Question From (1 To 50 )
1. An 8 y.o. child presents with lowgrade fever, arthritis, colicky abdominal pain, and a purpuric rash limited to the lower extremities. laboratory studies reveal a guaiac-positive stool, a urinalysis with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most likely diagnosis is:
A. Henoch-Schonlein’s vasculitis
B. Systemic lupus erythematosus (SLE)
C. Rocky Mountain spotted fever
D. Idiopathic thrombocytopenic purpura
E. Poststreptococcal glomerulonephritis
Answer: Henoch-Schonlein’s vasculitis
Explanation
| HThe correct answer is A. Henoch-Schonlein’s vasculitis. enoch-Schonlein’s vasculitis is a type of systemic vasculitis that affects small blood vessels, primarily in children. The most common symptoms include a purpuric rash on the lower extremities, joint pain, abdominal pain, and kidney involvement. The rash is often preceded by fever and malaise. In addition, laboratory studies may reveal a guaiac-positive stool, red blood cell casts and mild proteinuria in the urine, and a normal platelet count. Systemic lupus erythematosus (SLE) typically presents with a wide range of symptoms, including fever, fatigue, joint pain, and a characteristic butterfly rash on the face. While SLE can affect the kidneys and cause proteinuria, it is less likely to cause gastrointestinal symptoms or a purpuric rash limited to the lower extremities. Rocky Mountain spotted fever is a tick-borne illness that typically presents with fever, headache, and a rash that starts on the wrists and ankles and spreads to the trunk. It is less likely to cause joint pain, abdominal pain, or kidney involvement. Idiopathic thrombocytopenic purpura is a bleeding disorder characterized by a low platelet count and petechiae or purpura (bruising). It is less likely to cause joint pain, abdominal pain, or kidney involvement. Poststreptococcal glomerulonephritis is a type of kidney disease that can occur after a streptococcal infection. It typically presents with hematuria (blood in the urine), proteinuria, and hypertension. While it can cause joint pain, it is less likely to cause a purpuric rash or gastrointestinal symptoms. |
2. A 32 y.o. woman consulted a gynecologist about having abundant long menses within 3 months. Bimanual investigation: the body of the uterus is enlarged according to about 12 weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages are not palpated. Histological test of the uterus body mucosa: adenocystous hyperplasia of endometrium. Optimal medical tactics:
A. Surgical treatment
B. Hormonetherapy
C. Phytotherapy
D. Radial therapy
E. Phase by phase vitamin therapy
Answer: Surgical treatment
Explanation
| The patient’s symptoms, physical examination findings, and histological test results are highly suggestive of endometrial hyperplasia, which is a condition characterized by excessive growth of the endometrial lining of the uterus. In some cases, endometrial hyperplasia can progress to endometrial cancer, especially in the presence of certain risk factors, such as obesity, diabetes, and unopposed estrogen exposure. Given the patient’s age, symptoms, and the extent of the disease, surgical treatment is the optimal medical tactic. The appropriate surgical approach will depend on the patient’s fertility desires and other factors, but options may include hysterectomy (removal of the uterus) or endometrial ablation (removal or destruction of the endometrial lining). Hormone therapy may be used in some cases to manage endometrial hyperplasia, but it is generally not considered curative and may not be effective in advanced cases. Phytotherapy (herbal remedies) and vitamin therapy have not been shown to be effective treatments for endometrial hyperplasia. Radiation therapy is not typically used to treat endometrial hyperplasia, as it is associated with a risk of radiation-induced cancer. It may be used in some cases of endometrial cancer, but this is not the appropriate treatment for endometrial hyperplasia. |
3. A woman was hospitalised with fullterm pregnancy. In survey: the uterus is morbid, the abdomen is tense, heart sounds of the fetus are not auscultated. What is the most probable complication of pregnancy?
A. Premature detachment of the normally posed placenta
B. Preterm labour C. Back occipital presentation
D. Acute hypoxia of a fetus
E. Hydramnion
Answer: Premature detachment of the normally posed placenta
Explanation
| Premature detachment of the normally positioned placenta, also known as placental abruption, is a serious obstetric emergency that can occur in the third trimester of pregnancy. It is characterized by the premature separation of the placenta from the uterine wall, which can cause significant bleeding and deprive the fetus of oxygen and nutrients. The symptoms described in the question, including a morbid uterus, a tense abdomen, and the absence of fetal heart sounds, are consistent with placental abruption. The absence of fetal heart sounds indicates that the fetus is not receiving adequate oxygen and may be in distress. Preterm labor (B) is a possibility, but this would typically be accompanied by regular contractions and cervical dilation. Back occipital presentation (C) refers to a fetal position in which the back of the baby’s head is facing the mother’s spine, but this is not a complication that would cause the symptoms described in the question. Acute hypoxia of a fetus (D) is a potential consequence of placental abruption, but it is not the underlying complication. Hydramnion (E), or excessive amniotic fluid, may be associated with certain complications of pregnancy, but it would not cause the symptoms described in the question. |
4. By the end of the 1st period of physiological labour the clear amniotic waters were given vent. Contractions lasted 35-40 sec every 4-5 min. Palpitation of the fetus is 100 bpm. The AP is 140/90 mm Hg. Diagnosis:
A. Acute hypoxia of the fetus
B. Labors before term
C. Premature detachment of normally posed placenta
D. Back occipital presentation
E. Hydramnion
Answer: Acute hypoxia of the fetus
Explanation
5. A 51 y.o. women was taken to the emergency department in convulsive status epilepticus. The first means of medical management should be:
A. Ensuring that the airway is open and the patient is oxygenating
B. Inserting a tongue blade
C. Administering an instravenous bolus of 50% dextrose
D. Injecting 5 mg of diazepam followed by a loading dose of phenytoin
E. Inducing pentobarbital coma
Answer: Ensuring that the airway is open and the patient is oxygenating
Explanation
| The scenario described in the question is suggestive of a seizure, which is a sudden, uncontrolled electrical disturbance in the brain that can cause a range of symptoms, including convulsions, loss of consciousness, and abnormal movements or sensations. When a person is experiencing a seizure, their airway may become obstructed, and they may have difficulty breathing or oxygenating properly. The first priority in managing a seizure is to ensure the patient’s safety and protect their airway. This involves positioning the patient on their side to prevent choking and ensuring that their airway is open and unobstructed. Providing supplemental oxygen may also be necessary to ensure adequate oxygenation. Inserting a tongue blade (B) is not recommended, as this can cause injury to the patient’s mouth or throat and may exacerbate the seizure. Administering an intravenous bolus of 50% dextrose (C) is not indicated unless the patient has a documented history of hypoglycemia. Injecting 5 mg of diazepam followed by a loading dose of phenytoin (D) may be appropriate for managing a seizure, but ensuring the patient’s airway and oxygenation should be the first priority. Inducing pentobarbital coma (E) is not typically indicated for managing seizures, as it is associated with significant risks and side effects and should only be considered in rare, refractory cases. |
