200

A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of the thorax, cough, blood-streaked sputum. On X-ray: intensive triangle shadow in the area of lower lobe that is connected to mediastinum. What is the most likely disorder in the lungs?

Central cancer of lungs

Bronchiectasia

Pleuropneumonia

Tuberculosis of lungs

Pulmonary infarction

131 із 200

In a forest summer camp children have variable procedures to harden their organisms. What procedure has the most hardening power?

Contrast shower

Hygienic shower

Walking on the fresh air

Morning exercises on the fresh air

Bath with hydromassage

132 із 200

There is a dynamic growth of number of congenital abnormalities such as central paralysis, newborns blindness, idiocy among the population that lives near to pesticides production enterprise. Compounds of which pollutant can cause the development of this pathology?

Mercury

Iron

Strontium

Cadmium

Chrome

133 із 200

A 7 y.o. child had elevation of temperature tol 40° C in anamnesis. For the last 3 months he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal column. What is the most probable diagnosis?

Juvenile rheumatic arthritis

Septic arthritis

Toxic synovitis

Rheumatism

Osteoarthrits

134 із 200

A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left - 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?

Aortic stenosis

Open aortic duct

Coarctation of the aorta

Defect of interventricular septum

Defect of interatrial septum

135 із 200

At’s planned to construct multifield a new hospital in one of the cental city districts. What building type is the most appropriate in this case?

Centralized and blocked

Centralized

Mixed

Blocked

Decentralized

136 із 200

A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?

Thromboembolia of pulmonary artery

Valvular pneumothorax

Hemorrhagia

Myocardial infarction

Hypostatic pneumonia

137 із 200

A 1,5 y.o. child fell ill acutely with high temperature 38°C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occured in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis?

Polyomyelitis

Polyartropathy

Viral encephilitis

Hip joint arthritis

Osteomyelitis

138 із 200

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

Natural light coefficient

Time of the room insolation

Light coefficient

Depth of study room

Presence of mixed (upper-lateral) light

139 із 200

A 24 y.o. woman presents with prolonged fever, nocturnal sweating. She’s lost weight for 7 kg during the last 3 months. She had irregular intercourses. On examination: enlargement of all lymphaden groups, hepatolienal syndrom. In blood: WBC- 2, 2 * 109/L. What is the most likely diagnosis?

HIV-infection

Tuberculosis

Infectious mononucleosis

Chroniosepsis

Lymphogranulomatosis

140 із 200

A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated Si at apex, there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What rind of heart disorder is observed?

Mitral stenosis

Mitral valve insufficiency

Aortic valve insufficiency

Opened arterial duct

Pulmonary artery stenosis

141 із 200

A 31 y.o. woman has suffered from systemic sclerodermia for 14 years. She was treated in hospitals many times. She complains of periodical dull pain in the cardiac area, palpitation, dyspnea, headache, eyelids swelling, weight loss, pain and limbs deformities. Which organ’s disorder worsens the prognosis?

Kidneys

Heart

Skin and joints

Gastro-intestinal tract

Lungs

142 із 200

A 70 y.o. male patient with mild headaches complains of speech disorder, weakness in right limbs. There was a history of miocardial infarction and arrhythmia. On nu eroligical examination there are elements of motor aphasia, central paresis of VII and XII cranial nerves pairs on the right side, cental type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

Ischemic stroke

Cerebral tumor

Transitory ischemic attack

Epidural hematoma

Hemorrhagic stroke

143 із 200

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

Bicycle ergometry

Echocardiography

Blood lipoproteins

Transaminases of blood

General blood count

144 із 200

A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?

Hyperkaliemia

Hypokaliemia

Hypocalcemia

Hypernatremia

Hyperhydratation

145 із 200

A 20 daily y.o. female patient is suffering from chronic bronchitis. Recently there has been production about 0,5 L of purulent sputum with maximum discharge in the morning. Fingers are like 'drum sticks', there are 'watching glass'nails. What is the most probable diagnosis?

Bronchiectasia

Tuberculosis

Gangrene of lungs

Chronic bronchitis

Pneumonia

146 із 200

A 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/L; RBC- 3, 2 * 10i2/L; coloured index- 0,95; thromb.- 20 * 109/L. The sedi-mantation time according to Lee White is 5' hemorrhagia duration according to Duke is 8', 'pinch and tourniquet'test is positive. What is the most probable diagnosis?

