1. A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localised in frontal region of head, accompanied by nausea and stomach discomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. Inbetween the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index – 29), AP- 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?
A. Migraine
B. Chronic subdural hematoma
C. Epilepsy
D. Benign intracranial hypertension
E. Hypertensive encephalopathy
Answer: Migraine
Explanation
| The most probable diagnosis for the 47-year-old woman with paroxysmal headaches, nausea, and vision reduction preceding the onset of pain is migraine. Migraine is a type of headache that is typically one-sided, intense, throbbing, and accompanied by nausea, vomiting, and sensitivity to light and sound. It can also be preceded by visual disturbances known as auras, which may include vision reduction. The fact that the patient has a history of periodic high blood pressure and a high-calorie diet suggests that she may be at risk for hypertension, which can be a trigger for migraines. Additionally, the absence of neurological abnormalities suggests that there is no structural issue in the brain that is causing the headaches, making migraine a more likely diagnosis than chronic subdural hematoma or benign intracranial hypertension. Epilepsy and hypertensive encephalopathy are less likely diagnoses as they do not typically present with the specific symptoms described. It is important to note that a thorough medical evaluation is necessary to confirm the diagnosis of migraine and rule out other potential causes of headaches. The most probable diagnosis for the 47-year-old woman with paroxysmal headaches, nausea, and vision reduction preceding the onset of pain is migraine. Migraine is a type of headache that is typically one-sided, intense, throbbing, and accompanied by nausea, vomiting, and sensitivity to light and sound. It can also be preceded by visual disturbances known as auras, which may include vision reduction. The fact that the patient has a history of periodic high blood pressure and a high-calorie diet suggests that she may be at risk for hypertension, which can be a trigger for migraines. Additionally, the absence of neurological abnormalities suggests that there is no structural issue in the brain that is causing the headaches, making migraine a more likely diagnosis than chronic subdural hematoma or benign intracranial hypertension. Epilepsy and hypertensive encephalopathy are less likely diagnoses as they do not typically present with the specific symptoms described. It is important to note that a thorough medical evaluation is necessary to confirm the diagnosis of migraine and rule out other potential causes of headaches. |
2. A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a crosscountry race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37, 50. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Нb- 123 g/L, leukocytes – 5, 6 ∗ 109/L, thrombocytes – 354∗109/L, prothrombin time – 12 seconds (normally 10-15 seconds), partly activated thromboplastin time – 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?
A. Hemophilia A
B. Hemophilia B
C. Schoenlein-Henoch disease
D. Vitamin K deficiency
E. Thrombocytopenia
Answer: Hemophilia A
Explanation
| The most probable diagnosis for the 7-year-old boy with a painful, edematous right knee, and a decreased VIII:C factor is hemophilia A. Hemophilia A is a genetic disorder that affects the blood’s ability to clot due to a deficiency or absence of factor VIII, a clotting protein. The disease is usually inherited as an X-linked recessive trait, meaning that it primarily affects males. The fact that the boy’s symptoms began suddenly after participating in a cross country race suggests that he may have sustained a traumatic injury that resulted in bleeding within the knee joint. The decreased VIII:C factor and normal bleeding time are consistent with hemophilia A. The normal thrombocyte count and prothrombin time indicate that the patient’s platelet function and extrinsic clotting pathway are normal, respectively, making thrombocytopenia and vitamin K deficiency less likely diagnoses. Schoenlein-Henoch disease, also known as Henoch-Schönlein purpura, is a rare autoimmune disorder that typically presents with a skin rash, joint pain, and gastrointestinal symptoms, which are not present in this case. It is important for the patient to undergo further evaluation and management by a hematologist to confirm the diagnosis and initiate appropriate treatment to prevent further episodes of bleeding. |
3. On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bending forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation with frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the right chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?
A. Acute pericarditis
B. Pulmonary embolism
C. Tietze’s syndrome
D. Dissecting aortic aneurysm
E. Dressler’s syndrome
Answer: Acute pericarditis
Explanation
| The most probable diagnosis for the 55-year-old patient with a dull ache behind the breast bone, dyspnea, and atrial fibrillation with a rapid ventricular response, and pathological Q wave and S-T segment elevation on the right chest leads is acute pericarditis. Acute pericarditis is an inflammation of the pericardium, the sac that surrounds the heart. It can occur as a complication of acute myocardial infarction, resulting in chest pain that is typically relieved by bending forward. Other symptoms may include dyspnea, fever, and a pericardial friction rub on auscultation. The presence of atrial fibrillation with a rapid ventricular response suggests that the patient may be experiencing hemodynamic compromise, which can occur when the pericardium becomes inflamed and restricts the heart’s ability to fill with blood. The patient’s refusal of thrombolysis is not relevant to the diagnosis of acute pericarditis. Pulmonary embolism and dissecting aortic aneurysm are less likely diagnoses as they typically present with different symptoms and ECG findings. Tietze’s syndrome is a rare condition that causes inflammation of the costochondral joints, leading to pain and swelling in the chest wall. Dressler’s syndrome is a post-myocardial infarction syndrome that typically presents with fever, pleuritic chest pain, and pericardial effusion, which are not present in this case. It is important for the patient to undergo further evaluation and management by a cardiologist to confirm the diagnosis and initiate appropriate treatment to alleviate symptoms and prevent further complications. |
4. A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in occipital region and vomiting. In the medical hystory: moderate arterial hypertension, the patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about intense headache that was suppressed by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is absent. AP230/130 mm Hg, Ps- 50 bpm, BR- 12/min. What is your preliminary diagnosis?
A. Acute subdural hematoma
B. Myasthenia
C. Disseminated sclerosis
D. Migraine
E. Acute bacterial meningitis
Answer: Acute subdural hematoma
Explanation
| The most probable diagnosis for the 54-year-old man with sudden intense headache in the occipital region, vomiting, confusion, mydriasis, photophobia, left-side hemiparesis, and high blood pressure is acute subdural hematoma. Acute subdural hematoma is a type of bleeding that occurs between the dura and the arachnoid layers of the meninges surrounding the brain. It can be caused by traumatic injury or, in some cases, by spontaneous bleeding due to underlying conditions such as hypertension or anticoagulant use. The patient’s symptoms, including headache, vomiting, confusion, and neurological deficits such as hemiparesis, are consistent with a subdural hematoma. The high blood pressure may be a contributing factor to the development of the hematoma. The absence of fever and rash makes acute bacterial meningitis less likely. Myasthenia and disseminated sclerosis are not consistent with the specific symptoms described, and migraine does not typically present with neurological deficits or high blood pressure. It is important for the patient to undergo further evaluation and management by a neurologist or neurosurgeon to confirm the diagnosis and initiate appropriate treatment, which may include surgical intervention to evacuate the hematoma and control the bleeding. |
5. A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?
A. Cancer of esophagus
B. Diaphragmatic hernia
C. Diffuse constriction of esophagus
D. Myasthenia
E. Esophageal achalasia
Answer: Cancer of esophagus
Explanation
| The most probable diagnosis for the 76-year-old woman with progressing swallowing disorder, regurgitation of solid masses, weight loss, and icteric skin is cancer of the esophagus. Cancer of the esophagus is a malignant tumor that can cause difficulty swallowing, regurgitation, weight loss, and jaundice in advanced cases. The patient’s history of smoking, alcohol consumption, and use of aspirin and prolonged nitrates may increase her risk of developing esophageal cancer. The enlargement of the liver may also suggest metastatic spread of the tumor. Diaphragmatic hernia, diffuse constriction of the esophagus, and myasthenia are less likely diagnoses as they do not typically present with the specific symptoms described. It is important for the patient to undergo further evaluation and management by a gastroenterologist to confirm the diagnosis and initiate appropriate treatment, which may include endoscopy, biopsy, and staging of the cancer. |