6. Which gestational age gives the most accurate estimation of weeks of pregnancy by uterine size?
A. Less that 12 weeks
B. Between 12 and 20 weeks
C. Between 21 and 30 weeks
D. Between 31 and 40 weeks
E. Over 40 weeks
Answer: Less that 12 weeks
Explanation
| In the early stages of pregnancy, uterine size is relatively consistent among women, and the gestational age can be estimated with some accuracy based on the size of the uterus. This is because the uterus is still contained within the pelvis and has not yet expanded significantly. After about 12 weeks of gestation, however, the uterus begins to expand more rapidly, and individual variations in uterine size become more pronounced. This can make it more difficult to estimate gestational age based on uterine size alone, although other methods, such as ultrasound measurements, can be used to estimate gestational age more accurately. Between 21 and 30 weeks (C), the fundal height measurement, which is a measure of the distance from the pubic bone to the top of the uterus, is often used to estimate gestational age. However, this method can be less accurate than ultrasound, especially in cases of multiple gestations or fetal growth abnormalities. Between 31 and 40 weeks (D), the fundal height measurement may still be used, but it is less reliable due to the variability in individual uterine size and fetal positioning. Over 40 weeks (E), gestational age is typically estimated based on the woman’s last menstrual period or by ultrasound measurement. |
7. A number of viable fetuses per 1000 women at the age between 15 and 44 is determined by:
A. Genital index
B. Reproductive level
C. Birth rate
D. Perinatal rate
E. Obstetric rate
Answer: Genital index
Explanation
| The number of viable fetuses per 1000 women at the age between 15 and 44 is typically determined by the crude birth rate, which is the number of live births per 1,000 women in a given population during a specific time period. This rate includes all live births, regardless of the number of fetuses per pregnancy. The genital index is a term that is not commonly used in modern medical or demographic contexts, and it is not a standard measure of reproductive health or fertility. The reproductive level is also not a commonly used term in this context. The perinatal rate is the number of stillbirths and neonatal deaths per 1,000 live births, and it is used as a measure of perinatal health outcomes. The obstetric rate is a measure of the number of pregnancies, including live births and stillbirths, per 1,000 women of reproductive age. Therefore, the most appropriate answer to this question is C. Birth rate. |
8. A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in the lumbar part of his spine, increase of muscle tonus in the lumbar area and sluch during moving. X-ray pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most necessary for confirming a diagnosis?
A. HLA-B27
B. ESR
C. Rheumatoid factor
D. Uric acid in blood plasma
E. Antinuclear antibodies
Answer: HLA-B27
Explanation
| The symptoms and physical examination findings described in the question are suggestive of an inflammatory condition affecting the lumbar spine, such as ankylosing spondylitis (AS). AS is a type of arthritis that primarily affects the spine and sacroiliac joints and is characterized by inflammation, pain, stiffness, and reduced mobility in these areas. The sclerotic changes seen on X-ray are also consistent with AS. HLA-B27 is a genetic marker that is strongly associated with the development of AS and other spondyloarthropathies. Testing for HLA-B27 can help confirm a diagnosis of AS in patients with compatible symptoms and radiographic findings. ESR (B), rheumatoid factor (C), and antinuclear antibodies (E) are laboratory tests that may be used to evaluate for other types of inflammatory arthritis, but they are not specific for AS. Uric acid levels in the blood (D) are typically elevated in cases of gout, a type of inflammatory arthritis that primarily affects the joints of the feet, but this condition would not cause the symptoms described in the question. |
9. A 44 y.o. man has acute disarthria, right-sided Horner’s syndrome, hiccup, right-sided ataxia, loss of pain sensation of his face to the right and of his body to the left. The man is conscious. Computer tomography of brain is normal. The most reasonable measure will be:
A. Introduction of direct coagulants and observation
B. Endarterectomy of the right carotid artery
C. Endarterectomy of the left carotid artery
D. Out-patient observation
E. Surgical cerebral decompression
Answer: Introduction of direct coagulants and observation
Explanation
| The symptoms described in the question are suggestive of a stroke, which is a medical emergency that requires urgent evaluation and management. The presence of acute onset dysarthria, Horner’s syndrome, ataxia, and loss of pain sensation suggest involvement of the brainstem, which is a critical region of the brain that controls many vital functions. A normal brain CT does not rule out a stroke, as it may take several hours or days for changes to become visible on imaging. Therefore, additional diagnostic tests, such as magnetic resonance imaging (MRI) or angiography, may be necessary to confirm the diagnosis. Initial management of a stroke typically involves stabilization of the patient’s vital signs and supportive measures to prevent complications. The use of direct oral anticoagulants (DOACs) may be appropriate in certain cases of stroke, such as those caused by atrial fibrillation, but they are not indicated in all cases. The decision to use DOACs should be based on careful evaluation of the patient’s individual risk factors and medical history. Endarterectomy of the carotid arteries (B, C) may be indicated in cases of carotid artery stenosis, but it would not be appropriate as the initial management of an acute stroke. Out-patient observation (D) is not appropriate in this case, as the patient requires urgent evaluation and management. Surgical cerebral decompression (E) may be indicated in cases of cerebral edema or intracranial hemorrhage, but it is not typically used as the first-line treatment for stroke. |
10. A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma dveloped fever and chill, hypotension, sinus tachycardia. Skin is warm and dry. Clinical blood analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to be caused by:
A. Endotoxemia with activation of complement system
B. Secondary reflex vasodilatation as a result of lowered cardiac output
C. Secondary circulation insufficiency with retained systolic function as a result of peripheral vasoconstriction
D. Reflex vagus stimulation with lowered cardiac output
E. Secondary endothelial changes as a result of bacterial lesion
Answer: Endotoxemia with activation of complement system
Explanation