Idiopathic thrombocytopenic purpura

Hemophilia

Hemorrhagic diathesis

Marchiafava-Micheli’s disease

Iron deficiency anemia

147 із 200

A 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of 50 sec duration. There is a appearing of the fetus head. Perineum is of 4 cm height, has turned pale. What should be done in this case?

Episiotomy

Perineum protection

Perineotomy

Vacuum extraction of the fetus

Observation

148 із 200

A 28 y.o. male patient was admitted to the hospital because of high temperature 39° C, headache, generalized fatigue, constipation, sleep disorder for 9 days. There are sporadic roseolas on the abdomen, pulse- 78 bpm, liver is enlarged for 2 cm. What is the most probable diagnosis?

Abdominal typhoid

Brucellosis

Typhus

Sepsis

Leptospirosis

149 із 200

A 40 h.o. child age has hyperosthesia, CNS depression, dyspepsia. Sepsis is suspected. What should the differential diagnosis be made with?

Hypoglycemia

Hyperbilirubinemia

Hypocalcemia

Hypomagnesemia

Hyperkaliemia

150 із 200

A 20 y.o. patient with bronchial asthma experiences dyspnea attacks 3-4 times a week. Nocturnal attacks are 1 time a week. FEV1- 50% of necessary figures, during the day it’s variations is 25 %. What is the severity of bronchial asthma condition?

Moderate severity condition

Serious condition

Mild condition

Asthmatic status

Intermittent flow

151 із 200

A 40 y.o. man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP-170/130 mm Hg. On EchoCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the probable diagnosis?

Essential arterial hypertension

Cushing’s disease

Chronic pyelonephritis

Polycystic disease of the kidneys

Chronic glomerulonephritis

152 із 200

A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?

Threatened spontaneous abortion

Hydatid molar pregnancy

Spontaneous abortion which has begun

Placenta presentation

Stopped pregnancy

153 із 200

A primapara with pelvis size 25-2831-20 cm has active labor activity. Waters poured out, clear. Fetus weight is 4500 g, the head is engaged to the small pelvis inlet. Vasten’s sign as positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?

Caesarean section

Stimulation of the labor activity

Conservative tactics of labor

Vacuum extraction of the fetus

Obstetrical forseps

154 із 200

A 41 y.o. man complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious: lips and mucous are cyanotic, breathing rate is 28 per min, pulse-122 bpm., AP- 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S2 is accentuated over pulmonary artery. What is the urgent measure on the prehospital stage?

Air aspiration from the pleural cavity

Call for cardiologic team

Oxygen inhalation

Epinephrine introduction

Euphilline introduction

155 із 200

A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?

Autoimmune

Bacterial

Neurogenic

Viral

Virus-bacterial

156 із 200

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

Mesenterial vessels thrombosis

Volvulus

Ichemic abdominal syndrome

Erysipelas

Acute intestinal obstruction

157 із 200

A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 23- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase - 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?

Pancreatine

Levomicytine

Aminocapron acid

Contrykal

Imodium

158 із 200

A 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is mufflet, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation, fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The small fontanelle is at the symphis. What is the further tactics of the labor?

Application of obstetrical forceps

Ceasarian section

Application of craniodermal forceps by Ivanov’s

Application of obstetrical cavity forceps

Stimulation of the labor activity with oxitocyne

159 із 200

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

Admission to the mental hospital

Psychotherapeutic conversation

Out-patient treatment

Strict home supervision

Admission to the nu erological department

160 із 200

A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin’s area; sporadic extrasystoles. Liver isn’t palpated, there are no edema. Blood test: wBc- 6, 7* 109/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?

Acute myocarditis

Climacteric myocardiodystrophia

Ichemic heart disease, angina pectoris

Rheumatism, mitral insufficiency

Hypertrophic cardiomyopathy

161 із 200

A 52 y.o. male patient has become ill gradually. There is pain in the left side of the thorax during 2 weeks, elevation of temperature till 38 - 39°C. On examination: left chest side falls behind in breathing movement no voice tremor over the left lung. Dullness that is more intensive in lower parts of this lung. Right heart border is deviated outside. Sharply weakened breathing over the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most probable diagnosis?

Exudative pleuritis

Cirrhotic tuberculosis

Spotaneous pneumothorax

Infarction-pneumonia6- Atelectasis of lung

162 із 200

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

Newborn pemphigus

Ritter’s dermatitis

Pseudofurunculosis

Vesiculopustulosis

Sepsis

163 із 200

A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratoty disorders: sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy’s type in the child?