6. A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?
A. Esophagus achalasia
B. Myastenia
C. Cancer of esophagus
D. Esophagus candidosis
E. Gastroesophageal reflux
Answer: Esophagus achalasia
Explanation
| The most probable diagnosis for the 38-year-old man with occasional problems swallowing both hard and fluid food for many months, intense pain behind the breast bone, and asphyxia onsets at night is esophageal achalasia. Esophageal achalasia is a motility disorder of the esophagus that can cause difficulty swallowing, regurgitation of undigested food, and chest pain, especially after consuming hot drinks. The patient’s lack of weight loss and normal skin color make cancer of the esophagus less likely. The presence of esophageal dilatation on X-ray is consistent with achalasia, which can cause the esophagus to become enlarged due to the buildup of food and fluid. Myasthenia and esophageal candidiasis are less likely diagnoses as they do not typically present with the specific symptoms described. Gastroesophageal reflux may cause similar symptoms but would not explain the esophageal dilatation seen on X-ray. It is important for the patient to undergo further evaluation and management by a gastroenterologist to confirm the diagnosis and initiate appropriate treatment, which may include endoscopy, manometry, and surgical intervention. The most probable diagnosis for the 38-year-old man with occasional problems swallowing both hard and fluid food for many months, intense pain behind the breast bone, and asphyxia onsets at night is esophageal achalasia. Esophageal achalasia is a motility disorder of the esophagus that can cause difficulty swallowing, regurgitation of undigested food, and chest pain, especially after consuming hot drinks. The patient’s lack of weight loss and normal skin color make cancer of the esophagus less likely. The presence of esophageal dilatation on X-ray is consistent with achalasia, which can cause the esophagus to become enlarged due to the buildup of food and fluid. Myasthenia and esophageal candidiasis are less likely diagnoses as they do not typically present with the specific symptoms described. Gastroesophageal reflux may cause similar symptoms but would not explain the esophageal dilatation seen on X-ray. It is important for the patient to undergo further evaluation and management by a gastroenterologist to confirm the diagnosis and initiate appropriate treatment, which may include endoscopy, manometry, and surgical intervention. |
7. A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, consciousness is confused. AP- 80/40 mm Hg. The palpitation of the fetus is not determined. In medical hystory there was a Cesarean section a year ago. Make a diagnosis:
A. Hysterorrhesis
B. Presentation of the cord
C. Placental presentation
D. Abjointing of the mucous fuse from cervix of the uterus
E. Premature expultion of the amniotic waters
Answer: Hysterorrhesis
Explanation
The most probable diagnosis for the woman with stopped birth activity, bloody discharge from the vagina, pale skin, confused consciousness, low blood pressure, and no palpitation of the fetus is hysterorrhesis, which is a life-threatening condition characterized by the rupture of the uterus. The patient’s history of a previous Cesarean section may increase the risk of uterine rupture. Presentation of the cord, placental presentation, abjointing of the mucous fuse from cervix of the uterus, and premature expulsion of the amniotic waters may cause bleeding, but they would not explain the other symptoms described, such as the low blood pressure and confused consciousness. Immediate intervention is required to stabilize the patient’s condition and prevent further complications. The patient should undergo emergency surgery to repair the ruptured uterus and manage any bleeding that may be present. |
8. A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?
A. Irritable bowels syndrome
B. Celiac disease
C. Crohn’s disease
D. Pseudomembranous colitis
E. Dispancreatism
Answer: Irritable bowels syndrome
Explanation
The most probable diagnosis for the 35-year-old woman with occasional pains in the paraumbilical and iliac region that reduce after defecation or passage of gases, frequent defecation with loose stool and mucus, and a normal colonoscopy is irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel habits. The absence of weight loss, normal blood and urine tests, and soft abdomen make celiac disease, Crohn’s disease, pseudomembranous colitis, and dispancreatism less likely diagnoses. IBS is a diagnosis of exclusion, and other organic causes of the symptoms should be ruled out before making the diagnosis of IBS. It is important for the patient to undergo further evaluation and management by a gastroenterologist to confirm the diagnosis and initiate appropriate treatment, which may include dietary modifications, stress reduction, and medication to manage symptoms such as antispasmodics and laxatives. |
9. A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?
A. Varicocele
B. Inguinal lymphadenopathy
C. Ectopic testicle
D. Inguinal hernia
E. Varicosity of subcutaneous veins
Answer: Varicocele
Explanation
| The most probable diagnosis for the 60-year-old man with scrotal edema in the left part, a soft, scrotum-limited edema that disappears when the patient lies down, and normal-sized testicles is varicocele. Varicocele is a condition where the veins in the scrotum become enlarged and dilated, leading to scrotal swelling and discomfort. Inguinal lymphadenopathy, ectopic testicle, inguinal hernia, and varicosity of subcutaneous veins are less likely diagnoses as they do not typically present with the specific symptoms described. Inguinal lymphadenopathy may cause scrotal swelling, but it is usually accompanied by other symptoms such as pain, fever, and systemic illness. It is important for the patient to undergo further evaluation and management by a urologist to confirm the diagnosis and initiate appropriate treatment, which may include observation, medication, or surgery depending on the severity of the varicocele and the patient’s symptoms. |
10. A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?
A. Broken tubal pregnancy
B. Apoplexy of the ovary
C. Acute right-side adnexitis
D. Torsion of the crus of the ovary tumour
E. Acute appendicitis
Answer: Broken tubal pregnancy
Explanation
| The most probable diagnosis for the 26-year-old woman with sudden pains in the bottom of the abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts, positive signs of peritoneal irritation, and a delay of menses for 4 weeks is a broken tubal pregnancy. A ruptured ectopic pregnancy can cause severe abdominal pain, vaginal bleeding, and signs of peritoneal irritation. The bimanual examination findings of pain and tenderness in the back and dextral fornixes of the vagina, as well as the inability to determine the borders of the uterus body and appendages due to sharp pain, are also suggestive of a ruptured ectopic pregnancy. Apoplexy of the ovary, acute right-side adnexitis, torsion of the crus of the ovarian tumor, and acute appendicitis may present with some similar symptoms, but they would not typically cause the specific combination of symptoms and physical exam findings described. Immediate intervention is required to manage the patient’s condition and prevent further complications. The patient should undergo emergency surgery to manage the ruptured ectopic pregnancy and any associated bleeding. |
11. Name a statistical observation unit for determination of blood sugar impact on the healing of wound’s surface in a postoperative period:
A. The patient in a postoperative period
B. An amount of blood sugar
C. Blood analysis
D. The patient who has a wound surface
E. The patient who was discharged on an after-care
Answer: The patient in a postoperative period
Explanation
| The statistical observation unit for determining the impact of blood sugar on the healing of wound surface in a postoperative period would be “the patient in a postoperative period”. This unit refers to the individuals who have undergone surgery and are being monitored for wound healing progress and blood sugar levels. The data collected from these patients can be used to analyze the relationship between blood sugar levels and wound healing outcomes. The other options listed (an amount of blood sugar, blood analysis, the patient who has a wound surface, and the patient who was discharged on an after-care) may be relevant factors or variables in the study, but they are not the primary statistical observation unit |
12. Choose a method of graphic representation of monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values, obtained for 5 last years:
A. The linear diagram
B. The radial diagram
C. The sector diagram
D. The figured diagram
E. Curvilinear diagram
Answer: The linear diagram
Explanation
| The most appropriate method of graphic representation of monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values obtained for the last 5 years is the linear diagram. The linear diagram, also known as a line graph, is a graphical representation of data that uses a series of points connected by straight lines to show trends over time. This type of graph is commonly used to display time-series data, such as monthly data, and is effective in showing changes in data over time, such as increases or decreases in the number of registered cases of acute intestinal infections. Additionally, the linear diagram can also be used to show the average monthly values obtained for the last 5 years, making it a suitable choice for comparing current data to historical trends. The radial diagram, sector diagram, figured diagram, and curvilinear diagram are less suitable for representing monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values obtained for the last 5 years. |
13. A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?
A. Thecal whitlow (ligament panaritium)
B. Subcutaneous panaritium
C. Articular (joint) panaritium
D. Bone panaritium
E. Paronychia
Answer: Thecal whitlow (ligament panaritium)
Explanation
| The most likely diagnosis for the patient with pain in the I finger on the right hand, homogeneously hydropic finger in a bent position, worsening pain on attempting to unbend the finger, and acute pain during probing in ligament projection is thecal whitlow, also known as ligament panaritium. Thecal whitlow is a type of infection that involves the deep tissues of the finger, specifically the tendon sheath that surrounds the flexor tendons. This condition typically presents with swelling, redness, and pain in the affected finger, as well as limited range of motion and pain with movement. Subcutaneous panaritium, articular (joint) panaritium, bone panaritium, and paronychia may also cause finger pain and swelling, but the specific symptoms described, such as the homogeneously hydropic finger in a bent position and pain during probing in ligament projection, are more indicative of thecal whitlow. It is important for the patient to undergo further evaluation and management by a hand specialist or infectious disease specialist to confirm the diagnosis and initiate appropriate treatment, which may include antibiotics, splinting, and in some cases, drainage of the infection. |
14. An employee has been invalid for 6 months as a result of a hip fracture. Who has the right to authorize the issue of the medical sick-list for the last 2 months?
