In the case of iron deficiency anemia, primary prophylactic measures are recommended for certain populations who are at higher risk. Among the options provided, pregnant women are the group that is subject to primary prophylactic measures.

This is because pregnancy increases the demand for iron due to the expansion of blood volume and the needs of the developing fetus. Without sufficient iron intake, pregnant women are at an increased risk of developing iron deficiency anemia, which can have adverse effects on both the mother and the baby.  

While other groups, such as patients after 60, children, patients after an operation, or workers of industrial enterprises, may also be at risk for various health conditions, they are not specifically subject to primary prophylactic measures for iron deficiency anemia. The primary focus of prophylactic measures for iron deficiency anemia is on pregnant women due to their increased iron requirements during pregnancy.

In the given scenario, the patient has been receiving complex treatment including anticoagulants, nitrates, and alpha-adrenergic blockers. However, the persistence of pain after three days of treatment suggests that the current therapy might not be effectively relieving the underlying cause of the angina.  

To establish a definitive diagnosis and determine the cause of the patient’s ongoing symptoms, the most appropriate investigation is coronary angiography (also known as coronarography).

Coronary angiography is an invasive procedure that involves the injection of contrast dye into the coronary arteries followed by X-ray imaging. It allows the visualization of any blockages or narrowing in the coronary arteries, helping to identify the location and severity of the underlying problem causing the unstable angina.  

The other options listed, such as stress-echocardiogram, test with dosed physical exercises, esophageal electrocardiac stimulator, and myocardial scintigraphy, may be useful in evaluating different aspects of cardiovascular function or diagnosing other heart conditions.

However, in the context of unstable angina pectoris that is not adequately relieved by initial therapy, coronary angiography is the investigation of choice to directly assess the condition of the coronary arteries and identify any obstructive lesions.

which is an important consideration in this context.   Given the patient’s risk factors, including irregular casual sexual life and drug use, along with the presence of constitutional symptoms, it is important to consider the possibility of a sexually transmitted infection (STI) or other underlying conditions. However, HIV infection should be a primary concern due to its potential to cause constitutional symptoms, opportunistic infections, and hair loss.  

Therefore, the first examination to be conducted should be an examination for HIV. HIV infection can manifest with a wide range of symptoms, including flu-like symptoms, arthralgia, malaise, and fevers, especially during the acute phase. It is important to rule out or confirm HIV infection early, as timely diagnosis and appropriate management are crucial for the patient’s health and for preventing further transmission of the virus.  

While other examinations such as neuropathology (B), gonorrhea (C), fungi (D), and trichomoniasis (E) might also be relevant in certain clinical situations, considering the patient’s history and symptoms, HIV examination takes precedence as it addresses a potentially life-threatening condition and can guide further diagnostic and management decisions.

This method typically involves the use of structured or semi-structured questionnaires or surveys that can be administered to a large number of participants.   By using questioning as the preferred method, researchers can obtain specific details about the housing conditions, such as the type of accommodation (dormitory, rented apartment, etc.), living arrangements (alone, with roommates, with family, etc.), amenities available, cleanliness, comfort, safety, and any concerns or issues related to the housing.  

Questioning provides an opportunity to gather both quantitative and qualitative data, depending on the nature of the questions asked. It allows for standardized data collection, making it easier to analyze and compare responses across participants. Additionally, it can be more time-efficient compared to other methods such as interviewing, which requires one-on-one interactions with participants and may be more resource-intensive.  

While methods like interviewing (B), selecting materials (C), a method of directed selection (D), and statistical analysis (E) have their own applications in research, questioning is generally more appropriate and effective when studying housing conditions of a larger group of individuals, such as students in a medical high school, during a training period.

Time series representation: A linear diagram is well-suited for displaying data over time. In this scenario, you need to represent the monthly information for several years, where each month’s data is plotted against the corresponding time period on the x-axis (horizontal axis). This allows for a clear visualization of the progression of cases over time.  

Comparison to averages: The question specifically mentions comparing the monthly values to the average monthly values obtained for the previous five years. A linear diagram can easily accommodate this comparison by plotting two lines on the graph – one representing the monthly values and the other representing the average monthly values. By visually comparing the two lines, you can observe how each month’s value deviates from the average.  

Clarity and simplicity: Linear diagrams are straightforward and commonly used for representing trends over time. They provide a clear visual representation of the data, making it easy to understand the changes in the number of registered cases of acute intestinal infection.

The simplicity of the linear diagram allows for quick interpretation and analysis of the data.   While other diagram types, such as radial diagrams (B), sector diagrams (C), figured diagrams (D), may have their own uses in different contexts, they are not the most suitable options for representing monthly information and comparing it to average values over time. In this case, the linear diagram is the most appropriate method for a clear and effective visualization of the data.

It is typically maintained by the industrial enterprise or the occupational health department responsible for tracking and monitoring the health status of employees.   The card of the personal account of a case rate allows for a thorough study of an individual’s case rate, including the frequency and duration of temporary lost labor ability episodes, patterns of illnesses or injuries, and the impact on their work attendance and productivity. It serves as a central document for recording and analyzing the health-related aspects of an employee’s performance at the industrial enterprise.  

While the other options, such as the “Report on reasons of a temporary lost labor ability” (B), the sick-leave certificate (C), the ambulatory medical card (D), and the inpatient medical record (E), may contain relevant information about an individual’s health, the card of the personal account of a case rate (A) specifically focuses on the long-term tracking and documentation of an employee’s case rate within the industrial enterprise.

