Skip to content
- A patient with chronic bilateral purulent mesotympanitis at the remission stage (“dry perforation of the eardrum) has been hospitalized to the ENT unit of a hospital for hearing-improving surgery What surgical intervention should be performed in this case?
A. Tympanoplasty
B. Stapes mobilization
C. Radical ear surgery
D. Fenestration of the base of the stapes
E. Stapedoplasty
Correct Answer : A. Tympanoplasty
- Correct Answer: Tympanoplasty
- Explanation:
- Chronic bilateral purulent mesotympanitis in the remission stage with a dry perforation indicates inactive chronic otitis media of the mucosal type. The main problem here is conductive hearing loss due to tympanic membrane perforation and possible ossicular chain involvement.
- Tympanoplasty is specifically designed to repair the perforated eardrum and reconstruct the sound-conducting mechanism, thereby improving hearing. Since the ear is dry and infection-free, it is the ideal time for hearing-improving reconstructive surgery.
- Why Other Options Are Incorrect:
- B. Stapes mobilization:
- ❌ Used in otosclerosis, not in chronic otitis media with tympanic membrane perforation.
- C. Radical ear surgery:
- ❌ Indicated in active disease or cholesteatoma, not in dry, remission-stage mesotympanitis.
- D. Fenestration of the base of the stapes:
- ❌ An obsolete procedure for otosclerosis, unrelated to middle ear infection.
- E. Stapedoplasty:
- ❌ Done for stapes fixation in otosclerosis, not for tympanic membrane perforation.
- Therefore, tympanoplasty is the correct surgical intervention for hearing improvement in this case.
- A 9-year-old girl objectively presents with a fever of 39.2°C, lymphadenopathy, difficulty breathing through the nose, icteric skin, easily removable white-yellow deposits on the tonsiIs, and hepatosplenomegaly. Complete blood count: atypical mononuclear cells 9%. What is the most likely diagnosis in this case?
A. Tonsillar diphtheria
B. Infectious mononucleosis
C. Viral hepatitis A
D. Scarlet fever
E. Pseudotuberculosis
Correct Answer : B. Infectious mononucleosis
Correct Answer: Infectious mononucleosis
Explanation:
Infectious mononucleosis is a viral illness (EBV) characterized by high fever, generalized lymphadenopathy, tonsillitis with removable exudates, hepatosplenomegaly, and atypical mononuclear cells in blood.
In this case, the presence of easily removable white-yellow tonsillar deposits, nasal breathing difficulty due to lymphoid hyperplasia, jaundice, hepatosplenomegaly, and 9% atypical mononuclear cells strongly supports infectious mononucleosis as the best diagnosis.
Why Other Options Are Incorrect:
A. Tonsillar diphtheria:
❌ Diphtheria has gray, tightly adherent pseudomembranes that bleed on removal and usually lacks atypical mononuclear cells.
C. Viral hepatitis A:
❌ Causes jaundice and hepatomegaly but does not cause tonsillar exudates, lymphadenopathy, or atypical mononuclear cells.
D. Scarlet fever:
❌ Characterized by strawberry tongue and sandpaper rash, not hepatosplenomegaly or atypical mononuclear cells.
E. Pseudotuberculosis:
❌ Typically presents with abdominal pain and rash, not classic tonsillitis with atypical lymphocytosis.
Thus, infectious mononucleosis best explains all clinical and laboratory findings in this child.
- A 32-year-old woman complains of general weakness, headache, еxexcessive body weight, pain in her bones, and menstrual cycle disorders. Objectively, her skin is dry and cyanotic. There are purple-cyanotic stretch marks on her abdomen, shoulders, and thighs. Fat deposits are located mainly on her face, neck, and torso. Blood pressure-165/100 mm Hg. Blood test results: glucose – 7.2 mmol/L, elevated ACTH levels. X-ray of the bones detects signs of osteoporosis. What is the most likely diagnosis in this case?
A. Cushing disease
B. Conn syndrome
C. Cushing syndrome
D. Stein-Leventhal syndrome
E. Hypothyroidism
Correct Answer : A. Cushing disease
Correct Answer: Cushing disease
Explanation:
Cushing disease is caused by excessive ACTH secretion from a pituitary adenoma, leading to increased cortisol production. Typical features include central obesity, moon face, purple striae, hypertension, diabetes, osteoporosis, and menstrual disturbances.
In this patient, the presence of classic Cushingoid features along with elevated ACTH levels clearly points to an ACTH-dependent cause. Since the source is internal ACTH overproduction, this fits Cushing disease rather than other causes of hypercortisolism.
Why Other Options Are Incorrect:
B. Conn syndrome:
❌ Causes hyperaldosteronism with hypertension and hypokalemia, not Cushingoid features or high ACTH.
C. Cushing syndrome:
❌ Refers to ACTH-independent hypercortisolism; ACTH would be low, not elevated.
D. Stein-Leventhal syndrome:
❌ PCOS causes menstrual irregularities and obesity but lacks striae, osteoporosis, and cortisol excess.
E. Hypothyroidism:
❌ Causes weight gain and dry skin but does not cause purple striae, hypertension, or elevated ACTH.
Therefore, elevated ACTH with classic Cushing features confirms the diagnosis of Cushing disease.
4. A 53-year-old man has been hospitalized with complaints of shortness of breath and intense pain behind the sternum that radiates to his left shoulder blade and can be relieved in a sitting position. The duration of the symptoms is 7 hours. The patient has long history of arterial hypertension, he poorly adheres to the prescribed treatment treatment and has recovered from an enterovirus infection two wecks ago. Objectively, the patient’s heart rate is 91/min, his blood pressure is 150/85 mm Hg. ECG shows ST segment elevation in leads II, III, aVF, and V3-V6. What is the most likely diagnosis in this case?
A Acute pericarditis
B. Angina pectoris
C.-
D. Pneumonia
E. Acute myocarditis
Correct Answer : E. Acute myocarditis
Correct Answer: Acute myocarditis
Explanation:
Acute myocarditis is inflammation of the heart muscle, most commonly following a viral infection such as enterovirus. It presents with chest pain, shortness of breath, and ECG changes that can mimic myocardial infarction.
In this case, the recent enteroviral infection, prolonged chest pain (7 hours), dyspnea, and diffuse ST-segment elevation involving both inferior and precordial leads strongly favor myocarditis. The pain relief in sitting position and lack of classic ischemic pattern also support an inflammatory myocardial process rather than coronary artery disease.
Why Other Options Are Incorrect:
A. Acute pericarditis:
❌ Typically shows diffuse ST elevation in almost all leads with PR depression; myocarditis better explains dyspnea and viral history here.
B. Angina pectoris:
❌ Angina causes transient chest pain without persistent ST elevation and usually resolves with rest or nitrates.
D. Pneumonia:
❌ Presents with fever, cough, and lung findings, not ST elevation on ECG or cardiac-type chest pain.
Thus, the combination of viral prodrome, ECG findings, and clinical presentation makes acute myocarditis the most likely diagnosis.
5. A 19-year-old patient complains of severe fatigue and weight loss of 8 kg over the past three months. Signs of “dirty elbows and knees are positive. Hyperpigmentation of the gums and scrotum appeared. These symptoms developedafter patient’s recovery from a case of COVID19. His height is 176 cm, his weight is 57 kg. Blood test results: fasting glucose -3.4 mmol/, sodium -128 mmol/L. What is the most likely diagnosis in this case?
A. Cushing syndrome
B. Psychogenic anorexia
C. Symptomatic hypoglycemia
D. Secondary adrenal insufficiency
E. Primary adrenal insufficiency
Correct Answer : E. Primary adrenal insufficiency
Correct Answer: Primary adrenal insufficiency
Explanation:
Primary adrenal insufficiency (Addison disease) is due to destruction or dysfunction of the adrenal cortex, leading to deficiency of cortisol and aldosterone. This results in fatigue, weight loss, hypoglycemia, hyponatremia, and increased ACTH levels causing hyperpigmentation of skin and mucosa.
In this patient, classic signs like “dirty” hyperpigmentation of elbows, knees, gums, and scrotum, along with weight loss, low sodium (128 mmol/L), and low fasting glucose strongly point to Addison disease. Post-infectious autoimmune trigger after COVID-19 further supports primary adrenal failure.
Why Other Options Are Incorrect:
A. Cushing syndrome:
❌ Causes weight gain, hyperglycemia, and hypertension—not weight loss and hypoglycemia.
B. Psychogenic anorexia:
❌ Does not cause hyperpigmentation, hyponatremia, or hormonal abnormalities.
C. Symptomatic hypoglycemia:
❌ Hypoglycemia is a finding, not a unifying diagnosis explaining hyperpigmentation and hyponatremia.
D. Secondary adrenal insufficiency:
❌ ACTH is low, so hyperpigmentation and aldosterone deficiency are absent.
Primary adrenal insufficiency best explains the combination of hyperpigmentation, hyponatremia, hypoglycemia, and weight loss.
6. A 40-year-old man complains of vomiting and cramps in his leg muscles. He has history of chronic glomerulonephritis, observed over the last 10 years. Blood pressure- 180/120 mm Hg. Laboratory tests: serum creatinine770 mcmol/L, glomerular filtration rate5 mL/min. Over the past two days, his diuresis has decreased to 400 mL per 24 hours. What treatment tactics would be indicated for this patient?
A. Hemosorption
B. Plasmapheresis
C. Sorbents
D. Hemofiltration
E. Hemodialysis
Correct Answer : E. Hemodialysis
Correct Answer: Hemodialysis
Explanation:
This patient has end-stage chronic kidney disease due to long-standing chronic glomerulonephritis, as shown by extremely high creatinine (770 µmol/L), very low GFR (5 mL/min), and oliguria (400 mL/24 h). Vomiting and muscle cramps indicate uremia and electrolyte imbalance.
Hemodialysis is indicated in severe renal failure with uremic symptoms, oliguria, and life-threatening biochemical abnormalities. In this scenario, conservative measures are insufficient, and urgent renal replacement therapy is required to remove toxins and correct fluid–electrolyte disturbances.
Why Other Options Are Incorrect:
A. Hemosorption:
❌ Removes toxins from blood but does not correct severe uremia or fluid overload in end-stage renal failure.
B. Plasmapheresis:
❌ Used for immune-mediated diseases, not for advanced uremia or renal failure management.
C. Sorbents:
❌ Oral sorbents are ineffective in severe renal failure with very low GFR.
D. Hemofiltration:
❌ Mainly used in ICU settings for acute kidney injury; hemodialysis is standard for chronic end-stage renal disease.
Hemodialysis is the definitive and most appropriate treatment for this patient with uremic end-stage renal failure.
7. A 28-year-old woman complains of periodic loose stools, abdominal bloating, weight loss, and fatigability. These symptoms have been observed over the past 3 years. Objectively, the patient has dry skin, cheilitis, and atrophic glossitis, her BMI is 20.5 kg/m². Her abdomen is distended and mildly painful in its central segments. Blood test results: hemoglobin 90 g/L, mean erythrocyte volume- 70 fL. mean corpuscular hemoglobin concentration 280 g/L, leukocytes 6.2 10/L, platelets280 10/L. Stool testing detects steatorrhea. Blood testing detects IgA antibodies to tissue transglutaminase. What treatment tactics would be optimal in this case after verifying the diagnosis?