A. MSEC
B. Head physician of the polyclinic
C. DCC
D. DCC together with the head physician of a polyclinic
E. Deputy head physician on working capacity
Answer: MSEC
Explanation
| The medical sick-list for the employee who had an abortion by medical indications on the 6.03.2001 and stayed in the hospital until 17.03.2001 would be issued for 12 days. The sick-list is typically issued to cover the period of time that the patient is unable to work due to medical reasons, which in this case would be the duration of the hospital stay following the abortion. Therefore, the sick-list would run from March 6 to March 17 inclusive, which is a total of 12 days. |
15. An employee had an abortion by medical indications on the 6.03.2001 and she stayed in a hospital till 17.03.2001. What term is the medical sick-list issued for?
A. For 12 days
B. For 3 days
C. For 4 days
D. For 10 days
E. For 11 days
Answer: For 12 days
Explanation
| For question 14, the answer would depend on the specific regulations and laws of the country in question. In general, the authority to issue a medical sick leave may vary depending on the country, the workplace, and other factors. It is best to consult the relevant regulations and policies in the specific context to determine who has the right to authorize the issue of the medical sick-list. For question 15, the medical sick-list would be issued for 12 days, from March 6 to March 17 inclusive. This is the duration of the hospital stay following the abortion by medical indications. The medical sick-list is typically issued to cover the period of time that the patient is unable to work due to medical reasons. |
16. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density – 1,04 g/cm3, acidity – 210Т, reductase probe – weak-positive. What way is the product to be used in?
A. Sell but inform customers about milk quality
B. Discard for animal feeding
C. Technical utilization
D. Sell without limitations
E. Do the product away
Answer: Sell but inform customers about milk quality
Explanation
| Based on the lab analysis results, the 5 tons milk batch has a fat content of 2%, specific density of 1.04 g/cm3, acidity of 210Т, and a weak-positive reductase probe. An acidity level of 210Т indicates that the milk is slightly acidic, which may be an indication of bacterial growth or fermentation. The weak-positive reductase probe result may also be indicative of bacterial activity in the milk. Therefore, the milk batch does not meet the quality standards for fresh milk and should not be sold without informing customers about the quality issues. Depending on the regulations and policies in the specific context, the milk may need to be labeled as “substandard” or “not for direct consumption”. However, the milk may still be usable for other purposes, such as processing or manufacturing, and could be sold for these purposes. Therefore, the appropriate course of action would be to sell the milk batch but to inform customers about the quality issues and potential limitations for direct consumption. |
17. Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature – 200, relative humidity – 45%, air movement velocity – 0,3 m/s, light coefficient – 1/5, noise level – 30 dB. Do hygienic evaluation of the conditions meet the standards?
A. Discomfortable microclimate
B. Non-effective ventilation
C. Poor lighting
D. High level of noise
E. All conditions meet the requirements
Answer: Discomfortable microclimate
Explanation
| Based on the information provided, the hygienic evaluation of the conditions in the hospital ward for a patient with thyrotoxicosis does not meet the standards and is characterized as a discomfortable microclimate. The air temperature in the ward is not specified, and a temperature of “200” is unclear. Assuming it is a typographical error and the temperature is 20°C, it is within the acceptable range. However, the relative humidity of 45% is below the recommended range of 50-60% for indoor spaces and may cause discomfort for some individuals, especially those with respiratory issues. The air movement velocity of 0.3 m/s is within the recommended range, but the ventilation rate of 2.5/hr is below the recommended range of 4-6/hr for hospital wards, indicating non-effective ventilation. The light coefficient of 1/5 is inadequate for a hospital ward and may cause discomfort for patients and staff. The noise level of 30 dB is within the recommended range, but excessive noise can still cause discomfort and disruption to patient rest and recovery. Therefore, the overall conditions in the hospital ward for a patient with thyrotoxicosis do not meet the recommended standards and are considered a discomfortable microclimate. Improvements in ventilation, humidity, lighting, and noise levels may be necessary to provide a more comfortable and conducive environment for patient recovery. |
18. A 33 y.o. patient, works as a secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathology can result from this diet?
A. Obesity
B. Schizophrenia
C. Paradontosis
D. Common cold
E. Uterine fibromyoma
Answer: Obesity
Explanation
| The patient’s diet, which contains 150 g of protein (including 100 g of animal protein), 200 g of fat, and 600 g of carbohydrates, is high in calories and potentially low in essential nutrients such as vitamins and minerals. A diet high in calories can lead to weight gain, which can increase the risk of developing obesity. Therefore, the pathology that can result from this diet is obesity. Obesity is a complex medical condition characterized by excess body fat that can lead to negative health outcomes, such as an increased risk of developing type 2 diabetes, cardiovascular disease, and certain types of cancer. A diet high in calories, particularly from sources such as fat and carbohydrates, can contribute to the development of obesity. It is important for the patient to adopt a balanced and nutritious diet that includes a variety of foods from all food groups and appropriate portion sizes, as well as engage in regular physical activity, to maintain a healthy weight and reduce the risk of developing obesity and related health conditions. |
19. A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjuctiva. The patient’s skin is dry, scales off, folliculitis signs of the face skin are present. What is the cause of this disease?
A. Retinole deficit
B. Thiamine deficit
C. Biotin deficit
D. Folic acid deficit
E. Napthtochynones deficit
Answer: Retinole deficit
Explanation
| The symptoms described for the 15-year-old adolescent, including poor night vision, increased darkness adaptation time, Bitot’s spots on conjunctiva, dry and scaly skin, and folliculitis signs on the face, are suggestive of vitamin A deficiency, also known as retinol deficiency. Vitamin A is an essential nutrient that is important for vision, skin health, and immune function. A deficiency in vitamin A can lead to a range of symptoms, including poor night vision, dry and scaly skin, and folliculitis. Bitot’s spots, which are patches of foamy-looking material on the whites of the eyes, are a classic sign of vitamin A deficiency. The increased darkness adaptation time can also be a sign of impaired vision due to vitamin A deficiency. Therefore, the cause of the adolescent’s symptoms is likely a deficiency in vitamin A, or retinol deficiency. Treatment typically involves increasing the intake of foods rich in vitamin A, such as liver, sweet potatoes, carrots, and leafy green vegetables, or taking vitamin A supplements. |
20. What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?
A. Sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts
B. Draw up a statement about forensic medical examination
C. Conduct an inquiry by preliminary investigator of police department
D. Utilisation copy of medical documents
E. Conduct forensic medical examination by district forensic medicine expert
Answer: Draw up a statement about forensic medical examination
Explanation
| In cases of professional law violations by a physician, one guarantee against preconceived attitudes is the ability to draw up a statement about a forensic medical examination. This involves requesting an independent medical examination conducted by a qualified forensic medical expert to assess the situation and provide an unbiased opinion on the matter. Forensic medical examination is a process that involves the medical evaluation of evidence related to a legal case. In the case of professional law violations by a physician, a statement about a forensic medical examination can help to provide an objective assessment of the situation and may be used as evidence in legal proceedings. Other measures that may help to prevent preconceived attitudes in cases of professional law violations by a physician include a fair and impartial investigation by relevant authorities, such as the public prosecutor’s office or police department, and the involvement of a committee of experts to provide input and guidance on the matter. Utilization of copies of medical documents and conducting forensic medical examinations by district forensic medicine experts may also be useful in providing objective evidence and opinions on the case. Overall, the key is to ensure a fair and impartial investigation and assessment of the situation by qualified professionals to prevent preconceived attitudes and ensure that justice is served. |