In this case, the patient’s complaint of pain in the I finger on the right hand, along with the homogeneous swelling (hydrops) and the bent position of the finger, suggests involvement of the flexor tendon sheath. The worsening of pain upon attempting to unbend the finger is indicative of irritation and inflammation within the sheath. The presence of acute pain upon touching the ligament projection further supports the likelihood of thecal whitlow.  

The other options presented are:   B. Subcutaneous panaritium: Subcutaneous panaritium refers to an infection of the soft tissues surrounding the finger. However, the involvement of the ligament projection and the description of the finger being hydropic and in a bent position suggest a deeper infection within the flexor tendon sheath rather than the subcutaneous tissues.  

C. Articular (joint) panaritium: Articular panaritium involves infection and inflammation of the joint. While joint involvement can cause pain and limited range of motion, the acute pain on touching the ligament projection indicates primarily a sheath-related issue rather than joint involvement.  

D. Bone panaritium: Bone panaritium, or osteomyelitis, involves infection and inflammation of the bone. The symptoms described in the case, including the homogeneous swelling and acute pain on touching the ligament projection, do not align with bone involvement.  

E. Paronychia: Paronychia refers to an infection of the skin around the nail. It typically presents with localized redness, swelling, and tenderness near the nail, but it does not involve the flexor tendon sheath or ligament projection as described in the case.   Therefore, based on the symptoms described, the most likely diagnosis is A. Thecal whitlow (ligament panaritium). However, it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

The specific density of 1.04 g/cm3 does not indicate any significant issues with the milk. It falls within the typical range for milk.   Acidity: The acidity level of 210C is not provided in a standard format. Without further information or reference range, it is challenging to determine if this acidity level is acceptable or not. It would be best to consult a healthcare professional or refer to local regulations or standards for guidance.  

Reductase probe: The weak positive result from the reductase probe indicates the presence of bacteria or microbial activity in the milk. While a weak positive result does not necessarily indicate a severe contamination, it suggests some level of microbial growth.  

Based on the given information, the milk batch does not appear to have any critical issues regarding fat content and specific density. However, the presence of microbial activity indicated by the reductase probe result raises concerns about milk quality and potential bacterial contamination.  

In this situation, it is advisable to inform customers about the milk quality. Transparency is important, and customers have the right to be aware of any potential issues. By providing them with this information, they can make an informed decision about using the milk for their purposes. It is important to maintain consumer trust and ensure their safety.   Option A, selling the milk but informing customers about the milk quality, would be the most responsible and ethical approach in this case.

Relative humidity: The relative humidity of 45% falls within an acceptable range.   Air movement velocity: The air movement velocity of 0.3 m/s indicates a gentle airflow, which is generally comfortable.   Light coefficient: The light coefficient of 1/5 indicates poor lighting conditions. A coefficient of 1/5 suggests that the lighting in the ward is insufficient for proper visibility and may lead to discomfort or difficulties in carrying out tasks.  

Noise level: The noise level of 30 dB is relatively low, which is favorable for patients.   Considering the poor lighting conditions mentioned, it can contribute to a discomfortable microclimate. Inadequate lighting can affect the overall atmosphere of the ward, leading to reduced visibility, potential strain on the eyes, and difficulties in performing tasks or reading. Adequate lighting is essential for a comfortable and safe healthcare environment.  

Therefore, the correct answer is A. Discomfortable microclimate, indicating that the overall conditions are not optimal due to the poor lighting. Improving the lighting conditions would help create a more comfortable and suitable environment for the patient with thyrotoxicosis in the 2-bed hospital ward.

While protein intake is also mentioned (150 g, including 100 g of animal protein), it is important to note that protein itself is not directly associated with the development of obesity. However, consuming excessive calories from any macronutrient, including protein, can contribute to weight gain if energy intake consistently exceeds energy expenditure.  

Schizophrenia, paradontosis, common cold, and uterine fibromyoma are not directly related to the macronutrient composition of the diet mentioned and are not typically caused by dietary factors alone.  

It’s worth noting that the development of obesity is influenced by various factors, including genetics, lifestyle choices, overall calorie intake, physical activity levels, and individual metabolic factors. This answer is based solely on the information provided regarding the woman’s diet composition and its potential association with the development of obesity. It’s important to consider that a comprehensive evaluation of an individual’s health status requires a thorough assessment by a healthcare professional.

To accurately determine the girl’s health group, we would need more information about the specific classification system being used. This could include factors such as the frequency and severity of illnesses, the impact on growth and development, and any other relevant health conditions.  

If you have additional information about the classification system and its criteria for each group, please provide that information so that a more accurate determination can be made.

However, in certain conditions, such as nervous-arthritic diathesis, there can be an increased synthesis or decreased excretion of uric acid, leading to its accumulation in the body. This can result in hyperuricemia, a state of elevated uric acid levels in the blood.  

Elevated levels of uric acid can contribute to the development of arthritis, specifically gout, which is characterized by the deposition of uric acid crystals in the joints, leading to inflammation and pain.   Therefore, in the context of nervous-arthritic diathesis, the increased synthesis of uric acid is considered pathogenic. The correct answer is A. Uric acid.