| The symptoms and laboratory findings described in the question are suggestive of sepsis, a potentially life-threatening condition that occurs when the body’s immune response to an infection becomes dysregulated and causes systemic inflammation and organ dysfunction. The presence of fever and chill, hypotension, sinus tachycardia, and granulocytopenia are all consistent with sepsis. In the case described, the most likely cause of sepsis is endotoxemia, which occurs when bacterial endotoxins are released into the bloodstream and activate the complement system, a component of the immune system that plays a role in inflammation and host defense. Endotoxemia can occur as a result of a urinary tract infection, which is a common complication of benign prostatic hyperplasia (BPH) in older men. Secondary reflex vasodilatation as a result of lowered cardiac output (B) and secondary circulation insufficiency with retained systolic function as a result of peripheral vasoconstriction (C) are not consistent with the symptoms described in the question and would not be the primary cause of the hemodynamic changes seen in sepsis. Reflex vagus stimulation with lowered cardiac output (D) may occur in some cases of sepsis, but it is not the primary mechanism of hemodynamic instability and would not cause granulocytopenia. Secondary endothelial changes as a result of bacterial lesion (E) may occur in some cases of sepsis, but it is not the primary cause of the hemodynamic changes seen in this case. |
11. A woman in her 39-th week of pregnancy, the second labor, has regular birth activity. Uterine contractions take place every 3 minutes. What criteria describe the beginning of the II labor stage the most precisely?
A. Cervical dilatation no less than 4 cm
B. Cervical smoothing over 90%
C. Duration of uterine contractions more than 30 seconds
D. Presenting part is in the lower region of small pelvis
E. Rupture of membranes
Answer: Cervical dilatation no less than 4 cm
Explanation
| The first stage of labor is characterized by the onset of regular uterine contractions that cause progressive cervical dilation and effacement. The second stage of labor begins when the cervix is fully dilated (typically 10 cm) and ends with the delivery of the baby. In the case described, the woman is in the first stage of labor, with regular contractions occurring every 3 minutes. The most precise criterion for determining the beginning of the second stage of labor is cervical dilatation, as this indicates that the cervix has fully opened and the baby can begin to descend into the birth canal. Cervical smoothing (B) is not a standard criterion for determining the onset of the second stage of labor, as it can vary widely among women and does not necessarily indicate that the cervix is fully dilated. Duration of uterine contractions (C) can be a useful indicator of labor progress and may be used to help determine when to initiate active pushing in the second stage of labor, but it is not typically used as the primary criterion for determining the onset of the second stage. The presenting part being in the lower region of the small pelvis (D) is not a reliable indicator of the onset of the second stage of labor, as the baby’s position can change throughout labor and delivery. Rupture of membranes (E) is a common occurrence during labor and can occur at any stage, but it is not a reliable indicator of the onset of the second stage of labor. |
12. A 20 y.o. man has a stab knife wound in the left half of thorax close to nipple. AP is 90/60 mm Hg, Ps- 130/min, BR- 32/min. During inspiration there is increase of pulse wave in the region of jugular vein, decrease of peripheral arterial pulse and reduction of AP. Respiratory murmurs are unchanged. X-ray pattern of thorax organs has no pecularities. After introduction of 2 l of isotonic solution the AP stayed low, CVP raised up to 32 cm of water column. The first step in further treatment of the patient will be:
A. Echocardiogram
B. Catheterization of left pleural cavity while the outer end of catheter is submerged in water
C. Continued parenteral introduction of fliud in order to raise AP
D. Introduction of peripheral vasodilatators in order to reduce CVP
E. Introduction of loop diuretics in order to reduce CVP
Answer: Echocardiogram
Explanation
| The symptoms and findings described in the question are suggestive of cardiac tamponade, which is a medical emergency that occurs when fluid accumulates in the pericardial space and compresses the heart, impairing its ability to pump blood effectively. The stab wound in the left half of the thorax may have caused bleeding into the pericardial space, leading to tamponade. The presence of hypotension, tachycardia, tachypnea, jugular venous distension (JVD), and pulsus paradoxus (decrease in peripheral arterial pulse during inspiration) are all consistent with cardiac tamponade. The lack of significant changes on chest X-ray does not rule out this diagnosis. The initial treatment for cardiac tamponade typically involves urgent fluid resuscitation with isotonic solutions, as described in the question. However, in this case, the patient’s blood pressure did not improve despite the fluid resuscitation, and the central venous pressure (CVP) increased significantly, suggesting that the fluid may be accumulating in the pericardial space. Therefore, the next step in treatment should be to confirm the diagnosis of cardiac tamponade with an echocardiogram, which can visualize the pericardial sac and assess the function of the heart. If the diagnosis is confirmed, the patient may require urgent pericardiocentesis (B), which involves inserting a needle or catheter into the pericardial space to drain the fluid and relieve the pressure on the heart. Continued fluid resuscitation (C) may exacerbate the tamponade and is not recommended. Introduction of peripheral vasodilators (D) or loop diuretics (E) would not be appropriate in this case, as they would not address the underlying cause of the patient’s symptoms and may exacerbate the tamponade. |
13. A young man has painful indurations in the peripapillary regions of both mammary glands. The most reasonable action will be:
A. To leave these indurations untouched
B. To remove them
C. To cut and drain them
D. To take an aspirate for bacterial inoculation and cytology
E. To administer steroids locally
Answer: To leave these indurations untouched
Explanation
| The symptoms described in the question are suggestive of a condition known as acute mastitis, which is an inflammation of the breast tissue that can occur in both men and women. Acute mastitis can be caused by bacterial infection, and it typically presents with painful, swollen, and tender areas in the breast, often in the peripapillary regions. In cases of acute mastitis, it is important to obtain a sample of the affected tissue for bacterial culture and cytology, in order to identify the causative organism and rule out malignancy. This can be done by taking an aspirate of the induration using a needle and syringe. Leaving the indurations untouched (A) is not recommended, as untreated acute mastitis can lead to the development of abscesses and other complications. Removal of the indurations (B) or cutting and draining them (C) may be necessary in cases of abscess formation, but it is not typically indicated in cases of acute mastitis without abscess. Administering steroids locally (E) is not typically indicated in cases of acute mastitis, as it may exacerbate the infection and delay healing. Steroids may be used in certain cases of chronic mastitis or inflammatory breast cancer, but this is not the case described in the question. |