21. A 23 y.o. patient has a gunshot wound of his left arm.The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?
A. Primary surgical processing with a flowing suction
B. Wound saturing
C. Wound saturing and drying
D. Wound drying with towel gauzes
E. Aseptic dressing of the wound
Answer: Primary surgical processing with a flowing suction
Explanation
| In the case of a 23-year-old patient with a gunshot wound of the left arm where the bones are not damaged, the appropriate surgical care that must be provided to the patient is primary surgical processing with a flowing suction. Primary surgical processing involves cleaning and removing debris, foreign bodies, and any damaged tissue from the wound to prevent infection and promote healing. A flowing suction can be used to irrigate the wound with a sterile solution and remove any debris or contaminants. This process helps to minimize the risk of infection and promote wound healing. After the primary surgical processing, an aseptic dressing of the wound may be applied to protect it from further contamination and infection. The dressing should be changed regularly based on the condition of the wound and according to medical instructions. It is important to note that in cases of gunshot wounds, there may be a risk of internal damage that is not immediately apparent. Therefore, the patient should undergo a thorough medical evaluation to rule out any underlying injuries and receive appropriate treatment as necessary. Overall, the appropriate surgical care for a patient with a gunshot wound of the left arm where the bones are not damaged is primary surgical processing with a flowing suction, followed by an aseptic dressing of the wound and continued medical evaluation and treatment as necessary. |
22. A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog’s bite. What surgical care would you provide to the patient?
A. Wound bathing with detergent water and antiseptic application
B. Aseptic bandage
C. Cream bandage
D. Complete suturing of the wound
E. Incomplete suturing of the wound
Answer: Wound bathing with detergent water and antiseptic application
Explanation
| In the case of a 34-year-old patient who was bitten by a dog three hours ago and has a non-bleeding wound in his left arm caused by the dog’s bite, the appropriate surgical care that must be provided to the patient is wound bathing with detergent water and antiseptic application. Wound bathing with detergent water helps to clean the wound and remove any debris or contaminants that may be present. It is important to use a mild detergent solution and sterile water to prevent further contamination and injury to the wound. After cleaning the wound, an antiseptic solution or ointment may be applied to prevent infection and promote healing. An aseptic bandage may be used to cover the wound and protect it from further contamination. The bandage should be changed regularly based on the condition of the wound and according to medical instructions. It is important to note that in cases of dog bites, there may be a risk of infection and other complications. Therefore, the patient should undergo a thorough medical evaluation to rule out any underlying injuries and receive appropriate treatment as necessary, such as tetanus prophylaxis or antibiotics. Overall, the appropriate surgical care for a patient who was bitten by a dog and has a non-bleeding wound in their left arm is wound bathing with detergent water and antiseptic application, followed by an aseptic bandage and continued medical evaluation and treatment as necessary. |
23. A 37 y.o. patient complains of pain in the right arm which increases during motion, raised body temperature up to 390C. In the right cubital fossa there is a trace of injection, hyperemia and thickening along the vein. Your diagnosis?
A. Phlebit
B. Phlegmon
C. Abscess
D. Inflammation of lymph
E. Erysipelas
Answer: Phlebit
Explanation
| Based on the symptoms described for the 37-year-old patient, including pain in the right arm which increases during motion, raised body temperature up to 39°C, and a trace of injection, hyperemia, and thickening along the vein in the right cubital fossa, the most likely diagnosis is phlebitis. Phlebitis is an inflammation of a vein that can occur as a result of trauma or injury to the vein, infection, or other underlying medical conditions. Symptoms of phlebitis can include pain, redness, warmth, swelling, and tenderness along the affected vein. In this case, the presence of a trace of injection, hyperemia, and thickening along the vein in the right cubital fossa suggests that the patient may have had an intravenous injection, which could have caused trauma or damage to the vein and contributed to the development of phlebitis. Treatment for phlebitis typically involves rest and elevation of the affected limb, as well as the use of anti-inflammatory medications and pain relievers. In some cases, antibiotics may be necessary if there is an underlying infection. Warm compresses may also be used to help alleviate symptoms and promote healing. It is important to seek medical attention if you suspect you have phlebitis as prompt treatment can prevent complications and promote a faster recovery. |
24. A 35 y.o. woman was admitted to thoracic surgery department with fever up to 400C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?
A. Abscess of the lung
B. Complication of liver echinococcosis
C. Bronchiectatic disease
D. Actinomycosis of lungs
E. Pulmonary tuberculosis
Answer: Abscess of the lung
Explanation
| Based on the symptoms described for the 35-year-old woman, including fever up to 40°C, pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell, the most likely diagnosis is abscess of the lung. An abscess of the lung is a localized collection of pus within the lung tissue that can occur as a result of bacterial or fungal infection. Symptoms of a lung abscess can include fever, chest pain, coughing up blood or foul-smelling sputum, and difficulty breathing. The presence of fever, chest pain, and cough with purulent sputum and blood with bad smell are all consistent with an abscess of the lung. The pain during deep breathing is also a common symptom of a lung abscess, as the inflamed lung tissue can cause pain when expanded during breathing. Treatment for a lung abscess typically involves the use of antibiotics to treat the underlying infection, as well as drainage of the abscess if necessary. In some cases, surgery may be necessary to remove the abscess or affected lung tissue. It is important to seek medical attention promptly if you suspect you have a lung abscess, as the condition can be serious and potentially life-threatening if left untreated. |
25. A laboratory obtained a milk sample sent for analysis. Analysis gave the following data: color – whitish, smell – has no pecularities, taste – typical for milk, density – 1,038, acidity – Turner’s 350, fat – 3,2%. What is the quality level of this milk?
A. The milk is of poor quality
B. The milk is of high quality
C. The milk is of reduced quality
D. The milk is falsificated
E. The milk is nominally qualified
Answer: The milk is of poor quality
Explanation
| Based on the data provided for the milk sample, including a density of 1.038, acidity of Turner’s 350, and fat content of 3.2%, the quality level of this milk is poor. Milk quality is determined by a variety of factors, including its composition, appearance, taste, and smell. The density, acidity, and fat content are important indicators of milk quality. In this case, the density of the milk is higher than normal, which may indicate the presence of added water or other substances. The high acidity level may also suggest that the milk has begun to spoil or has been contaminated. Additionally, the fat content is within the normal range, but does not necessarily indicate good quality on its own. Overall, the data suggests that the milk is of poor quality and may not be safe for consumption. It is important to ensure that milk and other dairy products are obtained from a reliable source and are properly stored and handled to prevent contamination and spoilage. |
26. For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:
A. Thyroid gland
B. Skin
C. Reproduction system organs
D. Breast
E. Lungs
Answer: Thyroid gland
Explanation
| For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of the thyroid gland. The thyroid gland is one of the most radiation-sensitive organs in the human body, and exposure to radioactive iodine-131 is a major risk factor for the development of thyroid cancer. In the aftermath of a nuclear accident, such as the Chernobyl disaster, the release of radioactive iodine into the environment can lead to significant exposure for individuals living in the surrounding area. The risk of developing thyroid cancer is highest in children and adolescents, as their thyroid glands are still developing and are more susceptible to damage from radiation exposure. However, the risk remains elevated for several years after the initial exposure, and regular monitoring and screening may be necessary for individuals who live in areas affected by a nuclear accident. Other types of cancer, such as skin, lung, and breast cancer, may also be associated with radiation exposure, but the risk is generally lower than that of thyroid cancer in the aftermath of a nuclear accident. Overall, the greatest risk within the first decade for individuals living in a hot area after an accident at a nuclear object is represented by cancer of the thyroid gland. |
27. A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?
A. Operation on account of feochromocytoma
B. Operation on thyroid gland
C. Krail’s operation
D. Subtotal resection of thyroid gland and fascicular resection of limphatic nodes
E. Vanach’s operation
Answer: Operation on account of feochromocytoma
Explanation
| In a patient diagnosed with both medullary thyroid gland cancer and pheochromocytoma, the operation that should be performed first is an operation to remove the pheochromocytoma. Pheochromocytoma is a rare tumor of the adrenal gland that produces excess amounts of adrenaline and other hormones, which can cause high blood pressure, rapid heart rate, and other symptoms. The tumor can also cause complications during surgery, such as dangerously high blood pressure, so it is important to remove the pheochromocytoma before proceeding with the thyroid gland surgery. Once the pheochromocytoma is removed, the patient can undergo surgery to remove the medullary thyroid gland cancer. The specific type of surgery will depend on the extent and stage of the cancer, as well as other factors such as the patient’s age and overall health. Options for thyroid gland surgery may include a total thyroidectomy, which involves the complete removal of the thyroid gland, or a partial thyroidectomy, which involves removing only a portion of the gland. Lymph node dissection may also be necessary to remove any cancerous lymph nodes. Overall, in a patient diagnosed with both medullary thyroid gland cancer and pheochromocytoma, the operation that should be performed first is an operation to remove the pheochromocytoma, followed by surgery to remove the medullary thyroid gland cancer. |
28. A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus, it was also wetting and itching. What test should not be used for diagnostics in this case?