A lung abscess is a localized collection of pus within the lung parenchyma. It is typically caused by an infection, often bacterial, and can result in symptoms such as fever, chest pain, productive cough with foul-smelling sputum, and respiratory distress.Complications of liver echinococcosis (B), bronchiectatic disease (C), actinomycosis of lungs (D), and pulmonary tuberculosis (E) can also present with

respiratory symptoms, but the combination of symptoms described in the question, including the presence of purulent sputum and blood with a bad smell, is more indicative of a lung abscess.It is important to note that a definitive diagnosis can only be made by a healthcare professional based on a thorough evaluation of the patient’s symptoms, medical history, physical examination, and additional diagnostic tests such as imaging studies and laboratory investigations.

It can provide information about the presence and severity of carotid artery stenosis or plaque formation, which can be a potential cause of transient ischemic attacks. This diagnostic method is commonly used as the initial investigation for evaluating carotid artery disease and is safer and less invasive compared to other options such as cerebral angiography.

While other diagnostic methods like CT, MRI, cerebral angiography, or electroencephalography may be useful in certain situations, they are not the first-line investigations for assessing carotid artery disease and may be considered if further evaluation or more detailed imaging is required based on the initial findings from ultrasound dopplerography.

Paroxysmal ventricular tachycardia is a rapid heart rhythm originating in the ventricles of the heart. It is characterized by wide and distorted QRS complexes on ECG and can cause symptoms such as palpitations, dizziness, and shortness of breath.  

The absence of a natural relationship between the P and QRS waves suggests that the atria and ventricles are not contracting in a coordinated manner.   It is important to note that a definitive diagnosis can only be made by a healthcare professional after a thorough evaluation of the patient’s symptoms, physical examination, and additional diagnostic tests if needed.

Additionally, the involuntary urination at the end of the seizure is a common feature of tonic-clonic seizures.   Major epileptic seizures, also known as generalized tonic-clonic seizures or grand mal seizures, are a type of epileptic seizure characterized by loss of consciousness, convulsions, and muscle rigidity (tonic phase) followed by rhythmic jerking movements (clonic phase).

These seizures typically last for a few minutes and may be accompanied by other symptoms such as tongue biting and urinary incontinence.   It is important for the patient to receive appropriate medical evaluation and management by a healthcare professional experienced in the treatment of epilepsy.

The rash typically starts on the face and then spreads to other parts of the body, including the buttocks. Enlarged occipital glands are also a common feature of rubella.   Rubella is generally a mild and self-limiting illness in children.

However, it can be more serious if contracted by pregnant women, as it can lead to congenital rubella syndrome and cause birth defects in the baby.   Scarlet fever is caused by group A Streptococcus bacteria and presents with a distinct rash, high fever, sore throat, and a “strawberry tongue.”

Measles, also known as rubeola, typically presents with a high fever, cough, runny nose, and a widespread rash that starts on the face and spreads down the body. Adenoviral infections and pseudotuberculosis are less likely based on the given symptoms.   It’s important to consult a healthcare professional for an accurate diagnosis and appropriate management of the condition..

They can cause various symptoms depending on their size and hormone-secreting capacity. The symptoms in this case, including growing fingers and facial skull, changed face, poor eyesight, weakness, skin darkening, and loss of body weight, are consistent with the effects of a pituitary adenoma.

The broadening of the sella turcica (the bony structure that houses the pituitary gland) and thinning of the tuberculum sellae are characteristic radiographic findings associated with pituitary adenomas.

Encephalitis of the truncus, optico-hiasmatic arachnoiditis, adrenal gland tumor, and tumor of the pondo-cerebellar corner are less likely based on the symptoms and imaging findings described.It’s important for the individual to undergo further evaluation and confirmation of the diagnosis by a healthcare professional, typically an endocrinologist or neurologist..

Gangrene of the lung occurs when the blood supply to the lung tissue is severely compromised, leading to tissue death. The darkening on the X-ray film with a cavity in the center represents an area of necrosis or dead tissue in the lung.

The purulent sputum may be present due to bacterial infection of the necrotic tissue. In contrast to pneumonia complicated by an abscess, gangrene of the lung is associated with a more rapid onset of symptoms, which can include severe chest pain, shortness of breath, and a high fever.

Gangrene of the lung is a rare condition and can be life-threatening if not promptly diagnosed and treated. I hope this explanation clarifies the correct answer to the question.

The presence of proteinuria (albumin 0.9 g/L), increased blood pressure (140/100-180/100 mm Hg), and elevated levels of creatinine (406 mmol/L) indicate kidney dysfunction.The grey-pale skin color could be attributed to the decreased kidney function, which affects the elimination of waste products from the body.

The absence of edema and the findings of single red blood cells (RBC) and hyaline casts in the urine are consistent with chronic nephritis.Feochromocytoma (option B) is a tumor of the adrenal gland that can cause high blood pressure, but it doesn’t explain the other symptoms or laboratory findings in this case.

Hypertensive illness of the II degree (option C) is a possibility given the elevated blood pressure, but it does not fully explain the presence of proteinuria and other kidney-related findings.Nephrotic syndrome (option D) typically presents with significant proteinuria, edema, and low levels of protein in the blood, which are not prominent in this case.

Stenosis of the kidney artery (option E) is a narrowing of the renal artery, which can lead to high blood pressure, but it does not explain the other symptoms or laboratory findings.In conclusion, based on the provided information, the most appropriate diagnosis is chronic nephritis with violation of kidney function. However, it’s important to consult a healthcare professional for a comprehensive evaluation and accurate diagnosis.