Chest X-ray

Blood test

Blood gases

Proteinogram

Immunologic investigation

164 із 200

During intramuscular DTP vaccination in clinic, a 3 m.o. child developed signs of laryngospasm, paleness of skin, cyanosis of lips, 'cock cry', stop of respiration, tension of the whole body with overturned backward head. Allergologi-cal history of the child is not complicated. What is the most probable diagnosis?

Spasmophilia, tonic spasms

Meningoencephalitic reaction, clonic and tonic spasms

Cerebral haemorrhage, tonic spasms

Meningism, clonic and tonic spasms

Anaphylactic shock, clonic spasms

165 із 200

A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS-0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?

Acute glaucoma attack

Eye nerve’s neuritis

Right eye’s keratitis

Right eye’s uveitis

Maculodystrophy

166 із 200

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

Sulfasalasine

Linex

Kreon

Motilium

Vikasolum

167 із 200

A 49 y.o. female patient presents with acute attacks of headache associated with pulsation in temples, increasing AP to 280/140 mm Hg. Pheochromocytoma is suspected. What is the mechanism of hypertensive crisis in this patient?

Increasing of catecholamines concentration

Increasing of thyroxine excretion

Increasing of plasma renin activity

Increasing of vasopressin excretion

Increasing of aldosterone level in blood

168 із 200

To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

Citrate intoxication

Citrate shock

Anaphylactic shock

Pyrogenous reaction

Allergic reaction

169 із 200

A 20 y.o. patient suddely felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC-12, 2 * 109/L. What is the most probable diagnosis?

Acute appendicitis

Perforated ulcer

Rightside kidney colic

Acute pancreatitis

Acute cholecystitis

170 із 200

A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

I degree

V degree

IV degree

II degree

III degree

171 із 200

A 24 y.o. emotionally-labile woman presents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue following the divorce. On examination: palm hyperhydrosis, pulse rate- 72-78 bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case?

Neurasthenia

Ipochondric neurosis

Compulsive neurosis

Schizophrenia

Depressive neurosis

172 із 200

A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. 'Furrow symptom 'is positive on the left. Pulse on foot arteries and popliteal artery isn’t palpated, on the femoral artery it’s weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

Arteriosclerosis obliterans

Obliterating endarteritis

Buerger’s disease (thromboangiitis obliterans)

Hemoral arthery thombosis

Raynauld’s disease

173 із 200

A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid-0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?

Obesity

Hyperuricemia

Hypercholesterolemia

Hyperglycemia

Arterial hypertension

174 із 200

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

Celiakia (celiac disease)

Intestinal dysbacteriosis

Mucoviscidosis (cystic fibrosis)

Chronic enteritis

Disaccharidase insufficiency

175 із 200

On medical observation a doctor identified girl (162 cm tall and 59 kg weight) who complained loss of ability to see surrounding objects clearly in the evening. On examination: dry skin, hyperkeratosis. Her daily ration includes the following vi-tamines: vitamine A- 0,5 mg, vit.Bi2,0 mg, vit.B2- 2,5 mg, vit.B6- 2 mg, vit.C- 70 mg. What is the hypovitaminosis type?

A-hypovitaminosis

Bv-hypovitaminosis

B6-hypovitaminosis

C-hypovitaminosis

B2-hypovitaminosis

176 із 200

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

Cervix dilation stage

Preliminary stage

Expulsion of fetus stage

Prodromal stage

Placental stage

177 із 200

A 30 y.o. patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

Septicotoxemia

Primary burn shock

Acute burn toxemia

Secondary burn shock

Convalescence

178 із 200

A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?

Cancer of cervix of uterus

Fibromatous node which is being born

Polypose of cervix of uterus

Cervical pregnancy

Cancer of body of uterus

179 із 200

A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, people’s faces get cartoon features, loss of time and space judgement. What is the most likely diagnosis?

Cocainism

Nicotinism

Barbiturism

Cannabism

Morphinism

180 із 200

A 75 y.o patient can not tell the month, date and season of the year. After long deliberations she manages to tellher name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as 'invaluable books'. What is the most probable diagnosis?

Senile dementia

Presenile melancholia

Behaviour disorder

Dissociated personality (psychopathy)

Atherosclerotic (lacunar) dementia

181 із 200

A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom. What is the maximal term to make a diagnosis?