A. Incision biopsy
B. Yaks’s reaction
C. Radioisotope diagnostics
D. Termography
E. Glass-print
Answer: Incision biopsy
Explanation
| In the case of a 28-year-old woman with complaints of an enlarging in size inborn pigment nevus that is wetting and itching, incision biopsy should not be used for diagnostics. An incision biopsy involves making an incision in the skin to remove a small sample of tissue for examination under a microscope. While this may be a useful diagnostic tool in some cases, it is not recommended for the evaluation of a suspicious skin lesion that is enlarging in size and exhibiting symptoms such as wetting and itching. This is because an incision biopsy can potentially spread cancerous cells if the lesion is indeed malignant. Instead, other diagnostic tests such as a Yaks’s reaction, radioisotope diagnostics, thermography, or glass-print may be used to evaluate the pigmented nevus. A Yaks’s reaction involves injecting a small amount of tuberculin under the skin to determine if the lesion is a benign nevus or a malignant melanoma. Radioisotope diagnostics may involve the use of radioactive materials to detect abnormal tissue growth. Thermography uses infrared imaging to detect changes in skin temperature that may indicate abnormal cell growth, and glass-print involves applying a glass slide to the surface of the lesion to obtain a sample for microscopic examination. It is important to consult with a healthcare professional for proper diagnosis and management of any suspicious skin lesions. |
29. A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?
A. Trocar or open epicystostomy
B. Transuretral resection or prostatectomy
C. Introduction of permanent urethral catheter
D. Microwave thermotherapy of prostate
E. Placing of intraprostatic stent
Answer: Trocar or open epicystostomy
Explanation
| In the case of a 74-year-old patient with a history of benign prostate hyperplasia and acute urinary retention, along with an enlarged and painful right epididymis and purulent discharges from the urethra, the most appropriate emergency care would be trocar or open epicystostomy. A trocar or open epicystostomy involves creating an opening in the bladder through the abdominal wall to relieve pressure caused by urine buildup. This procedure can be performed quickly and effectively to provide immediate relief for the patient. In this case, the patient’s acute urinary retention and other symptoms may be caused by an infection or inflammation of the prostate gland and/or epididymis, which can occur as a complication of benign prostate hyperplasia. The purulent discharges from the urethra may also indicate a urinary tract infection. Transurethral resection or prostatectomy, microwave thermotherapy of the prostate, and placing of intraprostatic stent are all treatment options for benign prostate hyperplasia, but they are not appropriate for emergency management of acute urinary retention and suspected infection. Introduction of a permanent urethral catheter may not provide adequate relief for the patient’s symptoms and could potentially exacerbate the infection or inflammation. Overall, in this case, trocar or open epicystostomy is the most appropriate emergency care option to relieve the patient’s acute urinary retention and provide immediate relief. |
30. A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38, 50) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?
A. Acute rheumatic fever
B. Systemic lupus erythematosis
C. Juvenile rheumatoid arthritis
D. Reiter’s disease
E. Reactive arthritis
Answer: Acute rheumatic fever
Explanation
| The symptoms described for the 10-year-old boy, including joint pain and stiffness, fever, enlargement of cardiac dullness, tachycardia, weakness of the 1st sound, gallop rhythm, and weak systolic murmur near the apex are indicative of acute rheumatic fever. Acute rheumatic fever is a rare but serious complication of untreated strep throat caused by group A streptococcal infection. The condition can affect the heart, joints, central nervous system, and skin, and can lead to long-term complications if left untreated. The symptoms of acute rheumatic fever typically develop two to four weeks after a streptococcal infection and may include fever, joint pain and stiffness, chest pain, shortness of breath, and heart palpitations. The presence of an enlarged cardiac dullness, tachycardia, a weak systolic murmur, and gallop rhythm are all indicative of cardiac involvement in acute rheumatic fever. Other conditions, such as systemic lupus erythematosus, juvenile rheumatoid arthritis, Reiter’s disease, and reactive arthritis, may also present with joint pain and other symptoms, but the specific symptoms described in this case are most consistent with acute rheumatic fever. Treatment for acute rheumatic fever typically involves antibiotics to treat the underlying infection, as well as anti-inflammatory medications to reduce inflammation and control symptoms. In some cases, long-term antibiotic prophylaxis may also be necessary to prevent recurrence of the condition. Early diagnosis and treatment are important in preventing long-term complications of acute rheumatic fever. |
31. A baby boy was born in time, it was his mother’s 1st pregnancy. The jaundice was revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level – 5 mcmol/L, Hb- 150 g/L. Mother’s blood group – 0(I), Rh+, child’s blood group – A(II), Rh+. Make a diagnosis.
A. Hemolytic disease of newborn (АВО incompatibility), icteric type
B. Jaundice due to conjugation disorder
C. Hepatitis
D. Physiological jaundice
E. Hemolytic disease of newborn (Rh – incompatibility)
Answer: Hemolytic disease of newborn (АВО incompatibility), icteric type
Explanation
| The symptoms and laboratory findings described for the baby boy, including jaundice that progressed, adynamia, vomiting, and hepatomegaly, along with a high level of indirect bilirubin (275 μmol/L) and a normal level of direct bilirubin (5 μmol/L), and blood group incompatibility between the mother and child (0(I) and A(II), respectively) are indicative of hemolytic disease of the newborn (ABO incompatibility), icteric type. Hemolytic disease of the newborn (HDN) occurs when there is an incompatibility between the blood types of the mother and the baby, leading to the destruction of red blood cells in the baby. In this case, the mother is type 0(I) and the baby is type A(II), which can lead to the production of antibodies against the baby’s red blood cells by the mother’s immune system. The destruction of red blood cells leads to an increase in indirect bilirubin levels, which can cause jaundice and other symptoms such as adynamia, vomiting, and hepatomegaly. The normal level of direct bilirubin suggests that there is no underlying liver disease or conjugation disorder causing the jaundice. Physiological jaundice, which is a common condition in newborns, typically occurs within the first week of life and resolves on its own without treatment. However, the high level of indirect bilirubin and other symptoms described in this case are not consistent with physiological jaundice. Hepatitis can also cause jaundice, but it is less likely to occur in a newborn and would typically present with other symptoms such as fever and abdominal pain. Overall, the symptoms, laboratory findings, and blood group incompatibility between the mother and child are most consistent with hemolytic disease of the newborn (ABO incompatibility), icteric type. |
32. Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?