The patient’s history of a painless stomach ulcer for 4 years suggests that the current symptoms are likely due to complications of the ulcer.In particular, the coffee-ground appearance of the vomit indicates that there has been bleeding in the stomach.

The low blood pressure and rapid pulse (120 b/min) can be attributed to the blood loss.Option B (Ulcer of duodenum, complicated with bleeding) is less likely because the patient’s history mentions an ulcer of the stomach specifically.

Option C (Erosive gastritis) is less likely because erosive gastritis typically does not cause chronic painless ulcers.Option D (Acute pleurisy) and option E (Acute myocardial infarction, abdominal form) are less likely as they do not explain the patient’s symptoms and history of a stomach ulcer.

In conclusion, based on the provided information, the most likely diagnosis is an ulcer of the stomach complicated with bleeding. However, it is important to consult a healthcare professional for a thorough evaluation and accurate diagnosis.

Subacute bacterial endocarditis is an infection of the heart valves, typically caused by bacteria. It can occur in individuals with pre-existing heart conditions, such as rheumatic heart disease. The diastolic murmur in the mitral area on auscultation, along with the recent tooth extraction, raises concern for an underlying infection.

The presence of petechial lesions around the clavicle and a palpable spleen are known as Osler’s nodes and splinter hemorrhages, respectively, which are clinical manifestations associated with infective endocarditis.Recurrence of rheumatic fever (option B) is a possibility, but the symptoms and findings described are more indicative of an infective process such as endocarditis.

Thrombocytopenic purpura (option C) typically presents with low platelet counts and bleeding manifestations, such as petechiae and purpura, but it does not explain the cardiac symptoms and findings described in the case.Mitral stenosis (option D) and aortic stenosis (option E) can both cause symptoms similar to those described, but the presence of a diastolic murmur in the mitral area points more towards an infective process rather than a structural valvular abnormality.

In conclusion, based on the provided information, the most likely diagnosis is subacute bacterial endocarditis. However, it is important to consult a healthcare professional for a comprehensive evaluation and accurate diagnosis.

This can cause shock, which is a life-threatening medical emergency. Exudative pleuritis is a complication of pneumonia in which fluid accumulates in the pleural cavity, the space between the lungs and the chest wall. This can cause shortness of breath, but it is not typically associated with collapse. 

Bronchial obstruction can occur in pneumonia if mucus or other material blocks the airways, but it is also not typically associated with collapse. Toxic hepatitis is a liver condition in which liver inflammation occurs due to exposure to a toxic substance. It is not a common complication of pneumonia. 

Emphysema is a chronic lung condition in which the air sacs in the lungs are damaged, leading to shortness of breath. It is not directly related to pneumonia or its complications. In summary, septic shock is the most likely pneumonia complication to be accompanied by collapse, as it can cause a severe drop in blood pressure and inadequate blood flow to the organs.

It is typically characterized by inflammation of the stomach lining, which can lead to erosions or ulcers in the mucosa. The pain in the epigastrium that improves with food intake is a common symptom in this type of gastritis.Gastritis of A type (option B) refers to autoimmune gastritis, which is characterized by the immune system attacking the cells in the stomach lining. It is less likely in this case since the presence of H. pylori was detected.

Reflux gastritis (option C) refers to inflammation of the stomach lining due to the backflow of stomach acid into the esophagus. This condition is typically associated with gastroesophageal reflux disease (GERD) rather than the symptoms described in the case.Menetrier’s disease (option D) is a rare condition characterized by enlarged rugae in the stomach, excessive production of mucus, and protein loss.

It is not consistent with the symptoms and findings described in the case.Rigid antral gastritis (option E) is not a recognized medical term. It may be a misinterpretation or a non-standard term.Therefore, based on the given information, the most appropriate diagnosis is gastritis of type B, associated with Helicobacter pylori infection.

However, sulfonylureas can increase the risk of hypoglycemia, particularly during periods of fasting or reduced food intake. Therefore, it would be appropriate to switch to a medication that has a lower risk of hypoglycemia during the perioperative period. Fast-acting insulin, such as rapid-acting insulin analogs, can be used to control blood glucose levels during the perioperative period. These medications can be administered as needed to maintain blood glucose levels within a target range.

This allows for flexibility in dosing and can help prevent hypoglycemia during fasting periods. Glurenorm (gliquidone) is also a sulfonylurea medication and is not recommended in this case since it carries a similar risk of hypoglycemia as Maninilum.

Continuing with the current therapy or prescribing long-acting insulin or guanyl guanidines would not be appropriate for maintaining glycemic control during surgery. Therefore, the most appropriatetactic of hypoglycemic therapy in this case would be to prescribe fast-acting insulin to control blood glucose levels during the perioperative period and prevent hypoglycemia during fasting periods.

The presence of an enlarged, painless, and elastic thyroid gland suggests diffuse toxic goitre.Diffuse toxic goitre, also known as Graves’ disease, is an autoimmune disorder characterized by excessive production of thyroid hormones due to the stimulation of the thyroid gland by autoantibodies against the thyroid-stimulating hormone receptor. This leads to an enlarged thyroid gland (goitre) and the release of excessive amounts of thyroid hormones into the bloodstream, causing hyperthyroidism.