In 2 hours

In 3 hours

In 6 hours

In 1 hour

In 0,5 hours

182 із 200

A 33 y.o. patient was admitted to the hospital with stopped recurrent peptic ulcer bleeding. On examination he is exhausted, pale. Hb- 77 g/L, Ht- 0,25. Due to anemia there were two attempts of blood transfution of identical blood group A(II)Rh+. Both attempts were stopped because of anaphylactic reaction. What blood transfution environment is desirable in this case?

Washed erythrocytes

Erythrocyte emulsion

Freshcitrated blood

Erythrocyte mass poor for leucocytes and thrombocytes

Erythrocyte mass (native)

183 із 200

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

A surgeon

A traumotologist

An anaesthesilogist

A doctor of any speciality

A laboratory physician

184 із 200

A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor’s tactics in this case?

Immediate pregancy interruption

Maintenance of pregnancy till 36 weeks

Maintenance of pregnancy till delivery term

Pregnancy interruption after urine normalization

Pregnancy interruption at 24-25 weeks

185 із 200

A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It’s been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiting with blood reoccured in 2-3- hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?

Urgent surgery

Deferred surgery

Conservative treatment

Conservative treatment with following surgery

Taylor’s treatment

186 із 200

A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient’s blood from the abdominal cavity be used for autotransfusion?

Stomach rupture

Bladder rupture

Small intestines rupture

Splenic rupture

Liver rupture

187 із 200

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

Gout

Infectional arthritis

Erysipelatous inflammation

Osteoarthritis

Rheumatoid arthritis

188 із 200

A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patient’s state?

Malignisation

Stenosis

Perforation

Haemorrhage

Penetration

189 із 200

A 54 y.o. male patient suffers from dyspnea during mild physical exertion, cough with sputum which is excreted with diffculty. On examination: diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with prolonged expiration and dry whistling rales. Ap is 140/80 mm Hg, pulse is 92 bpm, rhythmic. Spi-rography: vital capacity (vC)/predicted vital capacity- 65%, FEV1/FVC- 50%. Determine the type of respiratory insufficiency (RI).

RI of mixed type with prevailing obstruction

RI of restrictive type

RI of obstructive type

There is no RI

RI of mixed type with prevailing resri-ction

190 із 200

A patient aged 18 with a cranial injury was in comatose state during several hours. In postcomatose period gets tired quickly, non-productive in dialog - in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

Nootropics

Neuroleptics

Tranquillisers

Stimulators

Antidepressants

191 із 200

A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?

Pleural cavity drainage

Intravenous infusions

Oxigenotherapy

Intubation

Analgetics

192 із 200

A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position. positive stretching symptoms were revealed on examination. What is an initial diagnosis?

Intervertebral ligaments disorder

Spinal cord tumor

Arachnomielitis

Polyneuritis

Myelopathy

193 із 200

A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

Strict following of feeding regimen

Hardening of the child

Gastro-intestinal disease prevention

Feces observation

Common cold prophilaxis

194 із 200

A male patient presents with swollen ankles, face, eyelids, elevated AP-160/100 mm Hg, pulse54 bpm, daily loss of albumine with urine- 4g. What therapy is pathogenetic in this case?

Corticosteroids

Diuretics

Calcium antagonists

Antibiotics

NSAID

195 із 200

During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

Increase of bleeding speed

Developing of cardiac insufficiency

Depositing of blood in venous channel

Presence of hypervolemia

Shunting

196 із 200

A male patient complains of heartburn which gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?

Gastroesophageal reflux

Gastric peptic ulcer

Chronic gastritis

Acute erosive gastritis

Duodenal peptic ulcer

197 із 200

A 2,5 m.o. child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin What is the dosage and frequency of vitamin D administration?

3000 IU daily

1000 IU every other day

500 IU every other day

500 IU daily

1000 IU daily

198 із 200

A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?

Irritable bowel syndrome

Colitis with hypertonic type dyskinesia

Atonic colitis

Spastic colitis

Chronic enterocolitis, exacerbation phase

199 із 200

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

Manual exploration of the uterine cavity

Use of hemostatic medications

External massage of uterus

Urine drainage, cold at lower abdomen

Use of uterine contracting agents

200 із 200

A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?

Paradoxal ischuria

Dysuria

Enuresis

Urinary incontinence

Pollakiuria