A.Following a gluten-free diet
B. Enzyme replacement therapy
C. Limiting lactose in the diet
D. Prescribing probiotics
E. Starting therapy with 5-aminosalicylic acid
derivatives
Correct Answer : A.Following a gluten-free diet
Correct Answer: Following a gluten-free diet
Explanation:
This patient has features of celiac disease, an autoimmune enteropathy triggered by gluten. Chronic diarrhea, bloating, steatorrhea, weight loss, iron-deficiency anemia (low Hb, low MCV, low MCHC), and positive IgA anti-tissue transglutaminase antibodies are classic findings.
After diagnosis is confirmed, the definitive treatment is a strict lifelong gluten-free diet. Removing gluten leads to mucosal healing, resolution of malabsorption, and correction of anemia and nutritional deficiencies, making it the most appropriate management strategy in this case.
Why Other Options Are Incorrect:
B. Enzyme replacement therapy:
❌ Used for pancreatic insufficiency, not autoimmune gluten-induced enteropathy.
C. Limiting lactose in the diet:
❌ Lactose intolerance may be secondary but is not the primary treatment.
D. Prescribing probiotics:
❌ Do not address the underlying immune-mediated cause of symptoms.
E. Starting therapy with 5-aminosalicylic acid derivatives:
❌ Used in inflammatory bowel disease, not celiac disease.
A gluten-free diet directly treats the cause of symptoms and is essential for recovery in this patient.
- A 25-year-old woman complains of a fever of38.6°C. pain in her lower abdomen, and dysuric disorders. She fell ill 3 days ago, when the above
symptoms appeared after an induced abortion. Gynecological examination detects a cylindrical cervix, its os is closed, the uterine body is slightly enlarged, painful, and soft. The uterine appendages are not palpable. The discharge is purulent and bloody. Blood test results reveal an elevated ESR and leukocytosis with the left shift of the blood formula. What is the most likely diagnosis in this case?
A. Pyosapinx
B. Acute endometritis
C. Acute cystitis
D. Acute endocervicitis
E. Acute salpingo-oophoritis
Correct Answer : B. Acute endometritis
Correct Answer: Acute endometritis
Explanation:
Acute endometritis is an infection of the uterine lining, most commonly occurring after childbirth, miscarriage, or induced abortion. It presents with fever, lower abdominal pain, uterine tenderness, purulent or bloody discharge, and systemic inflammatory signs.
In this case, symptoms started shortly after an induced abortion, with fever, leukocytosis, elevated ESR, soft and painful enlarged uterus, closed cervical os, and purulent-bloody discharge. These findings are classic for acute endometritis and fit the timing and examination findings precisely.
Why Other Options Are Incorrect:
A. Pyosalpinx:
❌ Involves pus in the fallopian tubes and usually presents with adnexal mass and severe pelvic pain.
C. Acute cystitis:
❌ Causes dysuria and urinary symptoms but does not explain uterine tenderness or purulent vaginal discharge.
D. Acute endocervicitis:
❌ Limited to the cervix; does not cause uterine enlargement or marked systemic signs.
E. Acute salpingo-oophoritis:
❌ Typically presents with adnexal tenderness or palpable appendages, which are absent here.
The combination of post-abortion onset, uterine tenderness, fever, and purulent discharge confirms acute endometritis as the diagnosis.
9. A girl with the body weight of 3100 g was born of the mother’s third pregnancy. The childbirth was at home. On the third day, the mother noticed small hemorrhages in the baby’s umbilical wound and “red dots”on the sclerae of the baby’s eyes. The mother is not registered with a maternity clinic. She breastfeeds the baby on demand. Physical examination detects subconjunctival hemorrhages. Laboratory testing results: hemoglobin concentration-155 g/L, the mother’s blood group is B(III) Rh-positive, the baby’s blood group is A(II) Rh-negative. What tactics would be optimal for the prevention of the baby’s health condition from from progressing?
A. Transfusion of packed erythrocytes
B. Vitamin K administration
C. Transition to formula-feeding with iron-for- tified formula
D. Administration of immunoglobulin human anti-Rhesus Rh0 (D)
E. Prescribing oral iron supplements
Correct Answer : B. Vitamin K administration
Correct Answer: Vitamin K administration
Explanation:
This newborn has signs of hemorrhagic disease of the newborn, caused by vitamin K deficiency. Typical features include bleeding from the umbilical stump and subconjunctival hemorrhages, with otherwise normal hemoglobin levels and no evidence of hemolysis.
The baby was born at home and did not receive routine neonatal prophylaxis. Exclusive breastfeeding without vitamin K supplementation increases the risk, as breast milk is low in vitamin K. Timely vitamin K administration prevents progression to severe bleeding, including intracranial hemorrhage.
Why Other Options Are Incorrect:
A. Transfusion of packed erythrocytes:
❌ Hemoglobin is normal; there is no anemia or massive blood loss.
C. Transition to formula-feeding with iron-fortified formula:
❌ Does not correct vitamin K deficiency or stop bleeding.
D. Administration of immunoglobulin human anti-Rhesus Rh0 (D):
❌ There is no Rh incompatibility causing hemolytic disease in this case.
E. Prescribing oral iron supplements:
❌ Iron deficiency is not present and does not explain bleeding manifestations.
Vitamin K administration directly addresses the cause of bleeding and prevents further hemorrhagic complications.
10. A 64-year-old patient complains of the absence of urination over the past 12 hours. Objectively, a painful mass is palpable above the pubis. The upper edge of the mass reaches the navel. Rectal examination detects an enlarged. painless, tubercular prostate of stony density. density Blood levels of prostate-specific antigen-24.2 ng/mL. What is the cause of the acute urinary retention in this case?
A. Acute prostatitis
B. Chronic paraproctitis
C. Epietdymo-orchitis
D. Prostate cancer
E. Benign prostatic hyperplasia
Correct Answer : D. Prostate cancer
Correct Answer: Prostate cancer
Explanation:
Acute urinary retention occurs when there is obstruction at the level of the bladder outlet. In elderly men, prostate pathology is the most common cause. Prostate cancer typically presents with a hard, irregular, tubercular prostate on rectal examination and markedly elevated PSA levels.
In this patient, the prostate is painless, stony hard, and nodular, with a very high PSA (24.2 ng/mL). These findings are characteristic of malignant prostate obstruction rather than benign or inflammatory causes, leading to acute urinary retention and bladder overdistension.
Why Other Options Are Incorrect:
A. Acute prostatitis:
❌ Usually presents with fever, pain, and a tender prostate, not a stony hard gland.
B. Chronic paraproctitis:
❌ A rectal condition that does not cause urinary retention or prostate enlargement.
C. Epididymo-orchitis:
❌ Causes scrotal pain and swelling, not bladder outlet obstruction.
E. Benign prostatic hyperplasia:
❌ Prostate is enlarged but soft and elastic, with PSA usually not so markedly elevated.
The hard nodular prostate with very high PSA confirms prostate cancer as the cause of acute urinary retention.
11. A multipara woman developed vaginal bleeding with the onset of full-term delivery. Internal obstetric examination detects a smoothed cervix with the opening of 6 cm, 1/3 of the internal os is obstructed by a spongy tissue. The amniotic sac is palpable in the rest of this area. The labor is active. Specify the further tactics of the delivery management in this case.
A. Cesarean section
B. Amniotomy
C. Stopping the active labor
D. Stimulation of the labor
E. Hemostatic therapy
Correct Answer : B. Amniotomy
Correct Answer: Amniotomy
Explanation:
This condition represents marginal placenta previa, where placental tissue partially overlaps the internal cervical os and presents as spongy tissue on vaginal examination, causing bleeding at the onset of labor.
In active labor with cervical dilation of 6 cm and only 1/3 obstruction, amniotomy is the correct tactic. Rupturing the membranes allows the fetal head to descend and compress the placental site, which helps control bleeding and allows vaginal delivery to continue safely.
Why Other Options Are Incorrect:
A. Cesarean section:
❌ Indicated in complete or major placenta previa, not when only a small marginal portion is involved and labor is advanced.
C. Stopping the active labor:
❌ Not appropriate in established active labor with favorable conditions for vaginal delivery.
D. Stimulation of the labor:
❌ Labor is already active; stimulation can worsen bleeding.
E. Hemostatic therapy:
❌ Does not address the mechanical cause of bleeding in placenta previa during labor.
Thus, amniotomy is the correct next step to control bleeding and safely continue delivery.
12. A 23-year-old woman complains of profuse foul-smelling purulent discharge from her genital tract and burning and itching in the area of her external genitalia, observed over the last three days. According to the patient’s history. the symptoms appeared after an unprotected sexual intercourse. Vaginal examination detects odeteets hyperemic profuse. vaginal mucosa, the discharge is profuse, yellow-green, and foamy. What is the most likely diagnosis in this case?
A. Bacterial vaginosis
B. Chlamydiosis
C. Mycoplasmosis
D. Candidal colpitis
E. Trichomonas colpitis
Correct Answer : E. Trichomonas colpitis
Correct Answer: Trichomonas colpitis
Explanation:
Trichomonas colpitis is a sexually transmitted infection caused by Trichomonas vaginalis. It typically presents with acute onset of foul-smelling, profuse vaginal discharge, itching, burning, and inflammation of the vaginal mucosa.
In this case, the symptoms started after unprotected intercourse, and examination shows hyperemic vaginal mucosa with yellow-green, foamy discharge, which is classic for trichomoniasis. These hallmark features make Trichomonas colpitis the best diagnosis.
Why Other Options Are Incorrect:
A. Bacterial vaginosis:
❌ Discharge is gray-white with fishy odor, usually without itching or marked inflammation.
B. Chlamydiosis:
❌ Often asymptomatic or causes mild discharge; does not produce foamy, foul-smelling discharge.
C. Mycoplasmosis:
❌ Usually causes mild, nonspecific symptoms, not acute purulent foamy discharge.
D. Candidal colpitis:
❌ Characterized by thick white “curd-like” discharge, not yellow-green or foul-smelling.
Thus, the presence of foamy, malodorous discharge after unprotected sex confirms trichomonas colpitis.
13. A 35-year-old woman complains of fou) sunelling discharge from her genital tract traс itching. For a long time, she has beenndng douching with a soda solution for hygiene purposes. Her menstrual cycle is normal. She has history of one childbirth. Mirror examinati on detects a homogencous wall white-gray coating on the vaginal wall, the vaginal wall is not hyperemic. Microscopy of the vaginal discharge Nugent score -7 points, Hay/Ison criteriagrade 3. What is the most likely diagnosis in this case?
A. Nonspecific vaginitis
B. Acrobic vaginitis
C. Vaginal candidiasis
D. Bacterial vaginosis
E. Trichomoniasis
Correct Answer : C . Vaginal candidiasis
Correct Answer: Bacterial vaginosis
Explanation:
Bacterial vaginosis is a dysbiosis of vaginal flora characterized by loss of lactobacilli and overgrowth of anaerobic bacteria. It commonly presents with foul-smelling discharge and minimal inflammation.