The options B, C, D, and E are less likely based on the clinical presentation. Option B (Diffuse euthyroid goitre of the 3rd degree) implies an enlarged thyroid gland without thyroid hormone abnormalities. Option C (Chronic autoimmune thyroiditis, hypertrophic type) typically presents with a painless, firm, and non-enlarged thyroid gland. Option D (Chronic fibrous thyroiditis) is characterized by a firm, fibrotic thyroid gland.

Option E (Toxic adenoma of the thyroid gland) refers to a single hyperfunctioning nodule within the thyroid gland, rather than diffuse enlargement.It is important for the patient to undergo further diagnostic tests, such as thyroid function tests (e.g., TSH, free T4), to confirm the diagnosis and to determine the appropriate management approach. A consultation with an endocrinologist is recommended for further evaluation and treatment.

The symptoms of carpal tunnel syndrome often worsen at night and can interfere with sleep.Rheumatoid arthritis is a chronic inflammatory condition that primarily affects the joints. While it can cause pain and stiffness in the hands and fingers, the presentation described in the scenario, with pain specifically in the first three fingers and worse at night, is more consistent with carpal tunnel syndrome. However, it is worth noting that individuals with rheumatoid arthritis may also be at an increased risk of developing carpal tunnel syndrome.Options B, C, D, and E are less likely based on the provided information.

Option B (Atlanto-axial subluxation of cervical spine) typically presents with symptoms such as neck pain, instability, and neurological deficits. Option C (Sensory peripheral neuropathy) would involve a more generalized sensory disturbance rather than affecting specific fingers.

Option D (Rheumatoid vasculitis) is associated with inflammation of blood vessels and can cause a range of symptoms depending on the affected organs. Option E (Rheumatoid arthritis without complication) does not explain the specific symptoms described.It is advisable for the patient to consult with a healthcare professional, such as a rheumatologist or orthopedic specialist, for a thorough evaluation, diagnosis, and appropriate management of their symptoms.

In Addisonian crisis, there is a sudden and severe deficiency of these hormones.The symptoms of Addisonian crisis can include weakness, dizziness, loss of consciousness, weight loss, nausea, vomiting, abdominal pain (including epigastric pain), diarrhea, and hyperpigmentation of the skin.

These symptoms result from the lack of cortisol and aldosterone, which are involved in maintaining blood pressure, electrolyte balance, and metabolism.Option B (Acute gastroenteritis) typically presents with symptoms such as diarrhea, nausea, vomiting, and abdominal pain, but it does not explain the other symptoms like weakness, loss of consciousness, hyperpigmentation, and weight loss described in the scenario.

Options C (Meningoencephalitis), D (Scleroderma), and E (Pellagra) do not adequately explain the range of symptoms described in the scenario and are less likely diagnoses based on the provided information.It is crucial for the patient to seek immediate medical attention as an Addisonian crisis requires urgent treatment with corticosteroids and fluid replacement to stabilize the condition.

The symptoms mentioned, such as shallow breathing, increased muscle tone, and cramps, can be indicative of low blood sugar levels.Signs of previous injection on the shoulders and hips suggest that the patient may have been using insulin to manage their diabetes. It is possible that they received an excessive dose of insulin, leading to hypoglycemia.Low blood glucose levels can cause neurological symptoms due to insufficient energy supply to the brain.

Moist skin may result from perspiration caused by the autonomic response to low blood sugar.Option B (Hyperglycemic coma) is incorrect because the symptoms described are not consistent with hyperglycemia. In hyperglycemic coma, blood glucose levels are extremely high, not low.Option C (Hyperosmolar coma) is unlikely because the symptoms of extreme thirst, dry mucous membranes, and high blood osmolality are not mentioned in the scenario.

Option D (Hyperlactacidotic coma) is also unlikely because the scenario does not provide any information suggesting metabolic acidosis and high lactate levels.Option E (Stroke) is unlikely based on the symptoms described, as strokes typically present with focal neurological deficits, not generalized symptoms like shallow breathing and muscle cramps.It’s important to note that a definitive diagnosis and appropriate medical intervention should be made by a healthcare professional based on a comprehensive evaluation of the patient’s history, physical examination, and laboratory tests.

The hallmark feature of Kartagener syndrome is situs inversus, which means the organs are positioned in a mirror image reversal. In this case, the right-sided cardiac silhouette seen on the chest X-ray is an indication of situs inversus, where the heart is located on the right side instead of the left.Chronic sinusitis and recurrent pulmonary infections are common in Kartagener syndrome due to the impaired function of the cilia in the respiratory tract.

The defective cilia lead to difficulty in clearing mucus and bacteria, resulting in chronic infections and bronchiectasis.Option B (Cystic fibrosis) is incorrect because cystic fibrosis primarily affects the lungs and digestive system, but it does not cause situs inversus.
Option C (Bronchiolitis obliterans) is unlikely as it typically affects the small airways of the lungs, but it does not cause situs inversus.Option D (Laryngotracheomalacia) is unrelated to the symptoms described in the scenario. It refers to the softening of the tissues of the larynx and trachea, which can cause breathing difficulties in infants.

Option E (α-antitrypsin deficiency) is a genetic disorder that primarily affects the liver and lungs, leading to liver disease and early-onset emphysema. It does not cause situs inversus.It’s important to consult with a healthcare professional for a comprehensive evaluation and accurate diagnosis in order to determine the underlying cause of the symptoms.