14. A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was admitted to the obstetric department with complaints of sudden and painful bloody discharges from vagina that appeared 2 hours ago. The discharges are profuse and contain grumes. Cardiac funnction of the fetus is rhytmic, 150 strokes in the minute, uterus tone is normal. The most probable provisional diagnosis will be:
A. Placental presentation
B. Detachment of normally located placenta
C. Vasa previa
D. Bloody discharges
E. Disseminated intravascular coagulation syndrome
Answer: Placental presentation
Explanation
| The symptoms and findings described in the question are suggestive of placental abruption, which is a medical emergency that occurs when the placenta partially or completely separates from the uterine wall before delivery. Placental abruption can cause sudden and painful vaginal bleeding, which may be accompanied by blood clots. Placental presentation (A) is a rare condition that occurs when the placenta covers the cervix and can cause bleeding in late pregnancy, but it is not consistent with the symptoms described in this case. Vasa previa (C) is a rare condition that occurs when fetal blood vessels cross the cervix and can cause bleeding in late pregnancy, but it typically presents with painless vaginal bleeding and is not consistent with the symptoms described in this case. Bloody discharges (D) is a non-specific symptom and does not provide a provisional diagnosis. Disseminated intravascular coagulation syndrome (E) is a potential complication of placental abruption, but it is not a provisional diagnosis and would not be the most probable diagnosis based on the symptoms and findings described in the question. Given the sudden onset of painful vaginal bleeding and the presence of blood clots, the most probable provisional diagnosis is detachment of the normally located placenta (B). This is a serious medical emergency that requires urgent evaluation and management to prevent fetal and maternal complications. |
15. A patient is 65 y.o. He has been a smoker for 40 years. Hew has lost 10 kg during the last 3 months. Complains of pain in the epigastric area after taking meals, diarrhea, jaundice. Physical examination revealed enlarged, painless gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed increased level of whole and direct bilirubin, alkaline phosphotase and glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin reaction and negative urobilinogene reaction. Where is the initial process that caused these changes?
A. In pancreas
B. In common bile duct
C. In liver
D. In duodenum
E. In gallbladder
Answer: In pancreas
Explanation
| The symptoms and findings described in the question are suggestive of pancreatic cancer, which is a malignant tumor that arises from the exocrine cells of the pancreas. Pancreatic cancer is more common in older adults, especially those with a history of smoking. The patient’s symptoms of epigastric pain after meals, weight loss, and jaundice are all consistent with pancreatic cancer. The presence of light-colored, clay-like stools and increased levels of bilirubin, alkaline phosphatase, and glutamine pyruvate transferase suggest obstruction of the common bile duct, which can occur when a pancreatic tumor grows and compresses the duct. A painless, enlarged gallbladder is also a common finding in cases of pancreatic cancer, as the tumor may compress the common bile duct and cause bile to accumulate in the gallbladder. The positive bilirubin reaction in the urine and negative urobilinogen reaction suggest that the obstruction is located above the level of the ampulla of Vater, which is where the common bile duct and pancreatic duct enter the duodenum. Therefore, the most likely initial process that caused these changes is a pancreatic tumor obstructing the common bile duct (A). While tumors in the common bile duct (B), liver (C), duodenum (D), and gallbladder (E) can also cause obstructive jaundice and other symptoms, the presence of an enlarged, painless gallbladder and a pancreatic mass on imaging studies would suggest that the initial process is located in the pancreas. |
16. A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and feeling of abdominal swelling in approximately 30 minutes after meals. He lost 10 kg during the last months because he doesn’t eat in order to avoid pain. Abdomen examination reveals no changes in the periods between pain attacks. Above the right femoral artery a murmur can be auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of stomach and colonoscopy reealed no changes. What is the leading factor of this pathogenesis?
A. Ischemia
B. Psychogenic changes
C. Neoplastic process
D. Inflammation
E. Transient obstruction
Answer: Ischemia
Explanation
| The symptoms and findings described in the question are suggestive of mesenteric ischemia, which is a condition that occurs when there is insufficient blood flow to the intestines due to a blockage or narrowing of the mesenteric blood vessels. Mesenteric ischemia can cause severe abdominal pain, vomiting, weight loss, and a feeling of abdominal swelling or fullness after meals. The presence of a femoral artery murmur and weak peripheral pulses in the lower extremities suggest the presence of peripheral artery disease (PAD), which is a common risk factor for mesenteric ischemia. PAD is a condition in which the blood vessels that supply the legs and feet become narrow or blocked, leading to reduced blood flow and a range of symptoms, including leg pain, cramping, and weakness. The lack of changes in the abdomen between pain attacks suggests that there is no ongoing inflammation (D) or transient obstruction (E) of the intestines. The normal findings on X-ray and colonoscopy also suggest that there are no structural abnormalities or neoplastic processes (C) in the gastrointestinal tract. Psychogenic changes (B) may contribute to the patient’s symptoms, but they are not the leading factor of this pathogenesis. Therefore, the leading factor of this pathogenesis is ischemia (A) due to mesenteric artery disease, which is a serious condition that requires urgent evaluation and management to prevent complications such as bowel infarction and gangrene. The patient should be referred to a specialist for further evaluation and treatment. |
17. A 75 y.o. woman with coronary heart disease constantly takes warfarin. She was taken to the acute care department with complaints of sudden sensation of weakness in the left half of her body and eyeball deviation to the left. What examination of the patient will be a primary task?