In this case, the white-gray homogeneous coating, absence of vaginal hyperemia, foul odor, history of frequent douching, and Nugent score of 7 with Hay/Ison grade 3 are classic diagnostic criteria for bacterial vaginosis.
Why Other Options Are Incorrect:
A. Nonspecific vaginitis:
❌ Usually associated with inflammation and hyperemia, which are absent here.
B. Aerobic vaginitis:
❌ Causes marked inflammation, pain, and redness of the vaginal wall.
C. Vaginal candidiasis:
❌ Presents with thick curd-like discharge and intense itching with hyperemia.
E. Trichomoniasis:
❌ Characterized by yellow-green foamy discharge and inflamed mucosa.
Thus, diagnostic scores and clinical features clearly confirm bacterial vaginosis.
14. A 14-year-old girl has chronic glomerulonephritis and chronic kidney disease. The girl’s anemia syndrome continues to progress. What drug should be prescribed to the patient for pathogenetic therapy of this anemia?
A. Folic acid
B. Iron supplements
C. Cyanocobalamin
D. Erythropoietin EP
E. Packed erythrocytes
Correct Answer : D. Erythropoietin EP
Correct Answer: Erythropoietin EP
Explanation:
In chronic kidney disease, anemia develops due to reduced production of erythropoietin by damaged kidneys. This leads to decreased stimulation of red blood cell formation in the bone marrow.
In this patient with chronic glomerulonephritis and CKD, progressive anemia is pathogenetically linked to erythropoietin deficiency. Therefore, replacement with erythropoietin directly targets the underlying cause of anemia.
Why Other Options Are Incorrect:
A. Folic acid:
❌ Useful only in folate deficiency anemia, not in CKD-related anemia.
B. Iron supplements:
❌ Iron may be supportive but does not correct erythropoietin deficiency.
C. Cyanocobalamin:
❌ Treats vitamin B12 deficiency anemia, not renal anemia.
Thus, erythropoietin is the correct pathogenetic treatment for anemia in chronic kidney disease.
15. A 44-year-old woman complains of spontaneous episodic whitening of her fingers, accompanied by a feeling of numbness and tingling, pain in the joints of her hands and in her elbow and knee joints, heartburn, and diffi- culty swallowing food. The onset of the disease was approximately one year ago. Objectively the patient’s face is amimic, there are alternating pigmented and depigmented areas, the skin of her face and fingers is compacted and cannot be pinched into a fold. Increased Increased levels of anti centromere blood.What is tibodies were likely detected diagnosis in her in this case?
A. Acute rheumatic fever
B. Systemic lupus erythematosus
C. Rheumatoid arthritis
D. Dermatomyositis
E . Systemic scleroderma
Correct Answer : E . Systemic scleroderma
Correct Answer: Systemic scleroderma
Explanation:
Systemic scleroderma is an autoimmune connective tissue disease characterized by progressive fibrosis of the skin and internal organs, along with vascular dysfunction. Raynaud phenomenon, skin tightening, and gastrointestinal involvement are classic features.
In this patient, episodic finger whitening (Raynaud phenomenon), mask-like amimic face, thickened non-pinchable skin, dysphagia, heartburn due to esophageal involvement, and positive anti-centromere antibodies strongly point to systemic scleroderma.
Why Other Options Are Incorrect:
A. Acute rheumatic fever:
❌ Occurs after streptococcal infection and does not cause skin thickening or Raynaud phenomenon.
B. Systemic lupus erythematosus:
❌ Causes rash and arthritis but not skin fibrosis or anti-centromere antibodies.
C. Rheumatoid arthritis:
❌ Causes joint pain and deformities but does not cause Raynaud phenomenon with skin tightening.
D. Dermatomyositis:
❌ Presents with muscle weakness and heliotrope rash, not sclerodactyly or esophageal dysmotility.
Thus, the combination of Raynaud phenomenon, skin fibrosis, and anti-centromere antibodies confirms systemic scleroderma.
16. A year-old woman who two days ago returned from Peru complains of pain and enlarged lymph nodes in her right inguinal regi- on. She has been diagnosed with bubonic plague What drug should be prescribed for the persons who were in contact with her for emergency prophylaxis?
A. Doxycycline
B. Chloroquine
C.Human immunoglobulin
D. Fluconazole
E. Heterologous serum
Correct Answer : A. Doxycycline
Correct Answer: Doxycycline
Explanation:
Plague is a severe bacterial infection caused by Yersinia pestis, which can be transmitted to close contacts. Doxycycline is an effective antibiotic for both treatment and post-exposure prophylaxis against plague.
In this scenario, persons who were in contact with the patient require emergency prophylaxis to prevent secondary infection. Doxycycline is recommended because it effectively prevents development of the disease in exposed individuals.
Why Other Options Are Incorrect:
B. Chloroquine:
❌ Used for malaria, not bacterial infections like plague.
C. Human immunoglobulin:
❌ Not indicated for prophylaxis against plague.
D. Fluconazole:
❌ Antifungal agent; has no activity against Yersinia pestis.
E. Heterologous serum:
❌ Historically used for treatment, not recommended for post-exposure prophylaxis.
Thus, doxycycline is the correct emergency prophylactic drug for contacts of plague patients.
17. A patient has been diagnosed with severe morphine poisoning Objectively, the patient is unconscious, severe respiratory depression can be observed, respiratory rate nun. What drug must be administered in this case?
A. Atropine sulfate
B. Naloxone
C. Diazepam
D. Flumazenil
E. Theophylline
Correct Answer : B. Naloxone
Correct Answer: Naloxone
Explanation:
Naloxone is an opioid antagonist that rapidly reverses the effects of opioid overdose, including severe respiratory depression and unconsciousness. It binds to opioid receptors, displacing morphine and other opioids, thereby restoring normal respiratory function.
In this patient with severe morphine poisoning, unconsciousness and dangerously low respiratory rate indicate life-threatening opioid toxicity. Immediate administration of naloxone is the standard emergency treatment to reverse these critical effects.
Why Other Options Are Incorrect:
A. Atropine sulfate:
❌ Used for bradycardia and organophosphate poisoning, not opioid overdose.
C. Diazepam:
❌ A sedative; contraindicated in respiratory depression as it may worsen it.
D. Flumazenil:
❌ Antagonist for benzodiazepines, not effective against opioids.
E. Theophylline:
❌ Bronchodilator; does not reverse opioid toxicity.
Thus, naloxone is the drug of choice for emergency treatment of severe morphine poisoning.
18. A 28-year-old woman came to a hospital on the tenth day after tenth day after the onset of the disease with complaints of marked general of marked general weakness insanmia, moderate headache, constipation, and a fever of 38.3-39.5°C Objectively, her consci cumess is preserved, ber skim is pale, there are 7 roseolas in her abdomen. The tongue is thickened, white-coated, and has teeth marks on its edges. The abdomen is distended. The percussion sound is shortened in the right thac region. Signs of peritoneal irritation are negati ve Hepatosplenomegaly is observed. Blood test resalts leukocytes-26-10/L, band neutrophi 4%, segmented neutrophils 30%, cou noplus 0%, lymphocytes 50%, monocytes 16%. ESR-10 mm/hour. What is the thost likely diagnosis in this case?
A. Viral hepatitis A
B. Shigellosis
C. Syphilis
D. Typhus
E Typhoid fever
Correct Answer : E Typhoid fever
Correct Answer: Typhoid fever
Explanation:
Typhoid fever is a systemic infection caused by Salmonella Typhi, characterized by gradual onset of fever, malaise, headache, constipation or diarrhea, abdominal distension, and rose-colored spots on the abdomen. Hepatosplenomegaly and leukocytosis or relative lymphocytosis may be present.
In this patient, the course on the tenth day with high fever, general weakness, insomnia, roseolas on the abdomen, abdominal distension, hepatosplenomegaly, and blood count showing relative lymphocytosis is typical for typhoid fever, making it the most likely diagnosis.
Why Other Options Are Incorrect:
A. Viral hepatitis A:
❌ Presents with jaundice, dark urine, nausea; rose spots and marked constipation are not typical.
B. Shigellosis:
❌ Causes acute dysentery with frequent bloody diarrhea, not constipation and systemic rose spots.
C. Syphilis:
❌ Chronic sexually transmitted infection; does not present acutely with fever, rose spots, or abdominal distension.
D. Typhus:
❌ Characterized by high fever and rash starting on the trunk and spreading; leukocyte changes differ.
Thus, the combination of prolonged fever, rose spots, abdominal distension, and hepatosplenomegaly confirms typhoid fever.
19. A 28-year-old woman came to a doctor with complaints of dull pain in her right breast, edema, and heaviness and discomfort, especially before menstruation. According to the patient’s medical history, the disease onset was three months ago. Objectively, there is no pathological discharge from the gland, the areola is not changed. Palpation detects a tumor 3×3 cm in size in the outer upper quadrant. The tumor is dense, relatively mobile, and moderately painful. The skin over the tumor remains unchanged. What is the most likely diagnosis in this case?
A. Fibroadenoma of the breast
B. Breast cancer
C. Solitary breast cyst
D. Paget’s disease of the breast
E. Diffuse cystic mastopathy
Correct Answer : A. Fibroadenoma of the breast
Correct Answer: Fibroadenoma of the breast
Explanation:
Fibroadenoma is a benign breast tumor common in young women, usually presenting as a painless or mildly tender, firm, mobile, well-circumscribed mass. Hormonal fluctuations can cause mild premenstrual discomfort or edema.
In this patient, the 3×3 cm dense, relatively mobile, moderately painful tumor in the outer upper quadrant, absence of skin changes or nipple discharge, and premenstrual discomfort are classic features of fibroadenoma, making it the most likely diagnosis.
Why Other Options Are Incorrect:
B. Breast cancer:
❌ Usually presents as a hard, immobile, painless mass with possible skin changes or nipple discharge; patient is young and features suggest benign lesion.
C. Solitary breast cyst:
❌ Typically fluctuant, soft, and may change size with menstrual cycle; usually painless.
D. Paget’s disease of the breast:
❌ Involves nipple-areola complex with eczema-like changes, not a discrete mobile mass.
E. Diffuse cystic mastopathy:
❌ Causes bilateral, diffuse nodularity and tenderness rather than a single well-defined mass.
Thus, the clinical presentation is most consistent with fibroadenoma of the breast.
20. A 55-year-old man came to his family doctor with complaints of weakness, thirst, dry mouth. and increased blood pressure. Objectively, the following is observed: BMI -35.6 kg/m², blood pressure- 140/90 mm Hg. dry skin, abdominal type of the subcutaneous fat distribution. Fasting glycemia – 6.0 mmol/L, postprandial glycemia-11.4 mmol/L, HbA1c -6.8%. What treatment strategy should be chosenfor for tthis patient?
A. Prescribe sulfonylurea derivatives
B. Tnsulin therapy
C. Prescribe metformin
D. Prescribe statins
E. Only diet therapy and exercise
Correct Answer: Prescribe metformin
Correct Answer: Prescribe metformin
Explanation:
Metformin is the first-line oral hypoglycemic agent for type 2 diabetes, especially in overweight or obese patients. It improves insulin sensitivity, reduces hepatic glucose production, and has a low risk of hypoglycemia, making it suitable for this patient with BMI 35.6 kg/m² and moderately elevated postprandial glucose.