A. Major epileptic seizure
B. Vegetatic crisis
C. Absence
D. Episode of hysteria
E. Fainting
Answer: Major epileptic seizure
Explanation
| The symptoms described in the case, including three episodes of lost consciousness and attacks during the day, followed by tonic and clonic convulsions of the trunk and extremities lasting for 4 minutes and ending with involuntary urination, are indicative of a major epileptic seizure. Major epileptic seizures, also known as generalized tonic-clonic seizures, are characterized by loss of consciousness, followed by stiffening of the body (tonic phase) and rhythmic jerking of the limbs (clonic phase). These seizures typically last for several minutes and are often followed by a period of confusion and fatigue. Vegetative crises typically involve symptoms such as palpitations, sweating, and changes in blood pressure, but do not typically involve convulsions or loss of consciousness. Absence seizures, also known as petit mal seizures, are characterized by brief episodes of staring and loss of awareness, often lasting only a few seconds. These seizures do not typically involve convulsions or loss of consciousness. Hysteria is a term that is no longer used in modern medical practice, and the symptoms that were once described as hysteria are now recognized as being related to a wide range of medical and psychiatric conditions. Fainting, also known as syncope, is a brief loss of consciousness typically caused by a temporary drop in blood pressure or a lack of oxygen to the brain. Fainting does not typically involve convulsions or involuntary urination. Overall, the symptoms described in the case are most consistent with a major epileptic seizure. |
33. A 2 y.o. girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?
A. Rubella
B. Scarlet fever
C. Measles
D. Adenoviral infection
E. Pseudotuberculosis
Answer: Rubella
Explanation
| The symptoms described in the case, including low-grade fever, severe catarrhal symptoms, a slight maculopapular rash on the buttocks, and enlarged occipital lymph nodes, are most consistent with a diagnosis of rubella. Rubella, also known as German measles, is a viral infection that is typically mild in children but can cause serious complications in pregnant women, including fetal malformations and miscarriage. The virus is spread through respiratory droplets and can cause symptoms such as fever, sore throat, enlarged lymph nodes, and a rash that typically starts on the face and spreads to the trunk and extremities. The slight maculopapular rash on the buttocks and enlarged occipital lymph nodes are both characteristic of rubella and can help to differentiate it from other viral infections such as measles or adenoviral infection. Scarlet fever typically presents with a high fever, sore throat, and a characteristic rash on the face, trunk, and extremities. Measles typically presents with a high fever, cough, and a rash that starts on the face and spreads to the trunk and extremities. Adenoviral infections can cause a wide range of symptoms, including respiratory symptoms, fever, and conjunctivitis. Pseudotuberculosis is a bacterial infection that typically causes abdominal pain, fever, and diarrhea. Overall, the symptoms described in the case are most consistent with a diagnosis of rubella. It is important to seek medical attention for proper diagnosis and management of the condition, especially if the patient is pregnant or may come into contact with pregnant women. |
34. A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?
A. Encephalitis
B. Meningitis
C. Meningoencephalitis
D. Myelitis
E. Neurotoxic syndrome
Answer: Encephalitis
Explanation
| The symptoms described in the case, including headache, weakness, vertigo, tremor of limbs, ataxia, mental confusion, and absence of meningeal signs, are most consistent with a diagnosis of encephalitis. Encephalitis is an inflammation of the brain that can be caused by a variety of viral, bacterial, or fungal infections. In this case, the encephalitis is likely a complication of the varicella (chickenpox) infection. The symptoms of encephalitis can vary, but they often include headache, fever, confusion, and neurological symptoms such as tremor, ataxia, and weakness. Meningitis, which is an inflammation of the membranes surrounding the brain and spinal cord, typically presents with symptoms such as headache, fever, and neck stiffness, and would be accompanied by positive meningeal signs. Meningoencephalitis, which is a combination of meningitis and encephalitis, typically presents with symptoms of both conditions, including headache, fever, confusion, and neurological symptoms. Myelitis is an inflammation of the spinal cord that can cause symptoms such as muscle weakness, sensory loss, and paralysis. Neurotoxic syndrome is a broad term that can encompass a variety of neurological symptoms caused by toxic substances or medications. Overall, the symptoms described in the case are most consistent with a diagnosis of encephalitis as a complication of varicella. Cerebrospinal fluid examination is typically normal in cases of encephalitis caused by viral infections, such as varicella. Treatment typically involves supportive care and antiviral medications, and long-term complications can occur in some cases. It is important to seek medical attention for proper diagnosis and management of the condition. |
35. A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3,2 kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?
A. 8
B. 10
C. 12
D. 20
E. 6
Answer: 8
Explanation
| By the ageof 1 year, a baby should have around 8 teeth, which are usually the four upper and four lower incisors. However, the exact number of teeth can vary from baby to baby and some babies may have more or less teeth than this average. The process of teething can also vary, with some babies starting to teeth earlier or later than others. It is important for parents to monitor their baby’s teething process and seek medical advice if there are any concerns or if the baby is experiencing significant discomfort or other symptoms. |
36. A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog. In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial astma attacks?
A. Epidermal
B. Dust
C. Pollen
D. Itch mite
E. Chemical
Answer: Epidermal
Explanation
| The boy’s history of atopic dermatitis caused by eating eggs, chicken, and beef, along with the development of an asthma attack and whistling rales after playing with a dog, suggests that the boy may be allergic to epidermal allergens. Epidermal allergens are substances that come from the skin, hair, or saliva of animals, such as dogs, cats, or horses. These allergens can cause allergic reactions in susceptible individuals, including asthma attacks, wheezing, and other respiratory symptoms. In this case, the boy’s history of atopic dermatitis caused by eating certain foods suggests that he may have a pre-existing allergic condition, which could make him more susceptible to developing allergic reactions to other allergens, including epidermal allergens. Dust, pollen, and itch mite allergens are other common allergens that can cause respiratory symptoms and asthma attacks, but given the history of exposure to a dog and the presence of atopic dermatitis caused by certain foods, epidermal allergens are the most likely cause of the boy’s asthma attack in this case. Chemical allergens can also cause respiratory symptoms and asthma attacks, but they are less likely to be the cause of the boy’s symptoms in this case, given the history of exposure to a dog and the presence of atopic dermatitis caused by certain foods. |
37. A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t 0- 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.
A. Subacute bacteria endocarditis
B. Recurrence of rheumatic fever
C. Thrombocytopenia purpura
D. Mitral stenosis
E. Aortic stenosis
Answer: Subacute bacteria endocarditis
Explanation
| The symptoms described in the case, including anorexia, weakness, weight loss, breathlessness, swelling of feet, diastolic murmur in the mitral area, petechial lesions, and palpable spleen, are most consistent with a diagnosis of subacute bacterial endocarditis (SBE) in a patient with rheumatic heart disease. SBE is a type of bacterial infection of the heart valves that typically develops slowly over weeks to months, and can cause a wide range of symptoms, including fever, fatigue, weight loss, and heart murmurs. In this case, the patient’s history of rheumatic heart disease, along with the presence of a diastolic murmur in the mitral area, suggest that the patient is at increased risk for developing SBE. The presence of petechial lesions and a palpable spleen are also characteristic of SBE, and can help to differentiate it from other conditions, such as recurrence of rheumatic fever or thrombocytopenic purpura. Mitral stenosis and aortic stenosis are both types of valvular heart disease that can cause heart murmurs, but they are less likely to be the cause of the patient’s symptoms in this case, given the history of rheumatic heart disease and the presence of petechial lesions and a palpable spleen. Overall, the symptoms described in the case are most consistent with a diagnosis of subacute bacterial endocarditis in a patient with rheumatic heart disease. It is important to seek medical attention promptly for proper diagnosis and management of the condition, as SBE can cause serious complications and requires aggressive antibiotic therapy. |