It is commonly transmitted to humans through contact with water, soil, or food contaminated with the urine of infected animals, such as rodents or livestock. Fishing in contaminated water sources can be a risk factor for acquiring leptospirosis. 

The symptoms of leptospirosis can vary from mild to severe. The initial phase often presents with flu-like symptoms such as high temperature, headache, and muscle pain. In more severe cases, icteric (yellowing) of the skin and scleras, hemorrhagic rash, and bloody urine can occur due to liver and kidney involvement. 

Options B (Yersiniosis), C (Salmonellosis), D (Brucellosis), and E (Trichinellosis) do not typically present with icteric dermal integuments, hemorrhagic rash, and bloody urine as described in the scenario. Each of these diseases has its own specific symptoms and modes of transmission. It’s important to consult with a healthcare professional for a proper evaluation, diagnosis, and treatment of the patient’s condition.

The presence of polyhydramnios in the mother is often associated with esophageal atresia. The excess amniotic fluid can result from the inability of the fetus to swallow and absorb the amniotic fluid due to the esophageal obstruction. Choanal atresia (option B) is a blockage of the nasal passages, which can cause difficulty in breathing but would not explain the symptoms related to feeding or the inability to place a nasogastric tube.

Laryngomalacia (option C) is a condition where the tissues of the larynx are soft and floppy, leading to noisy breathing but typically not causing issues with feeding or nasogastric tube placement. Tracheal atresia (option D) is a rare condition where the trachea does not develop properly, resulting in severe respiratory distress immediately after birth. It would not explain the symptoms related to feeding or nasogastric tube placement. 

Respiratory distress syndrome (option E) is a lung condition commonly seen in premature infants due to immature lung development. While it can cause breathing difficulties, it would not explain the specific symptoms described in the scenario. It is important to consult with a healthcare professional for a proper evaluation and diagnosis of the infant’s condition.

Exchange blood transfusion is a procedure where a small amount of the baby’s blood is slowly removed and replaced with compatible donor blood. It helps to rapidly decrease the levels of circulating bilirubin by removing the bilirubin-containing red blood cells and replacing them with unaffected red blood cells.

 Phototherapy (option B) is a commonly used treatment for hyperbilirubinemia, but it may not be sufficient in cases of severe or rapidly increasing bilirubin levels. Exchange blood transfusion is typically reserved for cases where phototherapy alone is insufficient or when the bilirubin level poses a significant risk to the newborn. Phenobarbital (option C) is not a direct treatment for hyperbilirubinemia.

It may be used in certain cases to help stimulate liver function and enhance the elimination of bilirubin, but it is not the primary treatment for severe hyperbilirubinemia. Intestinal sorbents (option D) and infusion therapy (option E) are not indicated for the treatment of hyperbilirubinemia in this context and would not address the underlying cause of the condition. It is important to note that the treatment approach may vary depending on the specific circumstances and the healthcare provider’s assessment.

It is always recommended to consult with a healthcare professional for appropriate management of hyperbilirubinemia in newborns.

At this level of blood loss, the body is unable to compensate for the loss of blood volume, leading to decreased perfusion to the vital organs and tissues. While a blood loss of 25-30% can be severe and require prompt medical attention, it is not necessarily lethal in all cases.

The minimum percentage volume of total blood loss that can result in death can vary depending on several factors, including the age, overall health, and physiological reserve of the individual, as well as the rate of blood loss and the cause of the bleeding. In summary, while a blood loss of 25-30% can result in severe symptoms and complications, including acute hemorrhagic anemia, it is not necessarily the minimum percentage volume of total blood loss that would result in death at acute hemorrhage.

The correct answer to this question may depend on the specific circumstances of the case.It’s important to note that the specific threshold for fatal blood loss can vary depending on various factors such as the individual’s overall health, age, underlying medical conditions, and the rate of blood loss. Immediate medical attention and interventions are crucial in cases of acute hemorrhage to control bleeding, restore blood volume, and provide appropriate resuscitation measures.

These medications belong to a class of drugs called azoles, which work by inhibiting the growth and reproduction of fungi. It’s important to note that the specific choice of antifungal medication may depend on the type of fungal infection, the severity of the infection, and other individual factors.

In some cases, topical antifungal creams or ointments may be used for localized infections, while systemic antifungal medications like fluconazole or itraconazole may be prescribed for more widespread or severe infections. 

The other options listed (B, C, D, and E) do not consist of medications used for the prevention or treatment of fungal infections.

Advanced maternal age is associated with a higher risk of complications during labor and delivery. Weak labor activity: The labor activity is described as weak, which indicates that the progress of labor may be slow or inadequate. Prolonged gestation: The woman is at 42-43 weeks of gestation, which is beyond the normal duration of pregnancy. Prolonged gestation increases the risk of fetal distress and complications during labor.

 Fetal distress: The muffled and rhythmic fetal heart rate, along with the greenish color of the amniotic fluid and fetal membranes (indicating meconium-stained amniotic fluid), suggest possible fetal distress. Fetal distress is a critical indication for a prompt delivery. Primigravida with infertility history: The woman’s history of infertility may indicate additional risks or complications that could further support the decision for a caesarean section. 