In this scenario, lifestyle modification alone (diet and exercise) is insufficient due to postprandial hyperglycemia and HbA1c of 6.8%, which indicates persistent hyperglycemia. Metformin addresses both glucose control and obesity-related insulin resistance.
Why Other Options Are Incorrect:
A. Prescribe sulfonylurea derivatives:
❌ Can cause hypoglycemia and weight gain; not first-line for overweight patients without contraindications to metformin.
B. Insulin therapy:
❌ Not indicated at this stage; patient’s hyperglycemia is moderate and manageable with oral therapy.
D. Prescribe statins:
❌ Useful for dyslipidemia, but does not address hyperglycemia; not primary therapy for diabetes.
E. Only diet therapy and exercise:
❌ Insufficient alone due to postprandial glucose of 11.4 mmol/L and HbA1c >6.5%.
Metformin is the safest and most effective initial pharmacologic therapy for this overweight patient with newly diagnosed type 2 diabetes.
21. A 37-year-old man complains of increasing abdominal pain, distension, a fever of 39.2°C and general weakness. He has history of ulcerative colitis, observed over the last 8 years. He had no bowel movements for the last 2 days. Objectively, marked abdominal tenderness Is observed during palpation along the large intestine, pulse- 116/min. Survey abdominal X-ray detects signs of large intestine distension that exceeds 6 cm. What complication has most likely developed in the patient?
A. Toxic megacolon
B. Small bowel perforation
C. Abdominal abscess
D. Pscudomembranous colitis
E. Acute mechanical bowel obstruction
Correct Answer : E. Acute mechanical bowel obstruction
Correct Answer: Toxic megacolon
Explanation:
Toxic megacolon is a severe complication of ulcerative colitis characterized by extreme dilation of the colon (>6 cm), systemic toxicity (fever, tachycardia, weakness), and abdominal tenderness. It often develops after prolonged inflammation and can be life-threatening.
In this patient, a history of long-standing ulcerative colitis, absent bowel movements, marked abdominal tenderness, fever, tachycardia, and X-ray showing colonic distension >6 cm strongly indicate toxic megacolon rather than simple bowel obstruction.
Why Other Options Are Incorrect:
B. Small bowel perforation:
❌ Rare in ulcerative colitis; distension is in the large intestine, not small bowel.
C. Abdominal abscess:
❌ Would present with localized tenderness and signs of sepsis, but not diffuse colonic dilation.
D. Pseudomembranous colitis:
❌ Typically associated with antibiotic use and diarrhea; X-ray would show colitis signs, not massive colonic dilation.
E. Acute mechanical bowel obstruction:
❌ Usually affects small bowel in adults; history and X-ray indicate colonic origin with systemic toxicity.
Thus, the combination of colonic dilation >6 cm, systemic signs, and ulcerative colitis confirms toxic megacolon.
22. A 52-year-old man was complaining of difficulty walking and sudden weakness and numbness in his limbs on the left. Objecti vely, left sided hemihypesthesia and mild hemi paresis were observed. Four hours later, the pati ent’s condition normalized, his focal symptoms regressed, and the patient was able to walk 120/80 mm Hg normally Blood pressure What is the most likely diagnosis in this case?
A. Hemorrhagic stroke
B. Ischemic stroke
C. Hypertensive crisis
D. Migrane with aura
E. Teffantient ischemic attack
Correct Answer : E. Teffantient ischemic attack
Correct Answer: Transient ischemic attack
Explanation:
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by temporary cerebral ischemia without permanent infarction. Symptoms typically resolve within 24 hours, often in minutes to a few hours.
In this patient, sudden onset of left-sided weakness and numbness, hemihypesthesia, and mild hemiparesis that completely resolved within four hours, with normalization of neurological function, is characteristic of a TIA.
Why Other Options Are Incorrect:
A. Hemorrhagic stroke:
❌ Causes persistent neurological deficits and often severe headache; symptoms do not resolve spontaneously.
B. Ischemic stroke:
❌ Infarction leads to persistent neurological deficits, unlike the transient symptoms here.
C. Hypertensive crisis:
❌ May cause headache or visual changes but does not produce focal neurological deficits that resolve completely.
D. Migraine with aura:
❌ Usually presents with visual or sensory aura and headache; motor deficits are rare and usually not sudden.
Thus, the transient focal neurological deficits confirm a diagnosis of transient ischemic attack.
23. A 35-year-old patient complains of shortness of breath, tightness in her chest on the r ght, and cough that produces a small amount of mucopurulent sputum stum. According to the patient’s medical history, she has been ill for seven days already and attributes her condi tion to overexposure to cold. Obj Objectively mi Id acrocyanosis of the lips is observed, body temperature 38.7°C, pulse 90/min, blood pressure 140/85 mm Hg, the right side of the chest lags helund in the act of breathing. Below the angle of the right scapula, percussion detects dulincs with the border that reaches the apex, breathing cannot be auscultated What is the most likely diagnosis in this case?
A. Hospital-acquired pneumonia
B. Pulmonary atelectasis
C. Exudative pleurisy
D. Pulmonary abscess
E. Community-acquired pneumonia
Correct Answer : C. Exudative pleurisy
Correct Answer: Exudative pleurisy
Explanation:
Exudative pleurisy is an accumulation of inflammatory fluid in the pleural cavity, often following pneumonia or viral infection. It presents with chest pain, dyspnea, cough, and diminished or absent breath sounds over the affected area. Percussion reveals dullness over the fluid.
In this patient, the right-sided chest lag, percussion dullness extending from the scapula to the apex, absent breath sounds, fever, and productive cough suggest a large pleural effusion (exudative pleurisy) as a complication of acute respiratory infection.
Why Other Options Are Incorrect:
A. Hospital-acquired pneumonia:
❌ Usually occurs after 48 hours of hospitalization; patient’s illness began in the community.
B. Pulmonary atelectasis:
❌ May cause localized dullness but usually lacks fever and productive cough with purulent sputum.
D. Pulmonary abscess:
❌ Typically presents with localized cavitary lesion, high fever, and foul-smelling sputum; percussion dullness is usually limited.
E. Community-acquired pneumonia:
❌ Pneumonia causes localized consolidation, but percussion dullness reaching the apex and absent breath sounds indicate fluid in the pleural space, not parenchymal consolidation.
Thus, the combination of absent breath sounds, percussion dullness, and systemic signs confirms exudative pleurisy.
24. A 32-year-old woman complains of constantirritability, rapid heart rate, lacrimation, and weight loss of 10 kg in 4 months. Objectively, her skin is warm and moist, exophthalmos is observed. Von Graefe, Kocher. Moebius, and Dalrymple signs are positive. The thyroid gland is painless, but diffusely enlarged, which is noticeable when the patient swallows. Pulse108/min, blood pressure – 140/60 mm Hg. Fine tremor of the fingers can be detected. What is the most likely diagnosis in this case?
A. Acute thyroiditis
B. Sybacute thyroiditis
C.Diffuse toxic goiter
D. Diffuse nontoxic goiter
E. Medullary thyroid carcinoma
Correct Answer : C. Diffuse toxic goiter
Correct Answer: Diffuse toxic goiter
Explanation:
Diffuse toxic goiter, also known as Graves’ disease, is an autoimmune disorder characterized by hyperthyroidism, diffuse painless goiter, and eye signs (exophthalmos, lid lag, lid retraction). Symptoms include irritability, weight loss, tachycardia, tremor, and warm moist skin.
In this patient, the combination of rapid weight loss, palpitations, exophthalmos with positive Von Graefe, Kocher, Moebius, and Dalrymple signs, diffuse painless goiter, and hyperdynamic cardiovascular findings is classic for diffuse toxic goiter.
Why Other Options Are Incorrect:
A. Acute thyroiditis:
❌ Painful, tender thyroid with fever and systemic signs; absent here.
B. Subacute thyroiditis:
❌ Usually follows viral infection; thyroid is tender and painful; exophthalmos is absent.
D. Diffuse nontoxic goiter:
❌ Enlarged thyroid without hyperthyroid symptoms or eye signs.
E. Medullary thyroid carcinoma:
❌ Usually presents as a thyroid nodule with possible diarrhea or MEN2 features; hyperthyroidism is not typical.
Thus, the patient’s hyperthyroid symptoms and characteristic eye signs confirm diffuse toxic goiter.
25. A 33-year-old woman, who has been suffering from migraine without aura for many years. has developed more frequent episodes over the past 6 months. According too the patient, the episodes occur more than three times a weck and significantly impair the quality of her life. After consultation with a neurologist, a decision was made to prescribe her preventive mi graine therapy. What drug is recommended for preventive migraine therapy?
A.Carbamazepine
B. Acetylsalicylic acid
C. Methylprednisolone
D. Pantoprazole
E. Topiramate
Correct Answer: Topiramate
Correct Answer: Topiramate
Explanation:
Topiramate is a first-line preventive therapy for recurrent migraine without aura, especially when attacks are frequent (>3 times per week) and significantly affect quality of life. It works by stabilizing neuronal excitability and reducing cortical spreading depression, which helps lower migraine frequency and severity.
In this patient, acute treatments are insufficient due to frequent attacks. Topiramate is suitable for long-term prophylaxis, improving daily functioning and reducing the burden of migraine.
Why Other Options Are Incorrect:
A. Carbamazepine:
❌ Used for trigeminal neuralgia or seizure disorders; not effective for migraine prevention.
B. Acetylsalicylic acid:
❌ Useful for acute migraine attacks in some cases, but not recommended for prophylaxis.
C. Methylprednisolone:
❌ Steroids are not standard preventive therapy for chronic migraine.
D. Pantoprazole:
❌ A proton pump inhibitor; unrelated to migraine therapy.
Topiramate is the recommended drug for preventive treatment in patients with frequent, disabling migraine attacks.
26. A 65-year-old woman complains of general weakness, fatigability, and numbness and tingling in her hands, observed for the past 4 onths. Objectively, the following is observed: body temperature- 36.6°C, respiratory rate -19/min, pulse 96/min, blood pressure115/70 mm Hg. Her skin and visible mucosa are pale and mildly icteric. Neurological examination detects a symmetrical decrease in sensitivity in her both arms. Complete blood count: erythrocytes 2.4 1012/L, hemoglobin – 105 g/L, leukocytes – 2.5 10/L, ESR-28 mm/hour, platelets – 180 10°/L. Smear microscopy detects megalocytosis, erythrocyte hyperchromia, neutrophil hypersegmentation, anisocytosis, and poikilocytosis. What is the most likely diagnosis in this case?
A. B12 deficiency anemia
B.Tron deficiency anemia
C. Autoimmune hemolytic anemia
D. Sideroachrestic anemia
E. Anemia of chronic disease
Correct Answer : B.Tron deficiency anemia
Correct Answer : B.Tron deficiency anemia
Explanation:
Vitamin B12 deficiency anemia is a megaloblastic anemia caused by impaired DNA synthesis, leading to large hyperchromic red blood cells, hypersegmented neutrophils, and pancytopenia. Neurological manifestations, such as symmetrical numbness and tingling in the hands, are characteristic.