A. Computer tomography of brain
B. Magnetic resonance tomography of brain
C. Electroencephalogram
D. Ultrasonic examination of carotid arteries
E. Spinal punction
Answer: Computer tomography of brain
Explanation
| The patient is presenting with symptoms of a stroke, also known as a cerebrovascular accident (CVA), which can be caused by a blood clot or a bleeding in the brain. Warfarin is a medication that is commonly used to prevent blood clots, but it can also increase the risk of bleeding. CT of the brain is the primary diagnostic test for patients who present with symptoms of a stroke. This is because it can quickly identify whether there is a blood clot or a bleeding in the brain, which can help guide treatment decisions. Magnetic resonance imaging (MRI) of the brain is another imaging modality that can be used to evaluate a stroke, but it is not typically the first choice due to its longer scan time and higher cost. The other options listed (EEG, ultrasound of carotid arteries, and spinal puncture) are not the primary diagnostic tests for a stroke, but they may be helpful in certain situations. EEG can be used to evaluate for seizure activity, ultrasound of carotid arteries can help identify blockages or narrowing in the arteries that supply blood to the brain, and spinal puncture can help rule out other causes of neurologic symptoms. However, in this case, CT of the brain is the primary diagnostic test that should be performed first. |
18. A 65 y.o. patient has acute pain, paresthesia, paleness of his left extremity. Pulse in the a. dorsalis pedis is absent. There is skin coldness and paleness that gradually spreads upwards. These symptoms are most likely to be the evidence of:
A. Arterial occlusion
B. Thrombophlebitis of superficial veins
C. Hernia of lumbar disc
D. Thrombophelebitis of deep veins
E. –
Answer: Arterial occlusion
Explanation
| The patient is presenting with symptoms of acute limb ischemia, which is a medical emergency caused by a sudden blockage of blood flow to the limb. The most common cause of acute limb ischemia is arterial occlusion, which can be caused by a blood clot, atherosclerosis (hardening and narrowing of the arteries), or trauma. The symptoms described, including acute pain, paresthesia (tingling or numbness), paleness, absent pulse, and skin coldness and paleness that gradually spreads upwards, are all consistent with acute limb ischemia caused by arterial occlusion. Thrombophlebitis of superficial veins (option B) is a condition characterized by inflammation of the veins close to the surface of the skin, which can cause pain, redness, and swelling, but it does not typically cause acute limb ischemia. Herniated lumbar disc (option C) can cause compression of the nerve roots that supply the lower extremities, which can cause pain, numbness, and weakness in the legs, but it does not typically cause acute limb ischemia. Thrombophlebitis of deep veins (option D) is a condition characterized by inflammation of the veins deep in the leg, which can cause pain, swelling, and warmth, but it also does not typically cause acute limb ischemia. Therefore, based on the symptoms described, the most likely cause of the patient’s condition is arterial occlusion, and he should receive immediate medical attention to restore blood flow to the affected limb. |
19. A 58 y.o. patient developed acute myocardium infarction 4 hours ago, now he is in the acute care department. ECG registers short paroxysms of ventricular tachycardia. The most appropriate measure will be to introduct:
A. Lidocain
B. Flecainid
C. Amyodaron
D. Propafenone
E. Veropamil
Answer: Lidocain
Explanation
| The patient is presenting with short paroxysms of ventricular tachycardia after an acute myocardial infarction, which can be a life-threatening arrhythmia. Lidocaine is a first-line medication for the treatment of ventricular tachycardia. It works by blocking the sodium channels in the heart, which can help stabilize the heart rhythm. Flecainide (option B), propafenone (option D), and verapamil (option E) are antiarrhythmic medications that can be used to treat certain types of supraventricular and ventricular arrhythmias, but they are not typically the first choice for treating ventricular tachycardia. Amiodarone (option C) is another antiarrhythmic medication that can be used to treat ventricular tachycardia, but it is usually reserved for patients who do not respond to other treatments or who have other medical conditions that make other antiarrhythmic medications unsafe. Therefore, in this case, the most appropriate measure would be to administer lidocaine to help control the ventricular tachycardia and stabilize the patient’s heart rhythm. |
20. A 23 y.o. woman who suffers from insulin-dependent diabetes was admitted to the acute care department with mental confusion, inadequate anxious behaviour, hyperhidrosis, excessive salivation, tachycardia. What examination will be a primary task?
A. Blood test for sugar
B. Clinical blood analysis
C. Plasma electrolytes test
D. Gaseous composition of arterial blood
E. Blood urea and creatinine test
Answer: Blood test for sugar
Explanation
| The patient is presenting with symptoms of hypoglycemia, which is a medical emergency in individuals with insulin-dependent diabetes. Hypoglycemia can cause a wide range of symptoms, including mental confusion, anxiety, sweating, excessive salivation, and tachycardia. The primary task in this situation is to check the patient’s blood sugar level with a blood test. A low blood sugar level is likely the cause of the patient’s symptoms, and immediate treatment is necessary to prevent further complications. The other options listed (clinical blood analysis, plasma electrolytes test, gaseous composition of arterial blood, and blood urea and creatinine test) may be helpful in identifying other potential causes of the patient’s symptoms, but in this case, the primary concern is hypoglycemia in a patient with insulin-dependent diabetes. Therefore, a blood test for sugar should be performed first to confirm the diagnosis and guide appropriate treatment. |