38. A 62 y.o. patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be used?
A. Prescribe fast-acting insulin
B. Give Glurenorm in place of Maninilum
C. Continue with the current therapy
D. Prescribe long-acting insulin
E. Prescribe guanyl guanidines
Answer: Prescribe fast-acting insulin
Explanation
| The patient with DM-2 who is undergoing surgery for inguinal hernia requires careful management of their blood sugar levels before, during, and after the procedure. In this case, the most appropriate tactic for hypoglycemic therapy during the perioperative period would be to prescribe fast-acting insulin. Fast-acting insulin, such as regular insulin or rapid-acting insulin analogs (e.g. lispro, aspart, or glulisine), can be used to rapidly lower blood sugar levels and maintain tight glycemic control during the perioperative period. This can help to minimize the risk of hyperglycemia-related complications, such as delayed wound healing, infection, and cardiovascular events. Continuing with the current therapy of diet and Maninilum may not be sufficient to maintain tight glycemic control during the perioperative period, as the stress of surgery can cause fluctuations in blood sugar levels. Similarly, long-acting insulin or guanyl guanidines may not be appropriate, as they are not designed to rapidly lower blood sugar levels and may not provide adequate glycemic control during the perioperative period. Switching to Glurenorm in place of Maninilum may be an option, as Glurenorm is a sulfonylurea medication that works similarly to Maninilum to stimulate insulin secretion. However, the rapid onset and short duration of action of fast-acting insulin make it a more appropriate choice for maintaining tight glycemic control during the perioperative period. Overall, the most appropriate tactic for hypoglycemic therapy during the perioperative period in this case would be to prescribe fast-acting insulin. |
39. A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria – 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:
A. DM 1st type, severe form, decompensation, insulin resistant
B. DM 2nd type, severe form, decompensation
C. DM st type, severe form, subcompensation, Somoji phenomenon
D. DM 2nd type, moderate form, Zabrodi phenomenon
E. DM 1st type, severe form, decompensation, allergic reaction to insulin
Answer: DM 1st type, severe form, decompensation, insulin resistant
Explanation
| The patient’s history of diabetes for 5 years, high insulin requirements of over 100 units per day, weight gain, elevated fasting blood glucose levels, and glucoseuria suggest that she has a severe form of diabetes that is poorly controlled. The presence of generalized microangiopathy suggests that she may also have long-standing diabetes-related complications. The fact that increasing the dose of insulin does not improve her glycemia suggests that she may be insulin resistant, which is a common complication of long-standing diabetes. Insulin resistance occurs when the body becomes less responsive to the effects of insulin, requiring higher doses to achieve the same level of glycemic control. Based on these findings, the most likely diagnosis is DM 1st type, severe form, decompensation, insulin resistant. While DM 2nd type can also be associated with insulin resistance, the patient’s age of onset and high insulin requirements make DM 1st type a more likely diagnosis. The other options listed in the answer choices are less likely based on the patient’s history and symptoms. Subcompensation and Somoji phenomenon are not relevant in this case, and Zabrodi phenomenon is a rare complication of insulin therapy that is unlikely to be the cause of the patient’s symptoms. Allergic reactions to insulin can occur, but they are uncommon and typically present with symptoms such as rash, itching, or difficulty breathing, which are not described in the case. |
40. A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus’ si- gn). What examination should be carried out first of all?
A. Wasserman test, IFT
B. T.pallidum Immobilization Test (TPI)
C. Detection of the nasal mucous membrane for Micobacterium Leprae Hansen
D. Consultation of neuropathist
E. CBC
Answer: Wasserman test, IFT
Explanation
| The patient’s symptoms of diffuse alopecia and Pinkus’ sign (stair-like eyelashes) are suggestive of a potential diagnosis of syphilis, which is a sexually transmitted infection that can cause a wide range of symptoms, including skin and hair changes. Therefore, the first examination that should be carried out in this case is the Wasserman test, also known as the Venereal Disease Research Laboratory (VDRL) test, and the Immunofluorescence assay (IFT) to check for the presence of antibodies to Treponema pallidum, the bacterium that causes syphilis. These tests are commonly used to screen for syphilis, as they can detect antibodies to the bacterium in the blood. If the tests are positive, further evaluation and treatment for syphilis would be necessary. The other options listed in the answer choices are less relevant in this case. The T.pallidum Immobilization Test (TPI) is another test for syphilis, but it is less commonly used than the Wasserman test and IFT. Detection of the nasal mucous membrane for Micobacterium Leprae Hansen is a test for leprosy, which is a different condition that is less likely to be the cause of the patient’s symptoms. A consultation with a neuropathist may be necessary if neurological symptoms are present, but it is not the first examination that should be carried out in this case. A CBC (complete blood count) can provide important information about the patient’s overall health, but it is not specific to the diagnosis of syphilis. |
41. A triad of symptoms (“stearing spot”, “terminal film”, “blood dew”) have been revealed on examination of a patient. What disease should you think about?
A. Psoriasis
B. Lichen ruber planus
C. Vasculitis
D. Seborrhea
E. Ritter’s disease
Answer: Psoriasis
Explanation
| The triad of symptoms described in the case, including “stearin spot”, “terminal film”, and “blood dew”, are classic features of psoriasis, a chronic inflammatory skin condition. The “stearin spot” refers to the characteristic scaling of psoriatic lesions, which resembles the appearance of stearic acid on the skin. T he “terminal film” refers to the thin layer of skin covering the scaling areas, which can be peeled off easily. The “blood dew” refers to the bleeding that can occur when the terminal film is removed. Lichen ruber planus, vasculitis, and Seborrhea are not typically associated with the triad of symptoms described in the case. Ritter’s disease, also known as staphylococcal scalded skin syndrome, can cause skin blistering and peeling, but it does not typically present with the specific triad of symptoms described in this case. Therefore, based on the triad of symptoms described in the case, the most likely diagnosis is psoriasis. However, further evaluation and confirmation of the diagnosis would be necessary through a comprehensive medical history, physical examination, and additional diagnostic tests if needed. |
42. A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophile type. What pathology must be excluded first of all?
A. Helminthic invasion
B. Lymphoprolipherative process
C. Hypoplastic anemia
D. Duodenal ulcer
E. Atrophic gastritis
Answer: Helminthic invasion
Explanation
| The symptoms of poor appetite, fatigue, and hypochromatic anemia in a 4-year-old child attending kindergarten are suggestive of a potential parasitic infection, such as a helminthic invasion. The leucomoid reaction of the eosinophilic type is another clue that suggests a possible parasitic infection, as eosinophils are a type of white blood cell that are typically elevated in response to parasitic infections. Therefore, the first pathology that must be excluded in this case is a helminthic invasion. This can be done through stool examination for the presence of parasitic eggs or larvae, as well as through blood tests to look for specific antibodies or antigens related to the suspected parasites. Lymphoproliferative processes, hypoplastic anemia, duodenal ulcer, and atrophic gastritis are less likely in a 4-year-old child and are not strongly suggested by the symptoms and laboratory findings described in the case. Overall, given the age of the patient, the symptoms of poor appetite and fatigue, and the laboratory findings of hypochromatic anemia and eosinophilia, a helminthic invasion should be considered as the most likely cause of the patient’s symptoms. |
43. A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?
A. Monitoring of the specific IgG IgM with the ELISA
B. Fetus wastage
C. Immunoglobulin injection
D. Cyclovin prescription
E. Interferon prescription
Answer: Monitoring of the specific IgG IgM with the ELISA
Explanation
| In this case, the woman’s contact with a child who has rubella raises concerns about the potential risk of rubella infection during pregnancy. Rubella infection during pregnancy can cause serious complications for the developing fetus, including congenital rubella syndrome, which can lead to hearing and vision impairments, heart defects, and developmental delays. The most appropriate tactic in this situation would be to monitor the woman’s immunity to rubella by testing for specific IgG and IgM antibodies using the ELISA (enzyme-linked immunosorbent assay) test. IgG antibodies indicate previous infection or vaccination, while IgM antibodies indicate recent infection. If the woman is found to be immune to rubella (i.e., positive for IgG antibodies), then she is unlikely to be at risk of infection and no further action may be required. If she is not immune (i.e., negative for IgG antibodies), then she may be at risk of infection and should be closely monitored for symptoms of rubella. If the woman is found to have recent infection (i.e., positive for IgM antibodies), then she should be counseled about the potential risks to the developing fetus and offered further testing and monitoring, including ultrasound examinations and amniocentesis to detect signs of congenital rubella syndrome. Fetus wastage (i.e., termination of pregnancy) may be considered in some cases of rubella infection during pregnancy, but this should be a decision made in consultation with the woman and her healthcare providers. Immunoglobulin injection, Cyclovin prescription, and Interferon prescription are not appropriate tactics for managing rubella infection during pregnancy and are not indicated in this case. |
44. A 32 y.o. woman has got the Laiel’s syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?
A. Steroid immunosupressants
B. Non-specific immune modulators
C. Specific immune modulators
D. Interferons
E. Non-steroid immunosupressants
Answer: Steroid immunosupressants
Explanation
| Laiel’s syndrome, also known as drug-induced hypersensitivity syndrome (DIHS), is a rare but potentially life-threatening allergic reaction to certain medications, including bactrim (sulfamethoxazole/trimethoprim), which is also known as biceptol. In this syndrome, the immune system overreacts to the medication, leading to a range of symptoms, including fever, rash, and organ involvement such as hepatitis. In cases of severe Laiel’s syndrome, treatment typically involves the use of systemic corticosteroids, which are steroid immunosuppressants that can help to suppress the immune response and reduce inflammation. Non-specific immune modulators, specific immune modulators, interferons, and non-steroid immunosuppressants are not generally recommended for the treatment of Laiel’s syndrome, as there is no specific immunomodulatory therapy that has been proven effective for this condition. Therefore, the most appropriate immunotrope medicine to prescribe in this situation would be steroid immunosuppressants, such as prednisone or methylprednisolone, which can be gradually tapered off as the patient’s symptoms improve. The use of corticosteroids should be carefully monitored by a healthcare professional to minimize the risk of side effects. |