In this patient, laboratory findings show pancytopenia, megalocytosis, hyperchromia, neutrophil hypersegmentation, and neurological symptoms, which are classic for B12 deficiency anemia, making it the most likely diagnosis.
Why Other Options Are Incorrect:
B. Iron deficiency anemia:
❌ Causes microcytic, hypochromic anemia without neurological symptoms or megalocytosis.
C. Autoimmune hemolytic anemia:
❌ Characterized by hemolysis with reticulocytosis and positive Coombs test; megaloblasts are absent.
D. Sideroachrestic anemia:
❌ Shows ringed sideroblasts and ineffective erythropoiesis; neurological signs are absent.
E. Anemia of chronic disease:
❌ Usually normocytic or mildly microcytic; does not cause megalocytosis or neuropathy.
Thus, the combination of megaloblastic changes and neurological symptoms confirms vitamin B12 deficiency anemia.
27. A 28-year-old woman on the second day of her postpartum period continues to take methyldopa that was prescribed during her pregnancy for the treatment of combined preeclampsia. Objectively, the patient’s general condition is satisfactory, she has no complaints, her blood pressure is within the range of 135-140/85-90 mm Hg, pulse 72/min, respiratory rate- 15/min. What should be the pharmacotherapy tactics in this case?
A. Continuation of methyldopa
B. Discontinuation of methyldopa
C. Discontinuation of methyldopa and prescribing ACE inhibitors
D. Continuation of methyldopa and additionally prescribing ACE inhibitors
E. Discontinuation of methyldopa and prescribing diuretics
Correct Answer : A. Continuation of methyldopa
Correct Answer: Discontinuation of methyldopa
Explanation:
Methyldopa is considered safe during pregnancy but is generally discontinued postpartum because safer and more effective antihypertensive agents are preferred for long-term blood pressure control. Postpartum, blood pressure is stable in this patient (135-140/85-90 mm Hg) and she is asymptomatic, so continuation is unnecessary.
The correct tactic is to stop methyldopa and monitor blood pressure. If needed, other antihypertensives suitable for non-pregnant women (e.g., ACE inhibitors) can be initiated later.
Why Other Options Are Incorrect:
A. Continuation of methyldopa:
❌ Unnecessary postpartum; methyldopa has slower onset and more side effects.
C. Discontinuation of methyldopa and prescribing ACE inhibitors:
❌ Premature if blood pressure is not severely elevated; immediate switch not required.
D. Continuation of methyldopa and additionally prescribing ACE inhibitors:
❌ Polytherapy is not justified; blood pressure is controlled.
E. Discontinuation of methyldopa and prescribing diuretics:
❌ Not indicated if blood pressure is within acceptable postpartum range.
Thus, the recommended approach is to discontinue methyldopa and monitor the patient postpartum.
28. A 52-year-old patient with the history of COVID-19, complicated by myocarditis. complained of dizziness and suddenly fainted. Objectively, heart rate = pulse = 39/min, blood pressure -110/70 mm Hg. ECG reveals rhythmic P waves that are not connected to the QRS complexes, the QRS complexes are rhythmic and occur at the rate of 40/min, the ORS complex width is normal. What disorder has occurred in the patient?
A. Atrial paroxysm
B. First-degree AV block
C. Bradycardia paroxysm
D.Third-degree AV block
E. Second-degree AV block
Correct Answer : D.Third-degree AV block
Correct Answer: Third-degree AV block
Explanation:
Third-degree (complete) AV block is a condition in which there is complete dissociation between atrial and ventricular activity: the atria and ventricles beat independently. P waves are present and regular, but they have no relationship with QRS complexes, which are also regular but escape rhythms.
In this patient, the ECG shows regular P waves and regular QRS complexes that are not connected, with a slow ventricular rate of 40/min. Symptoms of dizziness and syncope correspond to poor cardiac output due to complete heart block, confirming third-degree AV block.
Why Other Options Are Incorrect:
A. Atrial paroxysm:
❌ Sudden atrial tachycardia would show rapid atrial rate; no AV dissociation is present.
B. First-degree AV block:
❌ Characterized by prolonged PR interval but all P waves conduct to QRS; no dissociation.
C. Bradycardia paroxysm:
❌ A transient slow heart rate; does not explain P-QRS dissociation.
E. Second-degree AV block:
❌ Some P waves fail to conduct, but some QRS complexes are still linked to P waves; no complete dissociation.
Thus, complete AV dissociation with independent atrial and ventricular activity confirms third-degree AV block.
29. A 42-year-old man complains of dizziness lack of air,salivation, lacrimation, and headache According to the patient’s history, he was working several hours in a field treated with pesticides The above complaints appeared suddenly, half an hour ago. Objectively, the patient presents preser with general hyperhidrosis, miosis, and fibrillary twitching of the muscles around a small wound on his forearm. Pulse – 92/min, rhythmic. Blood pressure – 140/90 mm Hg. Auscultation detects heterogeneous wet crackles over the lungs, against the background of vesicular breathing. What rug must be prescribed to the patient first in this case?
A. Atropine
B. Prednisolone
C. Theophylline
D. Dexamethasone
E. Chlorpromazine
Correct Answer : A. Atropine
Correct Answer: Atropine
Explanation:
The patient shows signs of acute organophosphate (pesticide) poisoning: muscarinic symptoms (salivation, lacrimation, miosis, sweating), nicotinic symptoms (muscle fasciculations), and CNS effects (dizziness, headache). Atropine is a muscarinic antagonist that blocks the effects of excess acetylcholine at muscarinic receptors, rapidly relieving life-threatening symptoms such as bronchorrhea and bradycardia.
Immediate administration of atropine is essential in this patient to stabilize airway, breathing, and circulation. It is the first-line emergency therapy in organophosphate poisoning and must be given before other supportive measures.
Why Other Options Are Incorrect:
B. Prednisolone:
❌ Corticosteroid; has no role in acute organophosphate poisoning.
C. Theophylline:
❌ Bronchodilator; does not counteract cholinergic toxicity.
D. Dexamethasone:
❌ Corticosteroid; ineffective in acute pesticide poisoning.
E. Chlorpromazine:
❌ Antipsychotic; contraindicated in acute cholinergic crisis.
Thus, atropine is the first and life-saving drug in acute organophosphate poisoning .
30. Methicillin-resistant staphylococcus has been isolated from the blood of a 20-day-old full-term girl with a high fever, osteomyelitis of the right hip, and signs of pneumonia complicated by microbial destruction of the lungs. What antibacterial drug should be prescribed for this chiId?
A. Vancomycin
В. Doxycycline
C. Ampicillin
D. Azithromycin
E. Cefazolin
Correct Answer : A. Vancomycin
Correct Answer: Vancomycin
Explanation:
Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to all beta-lactam antibiotics, including penicillins and cephalosporins. Vancomycin is a glycopeptide antibiotic effective against MRSA, including severe systemic infections.
In this 20-day-old neonate with MRSA sepsis, osteomyelitis, and necrotizing pneumonia, vancomycin is the drug of choice because it covers resistant staphylococci and is safe for use in neonates with life-threatening infections.
Why Other Options Are Incorrect:
B. Doxycycline:
❌ Contraindicated in neonates due to effects on bone and teeth; ineffective for MRSA in this age group.
C. Ampicillin:
❌ A beta-lactam antibiotic; MRSA is resistant.
D. Azithromycin:
❌ Macrolide; generally ineffective for severe MRSA infections in neonates.
E. Cefazolin:
❌ First-generation cephalosporin; MRSA is resistant.
Thus, vancomycin is the appropriate antibacterial for MRSA in a neonate with severe systemic infection.
31. A 22-year-old pregnant woman has been hospitalized in a severe condition. Throughout the past three days, she developed edemas. headache, nausea, and one episode of vomiting. Objectively, her consciousness is clouded. her blood pressure is 160/130 mm Hg. She presents with small fibrillar twitching of her facial muscles and problems with nasal breathing. During transportation, the woman’s arms started twitching, her body stretched out, her spine curved, her jaws tightly clenched, and she stopped breathing. Then she developed clonic seizures and marked cyanosis. After that, the seizures stopped, a deep noisy inhale occurred. and blood-stained foam appea appeared on the patient’s lips. What is the most likely diagnosis in this case?
A.Eclampsia
B. Chorea
C. Epilepsy
D. Hypertensive crisis
E. Diabetic coma
Correct Answer : A.Eclampsia
Correct Answer: Eclampsia
Explanation:
Eclampsia is a life-threatening complication of preeclampsia, characterized by the occurrence of generalized tonic–clonic seizures in a pregnant woman with severe hypertension and signs of organ involvement. It is often preceded by edema, headache, nausea, vomiting, and altered consciousness.
In this patient, very high blood pressure (160/130 mm Hg), rapidly progressive edema, neurological symptoms, and the classic sequence of tonic phase, clonic seizures, apnea, cyanosis, and postictal deep noisy breathing with blood-stained foam are textbook features of an eclamptic seizure.
Why Other Options Are Incorrect:
B. Chorea:
❌ Causes irregular involuntary movements, not tonic–clonic seizures or severe hypertension.
C. Epilepsy:
❌ No prior seizure history and clear obstetric context with severe hypertension favors eclampsia.
D. Hypertensive crisis:
❌ May cause headache or encephalopathy but does not typically cause generalized tonic–clonic seizures in pregnancy.
E. Diabetic coma:
❌ Presents with altered consciousness without convulsive seizures and obstetric signs.
Therefore, the presence of severe preeclampsia with generalized seizures confirms the diagnosis of eclampsia.
32. A patient with ischemic stroke in the lett middle cerebral artery basin was undergoing treatment at the specialized stroke unit of hospital, when she developed a seizure episode with loss of consciousness that progressed into a status course What would be the drug of choice at the stage of extensive convulsive status epilepticus against the background of ischemie stroke?
A. Diazepam
B. Magnesium sulfate
C. Methylprednisolone
D. Carbamazepine
E. Pregabalin
Correct Answer :A. Diazepam
Correct Answer: A. Diazepam
Explanation:
Convulsive status epilepticus is a neurological emergency defined as continuous or recurrent generalized tonic–clonic seizures without recovery of consciousness. In the acute phase, rapid termination of seizures is critical to prevent neuronal damage, hypoxia, and worsening cerebral edema, especially in patients with ischemic stroke.
Benzodiazepines are the first-line drugs for immediate control of active seizures. Diazepam acts quickly by enhancing GABA-mediated inhibitory neurotransmission, making it the drug of choice for extensive convulsive status epilepticus in an emergency setting.
Why Other Options Are Incorrect:
B. Magnesium sulfate:
❌ Used for eclampsia-related seizures, not for post-stroke epileptic status.
C. Methylprednisolone:
❌ Has no role in acute seizure termination; used for inflammatory or demyelinating conditions.
D. Carbamazepine:
❌ Oral antiepileptic for chronic seizure control, not effective for acute status epilepticus.