21. A 40 y.o. woman has changes of mammary gland. What are the most often symtomps that precede the malignization?
A. Skin induration with inverted nipple
B. Painful movable induration
C. Painless movable induration
D. Bloody discharges from the nipple
E. Pure discharges from the nipple
Answer: Skin induration with inverted nipple
Explanation
| Skin induration with inverted nipple is a potential symptom of breast cancer and can precede malignancy. Inverted nipple refers to a nipple that is pulled inward instead of pointing outward. Skin induration refers to an area of skin that has become thicker and harder than the surrounding tissue. Other symptoms that may precede the malignancy of the breast include a palpable mass or lump in the breast, changes in the size or shape of the breast, skin changes on the breast, such as dimpling or puckering, and nipple discharge (especially if it is bloody). Painful movable induration (option B) and painless movable induration (option C) may also be symptoms of breast cancer, but they are less common than skin induration with an inverted nipple. Pure discharges from the nipple (option E) are usually not a sign of breast cancer, but bloody discharges from the nipple (option D) may be a cause for concern and should be evaluated by a healthcare provider. It is important to note that not all breast changes or symptoms indicate breast cancer, but any changes or symptoms should be evaluated by a healthcare provider to determine the cause and appropriate treatment. |
22. A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?
A. Increased potassium concentration in blood
B. Increased sodium consentration in blood
C. Reduced magnesium concentration in blood
D. Increased calcium level in blood
E. –
Answer: Increased potassium concentration in blood
Explanation
| The patient is experiencing arrhythmia as a result of a cardiac glycoside overdose, which can be treated with increased potassium concentration in the blood. Cardiac glycosides, such as digoxin, are commonly used to treat heart failure and certain types of arrhythmias, but they can also cause toxicity if the dose is too high. Diuretics, which are medications that increase the excretion of water and electrolytes from the body, can also increase the risk of cardiac glycoside toxicity by reducing potassium levels in the blood. Therefore, treating the patient’s arrhythmia with increased potassium levels in the blood can help counteract the effects of both the cardiac glycoside toxicity and the diuretic use. Increased sodium concentration in the blood (option B) would not be an appropriate treatment for this condition, as it can worsen the effects of cardiac glycoside toxicity and increase the risk of arrhythmias. Reduced magnesium concentration in the blood (option C) can also contribute to arrhythmias, but it is not typically the primary cause of arrhythmias in the setting of cardiac glycoside toxicity. Increased calcium level in the blood (option D) can worsen the effects of cardiac glycoside toxicity and is not typically used to treat arrhythmias caused by this condition. Therefore, in this case, the most appropriate treatment would be to increase the patient’s potassium concentration in the blood to counteract the effects of the cardiac glycoside toxicity and the diuretic use. |
23. Name a statistical observation unit for determination of influence amount of bloodsugar on the healing of wound’s surface in a postoperative period:
A. The patient in a postoperative period
B. An amount of bloodsugar
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
| In this study, the patient in a postoperative period would be the statistical observation unit. The goal of the study is to determine the influence of blood sugar levels on the healing of a wound surface in the postoperative period. Therefore, the healing of the wound surface would be the outcome or dependent variable, and the blood sugar levels would be the independent variable. To conduct the study, the researchers would need to measure the blood sugar levels of the patients in the postoperative period and monitor the healing of the wound surface over time. The patients would be the observation units, and the data collected would be used to determine the correlation between blood sugar levels and wound healing. 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) are not statistical observation units in this study, but rather factors or variables that would be measured or evaluated in the study. |
24. The parameter of infantile mortality for the last year was – 16,3, in present year – 15,7. Name a kind of the diagram that can be used for a graphic representation of it:
A. Stylar
B. Linear
C. Intrastylar
D. Sector
E. Radia
Answer: Stylar
Explanation
| A stylar diagram is a type of chart used to represent changes in a single variable over time. It consists of a horizontal axis representing time and a vertical axis representing the value of the variable being measured. The data points are plotted as vertical lines or bars, with the height of the bar representing the value of the variable at a given point in time. In this case, the variable being measured is infant mortality, and the data points for the last year and present year are 16.3 and 15.7, respectively. A stylar diagram would be an appropriate way to graphically represent these data points and show the change in infant mortality over time. Linear (option B), intrastylar (option C), sector (option D), and radial (option E) diagrams are not typically used to represent changes in a single variable over time, but may be used to represent other types of data or relationships. |
25. A 25 y.o. patient 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 patient’s symptoms, including pain in the I finger on the right hand, homogeneously hydropic finger in a bent position, worsening pain on attempt to unbend the finger, and acute pain during the probe in ligament projection, are indicative of thecal whitlow, also known as ligament panaritium. Thecal whitlow is a type of infection that affects the tendons and ligaments of the fingers or toes. The infection can spread quickly and cause significant pain, swelling, and stiffness in the affected digit. The condition typically requires prompt medical treatment, including antibiotics and sometimes surgical drainage. Subcutaneous panaritium (option B) is an infection of the soft tissue around the fingernail, while articular (joint) panaritium (option C) involves infection of the joint. Bone panaritium (option D) is a more severe form of infection that involves the bone as well as the surrounding tissues. Paronychia (option E) is another type of infection that affects the skin around the nail. However, none of these conditions fit the patient’s symptoms as well as thecal whitlow. Therefore, in this case, the most likely diagnosis is thecal whitlow (ligament panaritium), and prompt medical treatment is necessary to prevent further complications. |
26. A 9 y.o. child with diagnosis “chronic tonsillitis”stands dispanserization control. Within 1 year of observation there was one exacerbation of disease. Physical condition is satisfactory. The general state is not infringed. Define group of health:
A. III (a)
B. II-d
C. I-st
D. III (b)
E. III (c)
Answer: III (a)
Explanation
| Chronic tonsillitis is a long-standing inflammation of the tonsils, which can cause recurrent sore throat, fever, and other symptoms. In this case, the patient has had one exacerbation of the disease in the past year and is currently in satisfactory physical condition without any general impairments. According to the Russian classification of health groups, a patient with chronic tonsillitis who has had one exacerbation in the past year and is currently in satisfactory physical condition without any general impairments would be classified as III (a). This means that the patient has a chronic disease that does not significantly affect their daily activities and does not require constant medical attention. Group II-d (option B) is for patients with chronic diseases that require periodic medical attention, while group I-st (option C) is for patients without any chronic diseases or impairments. Group III (b) and III (c) (options D and E) are for patients with more severe chronic diseases or impairments that require ongoing medical attention or assistance with daily activities. Therefore, in this case, the most appropriate health group classification is III (a). |
27. An engineer-chemist at the age of 47 often fells ill with an occupational skin disease. Who makes a decision to transfer him to other job accepts?