Considering these factors, a caesarean section is the most appropriate course of action to ensure a safe delivery for both the mother and the baby. It allows for a controlled and timely delivery, minimizing the risk of potential complications associated with prolonged labor, fetal distress, and meconium aspiration. 

It is important to note that the final decision should be made by a healthcare professional based on a comprehensive evaluation of the individual case and the clinical findings at the time of labor.

The presence of hyperemia and swelling on the ventral surface of the finger, along with restricted finger movements, indicates inflammation and infection extending beyond the superficial tissues. The X-ray findings showing an early stage of osteomyelitis suggest the involvement of the bone in the infection process. 

Therefore, the most appropriate diagnosis in this case would be a bony panaris, indicating an infection that has spread to the bone of the fifth finger of the left hand. Prompt medical attention and appropriate treatment, such as antibiotics and possible surgical intervention, are necessary to manage the infection and prevent further complications.

This procedure is performed under sterile conditions by a healthcare professional. Pleural puncture (option D), or needle aspiration, is a temporary measure that may be used in certain situations, such as a small pneumothorax or if immediate surgical intervention is not available.

However, it is not the preferred treatment for a significant pneumothorax. Anti-inflammation therapy (option B) and symptomatic therapy (option C) may have a role in managing associated symptoms or complications, but they do not address the primary problem of air accumulation in the pleural cavity. 

Thoracotomy (option E) is a more invasive surgical procedure that may be considered in specific cases, such as a persistent or recurrent pneumothorax, or when other treatment methods have failed. It is important to consult with a healthcare professional to determine the most appropriate treatment approach based on the individual patient’s condition, severity of the pneumothorax, and available resources.

Elevated levels of IgE indicate an allergic response and can help confirm the presence of an allergic condition. IgJ (option B) is not a commonly measured immunologic index and is not specifically associated with allergic conditions. 

IgM (option C) is an immunoglobulin that is typically associated with acute infections rather than allergic conditions. IgA (option D) is an immunoglobulin that is primarily found in mucosal secretions and is not directly related to allergic conditions. 

Circulating immunocomplexes (option E) refer to the complexes formed by the binding of antibodies and antigens in the bloodstream. While they can be associated with certain autoimmune conditions, they are not specific to allergic conditions like atopic dermatitis. Therefore, in this case, measuring the level of IgE would be the most relevant immunologic index to assess the allergic response in the patient.

The presence of painful lymphatic nodules in the axillary area, along with erythematous and glistering skin over the affected area, supports this diagnosis. A. Bubonic plague is caused by the bacterium Yersinia pestis and typically presents with symptoms such as swollen and painful lymph nodes (buboes), high fever, chills, and systemic manifestations.

Although the scenario mentions painful lymphatic nodules, the other symptoms described, such as shaky gait, coated tongue, and frequent pulse, are not characteristic of bubonic plague. Bubonic plague is a serious and potentially life-threatening condition that requires immediate medical attention. 

C. Lymphogranulomatosis (Hodgkin’s lymphoma) is a type of lymphoma and would not typically present with acute symptoms of infection. D. Anthrax is caused by the bacterium Bacillus anthracis and usually presents with specific skin lesions called eschars, which are not mentioned in the scenario. 

E. Tularemia, caused by the bacterium Francisella tularensis, can cause swollen lymph nodes and fever, but the other symptoms described in the scenario are not typical of tularemia. It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

It commonly presents with symptoms such as acute pain, swelling, and deformity in the affected joints. The onset of rheumatoid arthritis can be triggered by an infection, such as the recent episode of angina in this patient. The symptoms of acute pain, joint deformation, swelling, and skin hyperemia are consistent with the characteristic features of rheumatoid arthritis. The presence of these symptoms after an infection supports the possibility of post-infectious rheumatoid arthritis. 

B. Systemic lupus erythematosus (SLE) is another autoimmune disease that can affect multiple systems, including the joints. However, SLE typically presents with a wide range of symptoms that may involve organs beyond the joints. The given symptoms do not strongly suggest SLE as the most likely diagnosis.

 C. Reactive polyarthritis is an inflammatory joint condition that occurs as a reaction to an infection in another part of the body. While it can cause acute joint pain and swelling, the description of joint deformation and skin hyperemia is more suggestive of rheumatoid arthritis. 

D. Infectious-allergic polyarthritis is not a well-defined medical term and does not correspond to a specific diagnosis. It does not provide a clear understanding of the underlying cause or mechanism of the joint inflammation. E. “Rheumarthritis” is not a recognized medical term and does not correspond to a specific diagnosis. 

It is important for the patient to consult a healthcare professional for a thorough evaluation and accurate diagnosis. Rheumatoid arthritis and other similar conditions require proper medical management for appropriate treatment and symptom relief.

Hemorrhagic fluid obtained on laparocentesis can be suggestive of pancreatitis, as it can indicate bleeding into the abdominal cavity due to pancreatic inflammation. B. Renal colic refers to the severe pain caused by the passage of a kidney stone through the urinary tract. While it can cause abdominal and back pain, it typically does not present with vomiting or hemorrhagic fluid. 

C. Acute enterocolitis refers to the inflammation of the small intestine and colon. While it can cause abdominal pain and vomiting, the presence of hemorrhagic fluid suggests a different diagnosis. D. Perforated gastric ulcer can cause sudden and severe abdominal pain, but it is less likely to cause vomiting or hemorrhagic fluid.