E. Pregabalin:
❌ Adjunct drug for chronic epilepsy or neuropathic pain, not for emergency seizure control.
Diazepam is chosen because rapid-acting benzodiazepines are the first-line treatment for acute convulsive status epilepticus.
33. After sustaining a severe injury to the chest and legs in a car accident, aa 30-year-old patient complains of dark urine, decreased urine output, and general weakness.Blood test results: creatinine – 340 mcmol/L, CPK>10000 U/L All muscle groups are extremely painful. Uri- nalysis shows ns aa positive posi result for blood. Urine microscopy detects no erythrocytes. What is the most ost likely cause of acute renal failure in this patient?
A.-
B. Erythrocyte hemolysis
C. Urolithiasis
D. Rhabdomyolysis
E. Acute glomerulonephritis
Correct Answer :E. Acute glomerulonephritis
Correct Answer: E. Placental abruption
Explanation:
Placental abruption is premature separation of a normally located placenta, leading to uterine hypertonicity, painful bleeding, and fetal distress. Bleeding may be dark and clotted, and the uterus often becomes tense and tender.
In this case, the patient has uterine hypertonicity, bloody discharge with clots, irregular contractions, and severe fetal distress (fetal heart rate 80–100/min, arrhythmic). The cervix is minimally dilated, ruling out bleeding due to labor progression, making placental abruption the most likely diagnosis.
Why Other Options Are Incorrect:
A. Marginal placenta previa:
❌ Causes painless, bright red bleeding with a soft uterus and no fetal distress initially.
B. Complete placenta previa:
❌ Presents with painless bleeding and malpresentation; uterine tone remains normal.
C. Uterine rupture:
❌ Usually occurs in scarred uterus with sudden loss of contractions and fetal parts palpable.
D. Cervical rupture:
❌ Occurs after rapid delivery and does not cause uterine hypertonicity or fetal distress.
Placental abruption is chosen because painful bleeding, uterine hypertonicity, and fetal distress form a classic exam triad.
34.A 20-year-old woman has been hospitalized with complaints of irregular contractions and bloody discharge from her genital tract. The gen gestational age is 39 weeks. External obstetric examination detects longitudinal lie, cephalic presentation. Hypertonicity of the uterus is observed. Internal obstetric examination reveals that the cervix is 1 cm long, the cervical canal is open by 2 cm. The fetal head is presenting and pressed to the entrance into the lesser pelvis. The discharge is bloody, with clots. The fetal heart rate is 80-100/min, arrhythmic. What complication has occurred in the patient?
A. Marginal placenta previa
B. Complete placenta previa
C. Uterine rupture
D. Cervical rupture
E. Placental abruption
Correct Answer :E. Placental abruption
Correct Answer: E. Placental abruption
Explanation:
Placental abruption is the premature separation of a normally implanted placenta before delivery, causing painful vaginal bleeding, uterine hypertonicity, and fetal hypoxia. The bleeding is often dark and may contain clots, and the uterus feels tense and tender on palpation.
In this patient, the presence of a hypertonic uterus, bloody discharge with clots, minimal cervical dilation, and severe fetal bradycardia with arrhythmia strongly indicates placental abruption rather than other obstetric causes of bleeding.
Why Other Options Are Incorrect:
A. Marginal placenta previa:
❌ Typically causes painless, bright red bleeding with a soft uterus; fetal heart rate is usually normal.
B. Complete placenta previa:
❌ Bleeding is painless and massive; malpresentation is common, uterine tone is not hypertonic.
C. Uterine rupture:
❌ Usually occurs in a scarred uterus; often associated with sudden abdominal pain, loss of fetal station, and maternal shock.
D. Cervical rupture:
❌ Rare, occurs during labor; does not cause uterine hypertonicity or fetal distress before delivery.
The combination of painful bleeding, tense uterus, and fetal compromise confirms placental abruption in this patient.
35. A 40-year-old woman at 36 weeks of her pregnancy has been hospitalized with moderate preeclampsia. She complains of headache and visual snow. She has history of essential hypertension. Objectively, her blood pressure is 150/110 mm Hg, her fundal height corresponds to 34 weeks of pregnancy. What drug must be urgently added to the patient’s treatment regimen?
A. Cortisol
B. Magnesium sulfate
C. Furosemide
D. Potassium iodide
E. Dexamethasone
Correct Answer : B. Magnesium sulfate
Correct Answer: B. Magnesium sulfate
Explanation:
Magnesium sulfate is the drug of choice for the prevention and treatment of eclamptic seizures in patients with preeclampsia. It acts as a central nervous system depressant and stabilizes neuromuscular activity, reducing the risk of convulsions.
In this patient, moderate preeclampsia with headache, visual disturbances, and high blood pressure (150/110 mm Hg) indicates increased risk of progression to eclampsia. Urgent administration of magnesium sulfate is necessary to prevent seizures and protect both mother and fetus.
Why Other Options Are Incorrect:
A. Cortisol:
❌ Not indicated for seizure prevention in preeclampsia; mainly used for fetal lung maturity in preterm labor.
C. Furosemide:
❌ Diuretic use is not first-line and may worsen placental perfusion.
D. Potassium iodide:
❌ Used for thyroid disorders, not preeclampsia.
E. Dexamethasone:
❌ Corticosteroid used for fetal lung maturation, not seizure prophylaxis.
Magnesium sulfate is the correct choice because it directly prevents eclamptic seizures in preeclamptic patients.
36.A 54-year-old patient complains of feeling generally unwell, dizziness, dark “tarry”stools. and one episode of “coffee ground”vomiting. The patient has history of a peptic ulcer of the duodenum, observed over the last 10 years. He periodically takes NSAIDs for osteoarthritis. Objectively, the following is observed: pale skin, pulse-116/min, blood pressure-90/55 mm Hg, soft abdomen without local tenderness. Blood test detects hemoglobin levels of 72 g/L,What is the most likely diagnosis in this case?
A. Acute gastritis
B. Gastrointestinal bleeding
C. NSAID gastropathy
D. Perforated gastric ulcer
E. Intestinal obstruction with secondary anemia
Correct Answer : B. Gastrointestinal bleeding
Correct Answer: B. Gastrointestinal bleeding
Explanation:
Gastrointestinal bleeding refers to hemorrhage occurring anywhere in the digestive tract, which may present acutely or chronically. It can manifest as melena (“tarry” stools), hematemesis (“coffee ground” vomiting), pallor, hypotension, and tachycardia, often leading to anemia.
In this patient, the history of a long-standing duodenal ulcer, NSAID use, melena, coffee-ground vomiting, hypotension, tachycardia, and severe anemia (Hb 72 g/L) strongly indicates an acute upper gastrointestinal bleed, making this the most likely diagnosis.
Why Other Options Are Incorrect:
A. Acute gastritis:
❌ May cause mild bleeding but usually does not produce severe anemia or hypotension.
C. NSAID gastropathy:
❌ Chronic mucosal damage, but the acute presentation with hypotension and severe anemia points to active bleeding.
D. Perforated gastric ulcer:
❌ Presents with acute severe abdominal pain and peritonitis; the abdomen here is soft without tenderness.
E. Intestinal obstruction with secondary anemia:
❌ Obstruction causes vomiting, distension, and pain, but not melena or coffee-ground vomiting.
Acute gastrointestinal bleeding explains the patient’s melena, hematemesis, anemia, and hemodynamic compromise.
37 .A 32-year-old woman complains of painful and heavy menstruation, long-lasting pain in her lower abdomen that intensifies before menstruation, and pain during a sexual intercourse (dyspareunia). The woman is married and has regular sexual life, but over the past 2 years no pregnancy has occurred. Bimanual examination reveals that the uterus is enlarged, round, and slightly tilted backwards. A dense mass 4 cm in diameter is palpable in the uterine appendages on the left. Ultrasound shows a homogeneous hypoechoic mass 42×53 mm in size in the left ovary. The mass has a double contour and is filled with hyperechoic “chocolate-like”contents. What is the most likely diagnosis in this case?
A. Follicular cyst of the left ovary
B. Dermoid cyst of the left ovary
C. Endometrioid cyst of the left ovary
D. Chronic bilateral salpingo-oophoritis
E. Left-sided tubo-ovarian tumor
Correct Answer : C. Endometrioid cyst of the left ovary
Correct Answer: C. Endometrioid cyst of the left ovary
Explanation:
An endometrioid (endometriotic) ovarian cyst, also called a “chocolate cyst,” forms when ectopic endometrial tissue grows within the ovary and fills it with old, hemolyzed blood. It commonly causes chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility.
In this patient, the ultrasound shows a homogeneous hypoechoic mass with double contour filled with hyperechoic “chocolate-like” contents, which is classic for an endometriotic cyst. The clinical history of dysmenorrhea, dyspareunia, and infertility supports this diagnosis over other ovarian pathologies.
Why Other Options Are Incorrect:
A. Follicular cyst of the left ovary:
❌ Usually thin-walled, simple, and asymptomatic; does not contain old blood.
B. Dermoid cyst of the left ovary:
❌ Contains hair, fat, or teeth; “chocolate-like” contents are absent.
D. Chronic bilateral salpingo-oophoritis:
❌ Usually presents with tenderness, adhesions, and bilateral involvement; imaging would not show a well-defined cyst with old blood.
E. Left-sided tubo-ovarian tumor:
❌ Malignant tumors are solid, irregular, and rarely contain hemorrhagic “chocolate” contents.
The combination of imaging findings and chronic cyclical pain confirms the diagnosis of an endometriotic (endometrioid) ovarian cyst.
38. A 5-year-old girl has been hospitalized with an electrical injury. The child’s condition is extremely severe, the t girl is unconscious, no unassisted reathing observed. During caro cardiopulmonary resuscitation, ECG shows waves varying in shape and amplitude with the frequency of 320/min. 320 There is no pulse on the periphery or on the central arteries. What emergency aid must be provided to the child in this case?
A. Administration of lidocaine solution, 20 mg, intramuscularly
B. Electrical defibrillation
C. Crystalloid transfusion, 10 mg/kg, intravenously
D. Tracheal intubation
E. Open-chest cardiac massage
Correct Answer : B. Electrical defibrillation
Correct Answer: B. Electrical defibrillation
Explanation:
Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, irregular waves on ECG and absence of effective cardiac output. Immediate defibrillation is the most effective intervention to restore organized cardiac rhythm and circulation.
In this patient, the ECG shows high-frequency, irregular waves with no palpable pulse, consistent with ventricular fibrillation following electrical injury. Prompt electrical defibrillation is the priority emergency measure in this scenario to prevent death.
Why Other Options Are Incorrect:
A. Administration of lidocaine solution:
❌ Antiarrhythmic drugs are adjunctive; they do not replace immediate defibrillation in VF.
C. Crystalloid transfusion:
❌ Fluid resuscitation alone cannot correct ventricular fibrillation.
D. Tracheal intubation:
❌ Secures airway but does not treat the underlying fatal arrhythmia first.
E. Open-chest cardiac massage:
❌ Reserved for failed external CPR; not first-line in immediate VF.
Electrical defibrillation is the correct lifesaving intervention for ventricular fibrillation in this child.