A. DCC
B. A head physician
C. The attending physician
D. The chief of shop
E. MSEC
Answer: DCC
Explanation
| In Russia, the decision to transfer an employee with an occupational skin disease to another job is made by the DCC (Department of Civil Defense and Emergency Situations) in accordance with the Labor Code and the Law on Occupational Safety and Health. The DCC is responsible for ensuring the safety and health of workers in hazardous industries, including chemical and industrial plants. They are responsible for monitoring and enforcing compliance with occupational safety and health regulations and for making decisions regarding the transfer of workers with occupational diseases to other jobs. While the attending physician (option C), the chief of shop (option D), and the MSEC (Medical and Social Expert Commission) may provide input or recommendations regarding the worker’s health and ability to work, it is ultimately the responsibility of the DCC to make decisions regarding the transfer of workers with occupational diseases to other jobs. The head physician (option B) may also be involved in the decision-making process, but their role would likely be limited to providing medical advice and recommendations, rather than making the final decision. Therefore, in this case, the decision to transfer the engineer-chemist to another job due to their occupational skin disease would be made by the DCC. |
28. 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
| The lab analysis of the milk batch revealed that it has a fat content of 2%, a specific density of 1.04 g/cm3, an acidity of 210T, and a weak-positive reductase probe. These values suggest that the milk is of lower quality and may not meet the standards for some types of dairy products. However, the milk can still be sold, but it is important to inform customers about its quality. This will allow customers to make an informed decision and take appropriate precautions when using the milk. Discarding the milk for animal feeding (option B) or technical utilization (option C) may be appropriate if the milk is of very poor quality and cannot be used for human consumption. However, based on the given information, it appears that the milk is still suitable for human consumption, albeit of lower quality. Selling the milk without limitations (option D) or doing away with the product (option E) would not be appropriate, as this could potentially harm consumers and damage the reputation of the company. Therefore, in this case, the most appropriate course of action would be to sell the milk but inform customers about its lower quality. |
29. An anestesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 210, humidity 50%, level of noise 30 dB. What occupational hazard is the principal one under these conditions?
A. Air pollution with anesthetic
B. Improper occupational microclimate
C. High level of noise
D. Mental overfatigue
E. Compelled working pose
Answer: Air pollution with anesthetic
Explanation
| In this scenario, the anesthesiologist is using halothane as an anesthetic, which can pose a significant risk of air pollution in the operating room. Halothane is a volatile anesthetic that can produce vapors that may be harmful if inhaled in high concentrations over an extended period of time. While the air temperature, humidity, and level of noise in the operating room may also be important factors to consider, the principal occupational hazard under these conditions is air pollution with anesthetic. Improper occupational microclimate (option B) may also be a concern if the air temperature and humidity are not within the recommended ranges for the operating room. High levels of noise (option C) may also be a concern, as exposure to noise can cause hearing loss and other health problems over time. Mental overfatigue (option D) and compelled working pose (option E) may also be concerns for the anesthesiologist, but they are not the principal occupational hazard in this scenario. Therefore, in this case, the most significant occupational hazard is the potential for air pollution with halothane, and appropriate measures should be taken to minimize exposure and ensure worker safety. |
30. 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: Sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts
Explanation
| In cases of professional law violations by a physician, several measures can be taken to ensure that there is no preconceived attitude towards the physician. These measures include: – Sanction of public prosecutor: The public prosecutor’s office can initiate legal proceedings against the physician if there is evidence of a professional law violation. This ensures that the case is handled by an impartial legal authority. – Inquiry by preliminary investigator of prosecutor’s office: The preliminary investigator of the prosecutor’s office can conduct an inquiry into the case to gather evidence and determine whether there is a case to answer. This ensures that the investigation is conducted impartially and without bias. – Committee of experts: A committee of experts can be established to review the case and provide an independent assessment of the evidence. This ensures that the case is reviewed by a group of impartial experts who can provide an unbiased opinion. These measures help to ensure that any professional law violations by a physician are handled fairly and impartially, without any preconceived attitudes or biases. Options B, C, and E (draw up a statement about forensic medical examination, conduct an inquiry by preliminary investigator of police department, and conduct a forensic medical examination by district forensic medicine expert) may also be appropriate in certain cases, but they do not necessarily provide guarantees against preconceived attitudes towards the physician. Utilization of a copy of medical documents (option D) is not directly related to ensuring impartial handling of cases of professional law violations by a physician. |
31. 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 non-bleeding wound caused by a dog’s bite, the most appropriate surgical care would be to clean the wound thoroughly with detergent water and apply antiseptic to prevent infection. Dog bites can introduce bacteria and other pathogens into the wound, which can lead to infection and other complications. Therefore, it is important to clean the wound thoroughly and apply antiseptic to prevent infection. Aseptic bandage (option B) or cream bandage (option C) may be appropriate after the wound has been cleaned and treated with antiseptic, but they are not the primary surgical care for this type of injury. Complete suturing of the wound (option D) or incomplete suturing of the wound (option E) may be appropriate in some cases, but they are not recommended for dog bites, as they can increase the risk of infection and other complications. Therefore, in this case, the most appropriate surgical care would be to clean the wound thoroughly with detergent water and apply antiseptic to prevent infection. The patient should also be monitored for signs of infection and other complications, and appropriate treatment should be provided if necessary. |
32. 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