45. A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38, 50, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?
A. Acute dysentery
B. Amebiasis
C. Colibacillosis
D. Nonspecific ulcerative colitis
E. Malignant tumors of large intestine
Answer: Acute dysentery
Explanation
| The symptoms described in the case, including fever, abdominal pain, and bloody and mucous diarrhea, are suggestive of acute dysentery, which is a type of bacterial infection that affects the colon and rectum. Acute dysentery is typically caused by the bacteria Shigella, which is transmitted through contaminated food or water. The symptoms of acute dysentery can range from mild to severe, and can include fever, diarrhea, abdominal pain, and rectal bleeding. In this case, the paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass, and palpable spasms in the sigmoid colon are all typical features of acute dysentery. Amebiasis, colibacillosis, nonspecific ulcerative colitis, and malignant tumors of the large intestine can also cause similar symptoms, but acute dysentery is the most probable diagnosis based on the clinical presentation described in the case. To confirm the diagnosis of acute dysentery, stool cultures can be performed to identify the presence of Shigella bacteria. Treatment typically involves antibiotics to eliminate the infection, as well as supportive measures to manage symptoms and prevent dehydration. |
46. The disease of a 21 y.o. patient began with raise of temperature up to 39, 00, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor revealed: cytosis – 1237 in 1 ml, including: 84% of neutrophils, 16% of lymphocytes. On bacterioscopy: gram-negative cocci are found in liquor. What is the most probable disease?
A. Meningococcal infection: purulent meningitis
B. Meningococcal infection: serous meningitis
C. Secondary purulent meningitis
D. Serous meningitis
E. Infectious mononucleosis
Answer: Meningococcal infection: purulent meningitis
Explanation
| The symptoms of high fever, headache, vomiting, and rigidity of the occipital muscles, along with the laboratory findings of high cerebrospinal fluid (CSF) cell count with predominantly neutrophils and gram-negative cocci on bacterioscopy, are highly suggestive of purulent meningitis, which is a serious bacterial infection of the membranes surrounding the brain and spinal cord. Meningococcal infection is a common cause of purulent meningitis, with Neisseria meningitidis being the most common causative agent. The high CSF cell count and presence of gram-negative cocci in the CSF are consistent with this diagnosis. Therefore, the most probable disease in this case is meningococcal infection with purulent meningitis. This is a medical emergency that requires urgent treatment with antibiotics and supportive care to manage the symptoms and prevent complications. Secondary purulent meningitis, serous meningitis, and infectious mononucleosis are less likely based on the clinical presentation and laboratory findings described in the case. However, a definitive diagnosis can only be made through further diagnostic tests, such as culture and sensitivity testing of the CSF and blood, as well as additional clinical evaluation. |
47. The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is professional tactics of the doctor in this situation?
A. The urgent hospitalization in surgical department
B. To inject intravenously the aminocapronic acid
C. The urgent hospitalization in therapeutic department
D. Treatment at a day time hospital
E. Treatment at home
Answer: The urgent hospitalization in surgical department
Explanation
| An acute bleeding of the intestine is a serious medical emergency that requires immediate attention and treatment. The most appropriate professional tactic in this situation is urgent hospitalization in a surgical department. The cause of the bleeding may be due to a variety of conditions, such as peptic ulcers, inflammatory bowel disease, tumors, or vascular malformations. The severity of the bleeding can range from mild to severe and can be life-threatening in some cases. Hospitalization in a surgical department is necessary to provide the patient with immediate access to specialized medical care, such as diagnostic tests (e.g., endoscopy, colonoscopy), blood transfusions, and surgical interventions if needed. Injecting aminocaproic acid intravenously may be considered as a treatment option for bleeding, but it is not appropriate as the first-line management for an acute intestinal bleed. Aminocaproic acid is typically used to prevent or reduce bleeding during surgical procedures, and is not indicated for the treatment of acute bleeding. Urgent hospitalization in a therapeutic department or treatment at a day time hospital or at home may not provide the patient with the necessary level of medical care and monitoring required for the management of an acute intestinal bleed. Therefore, the most appropriate professional tactic for a patient with an acute intestinal bleed is urgent hospitalization in a surgical department. |
48. A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?
A. Mitral comissurotomia
B. Conduction of current bicilinoprophilaxis
C. Prescription of anticoagulants
D. Prescription of venous vasodilatators
E. –
Answer: Mitral comissurotomia
Explanation
| The symptoms of palpitation, fatigue, dyspnea, attacks of dyspnea, and hemoptysis in a patient with rheumatic disease and mitral stenosis suggest a severe degree of mitral valve obstruction, which can lead to significant impairment in the function of the heart and lungs. In this situation, the most expedient tactic would be mitral commissurotomy, which is a surgical procedure used to treat mitral stenosis by opening up the fused commissures of the mitral valve and improving blood flow from the left atrium to the left ventricle. Mitral commissurotomy can be performed using a surgical approach or a minimally invasive technique, such as percutaneous balloon mitral valvuloplasty, depending on the individual patient’s condition and the severity of the mitral stenosis. Conducting current bicillin prophylaxis (i.e., antibiotic prophylaxis against streptococcal infections) may be recommended before and after the surgery to prevent infection, as infections can increase the risk of complications. Prescription of anticoagulants may also be necessary after the surgery, especially if there is a risk of blood clots forming in the heart or lungs. Prescription of venous vasodilators is not typically indicated in the management of mitral stenosis or mitral commissurotomy. Therefore, the most expedient tactic in this case would be mitral commissurotomy. |
49. A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?
A. 25-30%
B. 6-9%
C. 10-14%
D. 15-20%
E. 35-50%
Answer: 25-30%
Explanation
| Acute hemorrhagic anemia occurs when there is a sudden loss of blood volume due to bleeding, which can lead to decreased oxygen delivery to the body’s organs and tissues and can result in organ failure and death. The minimum percentage of whole blood volume that could result in death by acute hemorrhage depends on various factors, such as the individual’s age, overall health, and the rate and location of bleeding. However, in general, a loss of 25-30% or more of the total blood volume can result in hypovolemic shock, which is a life-threatening condition that occurs when the body loses a significant amount of blood and is unable to maintain adequate blood pressure and tissue perfusion. Therefore, in this case, the man’s death due to acute hemorrhagic anemia suggests that he lost at least 25-30% of his total blood volume as a result of the hemorrhage from the road accident. |
50. A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP95/60 mm Hg, Ps- 120/min, diuresis – 20 ml/h, HgB- 100 g/L, RBC- 2, 1 ∗ 1012/L. The patient needs introduction of:
A. Crystalloid and colloid
B. Crystalloid and red blood cells
C. Crystalloid and 5% dextrose
D. 5% dextrose and red blood cells
E. 5% dextrose and colloid
Answer: Crystalloid and colloid
Explanation
| The patient presented with diffuse abdominal pain and signs of cardiovascular collapse, including hypotension, tachycardia, and decreased urine output, indicating a state of shock. The laboratory findings of low hemoglobin and red blood cell count suggest anemia, which could be contributing to the patient’s condition. In this situation, the patient requires urgent fluid resuscitation to restore blood volume and tissue perfusion. The most appropriate choice would be the intravenous administration of crystalloid and colloid solutions. Crystalloid solutions such as normal saline or lactated Ringer’s solution can be used to restore the extracellular fluid volume and provide electrolytes to the body. Colloid solutions such as albumin or synthetic colloids can be used to increase the intravascular volume and improve tissue perfusion. The use of red blood cells may also be necessary if the patient’s anemia is severe and is contributing to the state of shock. However, crystalloid and colloid solutions should be administered first to stabilize the patient’s condition and restore blood volume. The use of 5% dextrose alone is not appropriate for fluid resuscitation in a patient with shock, as it does not provide the necessary electrolytes and volume expansion needed to restore tissue perfusion. T herefore, the most appropriate choice for the patient’s fluid resuscitation would be crystalloid and colloid solutions. |