39. A 35-year-old woman complains of nervousness, headache, ineffectiveness of pai- nkillers, and increased blood pressure on the day before menstruation. After menstruation, the symptoms disappear. The patient has no history of pregnancies. Objectively, blood pressure -130/80 mm Hg, pulse- 82/min. Bimanually, the uterus and its appendages are normal. What treatment should be prescribed for this patient?
A. Antispasmodics
B. Combined oral contraceptives
C.-
D. Calcium preparations
E. Hypotensive drugs
Correct Answer : B. Combined oral contraceptives
Correct Answer: B. Combined oral contraceptives
Explanation:
Premenstrual syndrome (PMS) is a cyclic disorder characterized by emotional, behavioral, and somatic symptoms appearing in the luteal phase and resolving after menstruation. When symptoms are moderate to severe and significantly affect quality of life, hormonal regulation using combined oral contraceptives (COCs) can stabilize hormonal fluctuations and reduce premenstrual symptoms.
In this patient, recurrent nervousness, headache, ineffective painkillers, and mild blood pressure rise before menstruation indicate moderate PMS. COCs are effective in suppressing ovulation, reducing luteal phase hormone fluctuations, and thereby alleviating both somatic and psychological symptoms.
Why Other Options Are Incorrect:
A. Antispasmodics:
❌ Relieve uterine cramps but do not address the systemic or emotional symptoms of PMS.
C. —
❌ Not specified; cannot be considered a treatment option.
D. Calcium preparations:
❌ Helpful as adjunct therapy for mild PMS but insufficient alone for moderate symptoms.
E. Hypotensive drugs:
❌ Blood pressure is only mildly elevated and transient; antihypertensives are not indicated.
Combined oral contraceptives are the appropriate therapy for moderate PMS causing significant premenstrual symptoms in this patient.
40. The parents complain that since the first weeks of life their 11-month-old child has had a constant cough with sputum that is difficult to expectorate. Objectively, the child lags behind in physical development, cyanosis of the nasolabial triangle is observed. Laboratory tests reveal neutrophilic leukocytosis. Blood electrolytes: Na+ 130 mmol/L, Cl-88 mmol/L. Sweat chlorides – 80 mmol/L. What is the most likely diagnosis in this case?
A. Pneumonia
B. Congenital lung malformation
C. Bronchiolitis
D. Acute obstructive bronchitis
E. Mucoviscidosis
Correct Answer: Mucoviscidosis
Correct Answer: Mucoviscidosis
Explanation:
Mucoviscidosis (cystic fibrosis) is a genetic disorder characterized by thick, sticky mucus affecting the lungs and pancreas. Early signs include persistent cough with difficult-to-expectorate sputum, delayed physical development, cyanosis, and recurrent respiratory infections. Laboratory findings often show electrolyte disturbances (hyponatremia, hypochloremia) and elevated sweat chloride (>60 mmol/L), which is diagnostic.
In this child, the chronic respiratory symptoms since the first weeks of life, poor growth, cyanosis, neutrophilic leukocytosis, low sodium and chloride, and elevated sweat chloride confirm cystic fibrosis as the most likely diagnosis.
Why Other Options Are Incorrect:
A. Pneumonia:
❌ Acute condition; does not explain chronic cough from birth or electrolyte abnormalities.
B. Congenital lung malformation:
❌ Usually presents with localized findings, not diffuse chronic symptoms and systemic issues.
C. Bronchiolitis:
❌ Typically affects infants under 1 year acutely; does not cause chronic symptoms or sweat chloride changes.
D. Acute obstructive bronchitis:
❌ Acute illness; chronic symptoms since birth are inconsistent.
Chronic respiratory issues, electrolyte imbalance, and positive sweat test strongly point to mucoviscidosis.
41. A 29-year-old patient,who 2 days ago injured his eye with a tree branch during his stay at his summer cottage, complains of intense pain in the eye, loss of vision, and headache. Objectively, blepharospasm and lacrimation are observed. visual acuity-0. Mixed injection is clearly visible on the eyeball. The patient presents with conjunctival chemosis and corneal edema. There are synechiae along the edge of the pupil, the pupil has a black area, and there is a strip of pus in the anterior chamber. The fundus reflex is yellow-green. The eye is in the correct position and retains its full mobility. Palpation of the ciliary body is painful. What is the most likely diagnosis in this case?
A Fibrinous-plastic iridocyclitis
B. Swelling cataract
C. Sympathetic ophthalmia
D. Panophthalmitis
E. Endophthalmitis
Correct Answer : A Fibrinous-plastic iridocyclitis
Correct Answer: A. Fibrinous-plastic iridocyclitis
Explanation:
Fibrinous-plastic iridocyclitis is an acute inflammation of the iris and ciliary body, often following ocular trauma or infection. It is characterized by severe eye pain, photophobia, blepharospasm, lacrimation, conjunctival injection, corneal edema, and formation of fibrin or synechiae in the anterior chamber.
In this patient, the history of eye trauma, intense pain, loss of vision, corneal edema, synechiae at the pupil edge, pus in the anterior chamber, painful ciliary body on palpation, and a yellow-green fundus reflex all point to fibrinous-plastic iridocyclitis. Early recognition and treatment are critical to prevent further ocular complications.
Why Other Options Are Incorrect:
B. Swelling cataract:
❌ Cataract develops gradually with lens opacity and vision loss, but does not cause acute pain, synechiae, or anterior chamber pus.
C. Sympathetic ophthalmia:
❌ Occurs as a bilateral granulomatous reaction after penetrating trauma; this case is unilateral and acute.
D. Panophthalmitis:
❌ Involves all eye coats, often with proptosis and limited eye mobility, which are absent here.
E. Endophthalmitis:
❌ Usually follows surgery or penetrating trauma; severe purulent involvement of the entire eyeball is expected, which is not observed.
Fibrinous-plastic iridocyclitis is the correct diagnosis due to acute post-traumatic inflammation, anterior chamber exudate, synechiae, and ciliary body tenderness.
42. A 47-year-old woman is being examined due to frequent episodes of increased blood pressure that reaches 280/140 mm Hg, observed over the past few months. She has no family history of arterial hypertension. The patient complains of intense headache, palpitations, and anxiety that occur in the morning and anvid Objectively, blood pressure – 300/160 mm Hg, heart rate – 128/min. Previously, such episodes were accompanied by hyperglycemia and leukocytosis. After the crisis subsided, noticeable polyuria could be observed. What group of drugs should be used for the elimination of this hypertensive crisis?
A. Calcium antagonists
B. Diuretics
C.&-Blockers
D. 8-Bløckers
E.Angiotensin-converting enzyme inhibitors
Correct Correct Answer: α-Blockers
Correct Answer: α-Blockers
Explanation:
α-Blockers are the first-line drugs for hypertensive crises caused by pheochromocytoma. They work by blocking α-adrenergic receptors, reducing vasoconstriction, and rapidly lowering blood pressure while preventing organ damage. In this patient, the paroxysmal episodes of severe hypertension, headache, palpitations, hyperglycemia, and polyuria are classic for pheochromocytoma, making α-blockers the appropriate initial therapy.
This approach stabilizes blood pressure before any potential addition of β-blockers (if tachycardia persists), but β-blockers alone are contraindicated initially as they can worsen hypertension due to unopposed α-adrenergic stimulation.
Why Other Options Are Incorrect:
A. Calcium antagonists:
❌ Can lower BP but are not first-line for catecholamine-induced crises; slower onset.
B. Diuretics:
❌ Ineffective in acute catecholamine-driven hypertensive crises; do not block α-stimulation.
C. β-Blockers:
❌ Dangerous if given before α-blockers; may cause severe hypertensive crisis due to unopposed α-adrenergic vasoconstriction.
D. β-Blockers (repeated):
❌ Same reasoning as above; contraindicated initially.
E. Angiotensin-converting enzyme inhibitors:
❌ Not rapid or effective enough for catecholamine-induced hypertensive crises.
α-Blockers are chosen because they directly counteract the excessive α-adrenergic stimulation causing the crisis.
43. A 54-year-old patient has been brought to a multispecialty hospital from home due to his condition becoming worse in the evening. According to the patient’s family, over the last two days he was w not sleeping sle and sometimes would talk to “invisible beings”. In the evening he began to tear down wallpaper and tried to “run away from spiders”. Objectively, the patient is disoricnted in place and time, anxious, has hand tremor and tachycardia (heart rate118/min), body temperature -378°C. According to his wife, he has been abusing alcohol for a long time and last drank alcohol in the morning. What is the most likely diagnosis in this case?
A. Atypical alcohol intoxication
B. Ethylene glycol poisoning
C. Delirium tremens
D.Paranoid schizophrenia
E. Alcoholic hallucinosis
Correct Answer : Correct Answer: Delirium tremens
Correct Answer: Delirium tremens
Explanation:
Delirium tremens is an acute, severe alcohol withdrawal syndrome that usually occurs 48–72 hours after the last drink in chronic alcoholics. It is characterized by confusion, disorientation, visual hallucinations (often involving animals or insects), agitation, tremor, tachycardia, fever, and autonomic instability. In this patient, the acute onset of disorientation, hallucinations, tremor, tachycardia, and fever after alcohol cessation strongly supports delirium tremens.
This is a medical emergency requiring urgent inpatient management with sedation, hydration, and correction of electrolyte disturbances.
Why Other Options Are Incorrect:
A. Atypical alcohol intoxication:
❌ Would present with inebriation signs rather than withdrawal; timing after cessation does not fit.
B. Ethylene glycol poisoning:
❌ Usually presents with metabolic acidosis, renal failure, and neurological depression; hallucinations alone are not typical.
D. Paranoid schizophrenia:
❌ Onset in older adult is unlikely; acute onset with autonomic signs favors withdrawal.
E. Alcoholic hallucinosis:
❌ Hallucinations occur without disorientation or autonomic instability; patient here is disoriented and febrile.
Delirium tremens is chosen because of the combination of hallucinations, disorientation, autonomic hyperactivity, and recent alcohol cessation.
44. A 43-year-old woman came to a doctor with complaintsis of intense pain behind the sternum. The pain occurs mainly at 5-6 a.m., when she sleeps or immediat liately after waking up, lasts 10 15 minutes, and is accompanied by cold sweat and fear of death. The pain is not associated with physical exertion and can be easily relieved by taking nitroglycerin. Similar episodes have been occurring several times a week for the past 2 months. According to the patient’s history, she is a smoker and previously was using narcotic substances (cocaine) Objectively, her general condition is satisfactory, blood pressure 120/80 mm Hg. ECG at rest detects no changes, while 24-hour ECG monitoring records ST segment elevation in leads II, III, and aVE during an episode. What is the most likely diagnosis in this case?
A. Vasospastic angina pectoris
B. Takotsubo syndrome
C. Acute ST-segment elevation myocardial infarction
D. Acute pericarditis
E. Stable exertional angina pectoris
Correct Answer : B. Takotsubo syndrome
Correct Answer: Vasospastic angina pectoris
Explanation:
Vasospastic angina, also called Prinzmetal angina, is caused by transient coronary artery spasm leading to myocardial ischemia. It typically occurs at rest, often at night or early morning, lasts 5–15 minutes, and may be accompanied by sweating, palpitations, and fear. Pain is relieved by nitroglycerin. In this patient, episodes occur mostly at 5–6 a.m., are not related to exertion, and 24-hour ECG shows transient ST-segment elevation during attacks, which is classic for vasospastic angina.