Perforated gastric ulcers can lead to peritonitis, which is a serious condition requiring immediate medical attention. E. Acute appendicitis typically presents with abdominal pain localized to the right lower quadrant, rather than pain radiating to the spine.

It may be associated with vomiting, but the presence of hemorrhagic fluid is not commonly seen in appendicitis. It is important to note that this is a hypothetical scenario, and a definitive diagnosis can only be made by a healthcare professional based on a thorough evaluation of the patient’s symptoms, medical history, and diagnostic tests.

The symptoms reported by the girl, such as pain in the suprapubic area, frequent painful urination, and a low-grade fever, are commonly associated with acute cystitis. The presence of white blood cells (WBCs) in the urine (20-25 in f/vis) indicates an inflammatory response in the urinary tract, supporting the diagnosis of cystitis. The negative Pasternatsky symptom suggests that there is no significant kidney involvement or renal damage.

The presence of a small amount of protein (0.033 g/L) and a few red blood cells (RBCs) in the urine can be attributed to the inflammation and irritation of the bladder lining. B. Dysmetabolic nephropathy refers to a condition involving metabolic abnormalities in the kidneys, and it is not likely to cause the specific symptoms described in this case. C. Acute glomerulonephritis is an inflammation of the glomeruli (filtering units) in the kidneys, which typically presents with symptoms such as hematuria (blood in the urine) and proteinuria (elevated protein levels in the urine).

However, the symptoms described by the girl, including suprapubic pain and frequent urination, are more indicative of bladder involvement rather than glomerular inflammation. D. Acute pyelonephritis involves an infection and inflammation of the kidneys.

While it can cause symptoms similar to cystitis, such as painful urination, the absence of significant flank pain and a negative Pasternatsky symptom make acute cystitis a more likely diagnosis.
E. Urolithiasis refers to the presence of urinary stones in the urinary tract. While it can cause symptoms such as suprapubic pain and blood in the urine, the presence of a urinary tract infection with associated symptoms suggests acute cystitis as the primary diagnosis. It’s important to note that a definitive diagnosis can only be made by a healthcare professional based on a comprehensive evaluation of the patient’s symptoms, medical history, physical examination, and additional diagnostic tests if necessary.

It commonly presents with a butterfly-shaped rash on the face (malar rash), joint pain and swelling, and oral ulcers. The presence of these symptoms, along with a low hemoglobin level (Hb), elevated white blood cell count (WBC), and elevated erythrocyte sedimentation rate (ESR), supports the diagnosis of SLE. 

Juvenile rheumatoid arthritis (JRA), systemic type (B), is another possibility, but the presence of the malar rash and oral ulcers is more suggestive of SLE. Periarteriitis nodosa (C) is a rare autoimmune condition that affects the medium-sized arteries and is less likely in this case.

Acute rheumatic fever (D) typically presents with joint pain, carditis, and a history of streptococcal infection, which are not mentioned in the patient’s symptoms. Dermatomyositis (E) primarily involves muscle weakness and skin rash and is less likely based on the given presentation. 

However, it’s important to note that a definitive diagnosis can only be made by a healthcare professional who evaluates the patient’s complete medical history, conducts a thorough physical examination, and considers additional diagnostic tests if necessary.

Symptoms of fluorine intoxication can include loosening of teeth, bone and joint pains, cardiac symptoms like piercing pains in the heart area, and gastrointestinal symptoms like vomiting. Mercury intoxication (B) typically presents with symptoms such as neurological disturbances, tremors, and behavioral changes, which are not mentioned in the patient’s symptoms.

Lead intoxication (C) may cause a variety of symptoms including neurological and gastrointestinal symptoms, but loosening of teeth is not typically associated with lead poisoning. Phosphorus intoxication (D) can cause bone and joint pains, but the other symptoms mentioned are not commonly associated with phosphorus poisoning. Manganese intoxication (E) is associated with neurological symptoms and movement disorders, and the symptoms described in the case are not consistent with manganese toxicity. 

It’s important to note that a definitive diagnosis can only be made by a healthcare professional who evaluates the patient’s complete medical history, conducts a thorough physical examination, and considers additional diagnostic tests if necessary.

The presence of tenderness on palpation of the left cheek and red, turgescent mucous membrane in the left nasal cavity further support the involvement of the maxillary sinus. The visualization of purulent exudates in the middle meatus of the maxillary sinus indicates an active infection in this sinus.

This is consistent with acute purulent maxillary sinusitis, which is a common type of sinusitis characterized by inflammation and infection of the maxillary sinus. It’s important to note that a definitive diagnosis can only be made by a healthcare professional who evaluates the patient’s complete medical history, conducts a thorough physical examination, and may order additional diagnostic tests if necessary.

The bluish skin discoloration seen over the upper lip is known as cyanosis, which indicates a decrease in oxygen levels. In croup, the airway becomes inflamed, particularly in the area of the larynx and trachea, leading to the characteristic symptoms.

The respiratory rate may increase due to the airway obstruction, and the heart rate can also be elevated as a compensatory response. It’s important to note that croup symptoms are often worse at night and can be triggered by colds or upper respiratory infections.

The body temperature of 37.5°C indicates a mild fever, which can be seen with viral infections. Treatment for croup may involve providing humidified air or cool mist, keeping the child calm and comfortable, and in some cases, the administration of oral or inhaled corticosteroids. Severe cases may require hospitalization and more aggressive interventions.