This fits the clinical scenario better than exertional or infarction-related chest pain, especially given the history of cocaine use, which can trigger coronary spasm.
Why Other Options Are Incorrect:
B. Takotsubo syndrome:
❌ Usually triggered by emotional stress, causes chest pain and ECG changes with wall motion abnormalities, not brief, recurrent early-morning episodes.
C. Acute ST-segment elevation myocardial infarction:
❌ MI pain is persistent, not brief; ST elevation would be continuous, and troponins would be elevated.
D. Acute pericarditis:
❌ Pain is pleuritic, positional, and may have pericardial friction rub; ECG shows diffuse ST elevation, not localized transient episodes.
E. Stable exertional angina pectoris:
❌ Occurs with physical exertion, not at rest or at night; relieved by rest, not necessarily by nitroglycerin during sleep.
Vasospastic angina is chosen because of brief, recurrent, rest-related chest pain with transient ST elevation relieved by nitroglycerin.
45. A patient, who had been diagnosed with urogenital chlamydia based on clinical presentation and laboratory findings, came to a venereologist. What drug should be prescribed to this patient for etiotropic therapy?
A. Tinidazole-type drug
B. Sulfonamide
C. Macrolide antibiotic
D. Glucetorticoid
E. Penicillin antibiotic
Correct Answer: Macrolide antibiotic
Correct Answer: Macrolide antibiotic
Explanation:
Chlamydia is an intracellular bacterial infection that requires antibiotics capable of penetrating cells. Macrolides, such as azithromycin, are highly effective for treating urogenital chlamydial infections and are considered first-line therapy. A single dose of azithromycin or a short course of doxycycline is typically used to eradicate the infection.
In this patient, clinical presentation and lab confirmation indicate active chlamydial infection, making a macrolide the most appropriate choice for targeted (etiotropic) therapy.
Why Other Options Are Incorrect:
A. Tinidazole-type drug:
❌ Effective for protozoal infections like trichomoniasis, not Chlamydia.
B. Sulfonamide:
❌ Not effective against intracellular Chlamydia species.
D. Glucocorticoid:
❌ Symptom-relieving only; does not treat the infection.
E. Penicillin antibiotic:
❌ Chlamydia lacks a typical peptidoglycan cell wall, so penicillins are ineffective.
Macrolides are chosen because they specifically target intracellular Chlamydia, ensuring effective eradication.
46. A 45-year-old patient complains of shortness of breath, rapid heart rate, irregular heart rhythm, and leg edema. He considers himself sick for approximately 2 years and does not attribute his disease to anything specific. His condition was deteriorating gradually. Objectively, acrocyanosis can be observed, blood pressure 115/75 mm Hg. pulse – 120/min, arrhythmic. Auscultation detects arrhythmic cardiac activi- ty and systolic murmur over the apex and xiphoid process. Edema of the legs is observed. ECG shows atrial fibrillation. Echocardiography reveals dilation of all heart chambers, left ventri- cular ejection fraction – 34%, diffuse hypoki- nesis. What drug can be recommended for the heart rate control in this case?
A. Propafenone
B. Flecainide
C. Amlodipine
D. Verapamil
E. Bisoprolol
Correct Answer : E. Bisoprolol
Correct Answer: E. Bisoprolol
Explanation:
Bisoprolol is a selective beta-1 blocker used to control heart rate in patients with atrial fibrillation, especially when there is underlying heart failure with reduced ejection fraction. It reduces sympathetic stimulation, slows the ventricular response, improves symptoms, and can prevent further deterioration of cardiac function.
In this case, the patient has atrial fibrillation with rapid ventricular rate and dilated cardiomyopathy (EF 34%). Bisoprolol is the best choice because it safely controls heart rate without worsening systolic dysfunction, which is critical in heart failure patients.
Why Other Options Are Incorrect:
A. Propafenone: ❌ A class IC antiarrhythmic; contraindicated in structural heart disease and reduced EF due to proarrhythmic risk.
B. Flecainide: ❌ Also class IC; unsafe in patients with reduced EF and structural heart disease.
C. Amlodipine: ❌ A calcium channel blocker used for hypertension; ineffective for rate control in AF.
D. Verapamil: ❌ Non-dihydropyridine calcium channel blocker; may worsen systolic heart failure in reduced EF.
Bisoprolol is chosen because it effectively controls heart rate and is safe in atrial fibrillation with systolic heart failure.
47. A 3-year-old child with tetralogy of Fallot, who was regularly receiving propranolol. suddenly developed vomiting, bradycardia. hypotension, and seizures. The mother found an empty bottle of propranolol tablets among the child’s toys. Objectively, the child is in an extremely severe condition, unconscious and intubated. Cerebral edema is suspected. What drug should be administered in this case?
A. Magnesium sulfate
B. Sodium bicarbonate
C. Calcium gluconate
D. Atropine sulfate
E. Glucagon
Correct Answer : E. Glucagon
Correct Answer: Glucagon
Explanation:
Propranolol is a non-selective beta-blocker. Overdose can cause life-threatening bradycardia, hypotension, seizures, and shock. Glucagon acts independently of beta-adrenergic receptors, directly stimulating cardiac adenylate cyclase to increase cAMP, thereby improving heart rate and contractility. It is the first-line antidote for severe beta-blocker poisoning.
In this child with propranolol overdose, presenting with bradycardia, hypotension, and neurological symptoms, glucagon is the most effective drug to reverse cardiovascular collapse and support cardiac function.
Why Other Options Are Incorrect:
A. Magnesium sulfate:
❌ Used for seizures related to eclampsia or torsades; not effective for beta-blocker overdose.
B. Sodium bicarbonate:
❌ Indicated for severe metabolic acidosis or tricyclic antidepressant toxicity, not propranolol poisoning.
C. Calcium gluconate:
❌ May slightly help in cardiac depression, but is insufficient as the primary therapy.
D. Atropine sulfate:
❌ Can increase heart rate transiently but often ineffective in severe beta-blocker toxicity.
Glucagon is the drug of choice because it directly counteracts beta-blocker-induced cardiac suppression.
48. A 48-year-old patient complains of a headache in the occipitàl region, accompani- ed by nausea and general weakness. Objecti- vely, blood pressure – 180/110 mm Hg, pulse- 110/min. No pathological changes were detected in other organs. The patient has history of bronchial asthma. What drug should be administered first in this case?
A. Captopril
B. Paracetamol
C. Nifedipine
D. Metoprolol
E. Magnesium sulfate
Correct Answer : A. Captopril
Correct Answer: A. Captopril
Explanation:
Captopril is an angiotensin-converting enzyme (ACE) inhibitor used to lower blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation. It is often chosen in acute or chronic hypertension, especially when rapid blood pressure control is needed in adults.
In this scenario, captopril is the best choice because it provides effective and fast antihypertensive action suitable for managing elevated blood pressure in a controlled clinical setting.
Why Other Options Are Incorrect:
B. Paracetamol: ❌ An analgesic and antipyretic; does not lower blood pressure.
C. Nifedipine: ❌ A calcium channel blocker; while it lowers BP, rapid-acting forms are less preferred due to risk of hypotension and reflex tachycardia.
D. Metoprolol: ❌ A beta-blocker; used for hypertension and cardiac conditions, but slower onset than captopril for acute BP control.
E. Magnesium sulfate: ❌ Used primarily for seizure prophylaxis in eclampsia and for neuroprotection; it is not a first-line antihypertensive.
Captopril is chosen because it offers rapid and effective blood pressure reduction in acute or high-risk cases.
49. A 6-year-old child complains of a fever of 39.9°C, itching skin, loss of appetite, and a rash all over the body. According to the patient’s medical history, the disease onset was three days ago. Objectively, the child’s skin is pale. There is a polymorphic rash on the scalp, face, torso, and limbs, consisting of spots, papules, vesicles, and scabs. What is the most likely diagnosis in this case?
A. Scarlet fever
B. Pseudotuberculosis
C. Measles
D. Infectious mononucleosis
E. Chickenpoх
Correct Answer : E. Chickenpoх
Correct Answer: Chickenpox
Explanation:
Chickenpox (varicella) is an acute viral infection characterized by fever, generalized pruritic rash, and loss of appetite. The rash is polymorphic, presenting simultaneously as macules, papules, vesicles, and crusts, and typically begins on the scalp, face, and trunk before spreading to the limbs. It mainly affects children and develops over several days.
In this 6-year-old with high fever, generalized itchy rash with vesicles and scabs, and recent onset of illness, the presentation is classic for chickenpox. The polymorphic nature of the rash differentiates it from other febrile rashes.
Why Other Options Are Incorrect:
A. Scarlet fever:
❌ Rash is fine, sandpaper-like, starts on the neck/chest, and lacks vesicles.
B. Pseudotuberculosis:
❌ Often presents with mesenteric lymphadenitis and abdominal pain; rash is not vesicular.
C. Measles:
❌ Rash is maculopapular, confluent, starts at hairline, with Koplik spots in the oral mucosa; no vesicles.
D. Infectious mononucleosis:
❌ Presents with pharyngitis, lymphadenopathy, hepatosplenomegaly, but no vesicular rash.
Chickenpox is the correct diagnosis due to fever, pruritus, and polymorphic vesicular rash.
50. A 24-vear-old woman at 40 weeks of her pregnancy is undergoing a planned cesarean section. After being placed on the operating table, the patient complained of weakness and nausea, her blood pressure decreased to 90/60 mm Hg. When she was turned to her left side, all her parameters returned to normal. What pathological condition has occurred in this case?
A. Bleeding
B. Uterine rupture
C. Eclampsia
D. Inferior vena cava syndrome
E. Superior vena cava syndrome
Correct Answer : D. Inferior vena cava syndrome
Correct Answer: D. Inferior vena cava syndrome
Explanation:
Inferior vena cava (IVC) syndrome occurs when the gravid uterus compresses the inferior vena cava while the pregnant woman lies supine, reducing venous return to the heart. This leads to hypotension, weakness, nausea, and sometimes dizziness. Turning the patient to her left side relieves the compression and restores blood pressure and perfusion.
This option is the best choice because the patient experienced acute hypotension and symptoms immediately after lying on her back, which resolved with left lateral positioning—a classic presentation of supine IVC compression in late pregnancy.
Why Other Options Are Incorrect:
A. Bleeding: ❌ Would cause persistent hypotension and tachycardia; symptoms here were transient and position-dependent.
B. Uterine rupture: ❌ Usually presents with severe abdominal pain, vaginal bleeding, and fetal distress; none were described.
C. Eclampsia: ❌ Characterized by hypertension and seizures, which are absent in this patient.
E. Superior vena cava syndrome: ❌ Causes facial swelling, venous distension, and dyspnea, not positional hypotension in pregnancy.
Inferior vena cava syndrome is chosen because positional hypotension in late pregnancy that resolves on the left side is pathognomonic.