| The patient’s symptoms, including pain in the right arm that 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, suggest a diagnosis of phlebitis. Phlebitis is an inflammation of a vein that can be caused by a variety of factors, including infection, injury, or irritation from an IV catheter or injection. Symptoms of phlebitis may include pain, swelling, redness, and warmth along the affected vein. Phlegmon (option B) and abscess (option C) are also types of infections that can cause similar symptoms, but they typically involve deeper tissues and may produce a visible collection of pus or other fluids. Inflammation of lymph (option D) and erysipelas (option E) are also infections that can cause similar symptoms, but they typically involve the lymphatic vessels or skin, respectively. Therefore, in this case, the most likely diagnosis is phlebitis, and appropriate treatment should be provided to manage the inflammation and prevent complications such as thrombosis or sepsis. |
33. A 38 y.o. woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is obtained. What disease is suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Perforative gastric ulcer
E. Acute appendicitis
Answer: Acute pancreatitis
Explanation
| The patient’s symptoms, including acute abdominal pain irradiating to the spine and vomiting, along with the presence of hemorrhagic fluid on laparocentesis, suggest a diagnosis of acute pancreatitis. Acute pancreatitis is an inflammation of the pancreas that can cause severe abdominal pain, nausea, vomiting, and other symptoms. In severe cases, it can lead to hemorrhage and other complications. Renal colic (option B) is a type of pain caused by the passage of kidney stones and typically does not cause hemorrhagic fluid on laparocentesis. Acute enterocolitis (option C) is an inflammation of the small intestine and colon that can cause abdominal pain, diarrhea, and other symptoms, but it typically does not cause hemorrhagic fluid on laparocentesis. Perforative gastric ulcer (option D) is a type of ulcer that can cause abdominal pain and other symptoms, but it typically does not cause hemorrhagic fluid on laparocentesis. Acute appendicitis (option E) is an inflammation of the appendix that can cause abdominal pain, nausea, vomiting, and other symptoms, but it typically does not cause hemorrhagic fluid on laparocentesis. Therefore, in this case, the most likely diagnosis is acute pancreatitis, and appropriate treatment should be provided to manage the inflammation and prevent complications. |
34. A 40 weeks pregnant woman in intrinsic obstetric investigation: the cervix of a uterus is undeveloped. The oxytocin test is negative. Upon inspection at 32 weeks it is revealed: AP- 140/90 mm Hg, proteinuria 1 g/l, peripheric edemata. Reflexes are normal. Choose the most correct tactics of guiding the pregnant:
A. Laborstimulation after preparation
B. Strict bed regimen for 1 month
C. Complex therapy of gestosis for 2 days
D. Cesarean section immediately
E. Complex therapy of gestosis for 7 days
Answer: Laborstimulation after preparation
Explanation
| The patient’s symptoms, including elevated blood pressure, proteinuria, and peripheral edema, suggest a diagnosis of preeclampsia, which is a serious complication of pregnancy that can lead to maternal and fetal complications. In this case, the most appropriate tactic would be to stimulate labor after preparation. This would allow for the safe delivery of the fetus and the management of maternal complications associated with preeclampsia. Strict bed rest for one month (option B) may be appropriate in some cases of preeclampsia, but it is not recommended in this case as the patient is already at 40 weeks of gestation and the risk of complications is higher. Complex therapy of gestosis for 2 or 7 days (options C and E) may be appropriate in some cases of preeclampsia, but it is not recommended in this case as the patient’s symptoms are severe and delivery is necessary. Cesarean section immediately (option D) may be appropriate in some cases of preeclampsia, but it is not recommended in this case as there is no indication for emergency delivery and labor stimulation after preparation is a safer and more appropriate option. Therefore, in this case, the most appropriate tactic would be to stimulate labor after preparation to manage the complications of preeclampsia and ensure the safe delivery of the fetus. |
35. A 41 y.o. patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding?
A. Introduction of obturator nasogastric tube
B. Intravenous administration of pituitrin
C. Hemostatic therapy
D. Operation
E. Administration of plasma
Answer: Introduction of obturator nasogastric tube
Explanation
| The correct answer is C. Hemostatic therapy. In this case, the patient is experiencing hemorrhagic shock due to gastric bleeding from esophageal veins and has a history of hepatitis B. The most effective method for Hemostatic therapy is a treatment that is aimed at stopping bleeding by promoting blood clotting. It can be achieved through various methods, including the administration of medications such as vasopressin or somatostatin to constrict blood vessels, or the use of endoscopic techniques to apply clips or thermal therapy to the bleeding site. Introduction of obturator nasogastric tube (option A) may help to control bleeding from the stomach by removing any blood clots or other debris that may be obstructing the bleeding vessel, but it is not a definitive treatment for esophageal variceal bleeding. Intravenous administration of pituitrin (option B) is a treatment that is used to increase blood pressure and cardiac output, but it is not a specific treatment for esophageal variceal bleeding. Operation (option D) may be necessary in some cases of esophageal variceal bleeding, but it is not the first-line treatment and is usually reserved for cases that are refractory to other treatments. Administration of plasma (option E) may help to replace blood volume and improve clotting factors, but it is not a specific treatment for esophageal variceal bleeding. Therefore, in this case, the most effective method for control of the bleeding is hemostatic therapy, which can be achieved through various methods depending on the severity and location of the bleeding. |
36. A woman had the rise of temperature up to 390 on the first day after labour. The rupture of fetal membranes took place 36 hours before labour. The investigation of the bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of group
A. The uterus body is soft, tender. Discharges are bloody, mixed with pus. Specify the most probable postnatal complication:
A. Metroendometritis
B. Thrombophlebitis of pelvic veins
C. Infected hematoma
D. Infection of the urinary system
E. Apostatis of junctures after the episiotomy
Answer: Metroendometritis
Explanation
| The patient’s symptoms, including a fever of 39°C on the first day after labor, soft and tender uterus, and bloody discharges mixed with pus, suggest a diagnosis of postpartum metroendometritis. Metroendometritis is a bacterial infection of the uterus that can occur after delivery. Risk factors for postpartum metroendometritis include prolonged rupture of membranes, prolonged labor, multiple vaginal examinations, and the presence of group A streptococcus. Thrombophlebitis of pelvic veins (option B) is a complication that can occur after delivery, but it typically presents with pain, redness, and swelling in the affected leg, not with fever and uterine tenderness. Infected hematoma (option C) is a complication that can occur after delivery, but it typically presents with localized pain, swelling, and redness, not with fever and uterine tenderness. Infection of the urinary system (option D) can occur after delivery, but it typically presents with symptoms such as dysuria, frequency, and urgency, not with fever and uterine tenderness. Apostatis of junctures after the episiotomy (option E) is a complication that can occur after delivery, but it typically presents with pain, swelling, and redness in the perineal area, not with fever and uterine tenderness. Therefore, in this case, the most probable postnatal complication is metroendometritis, and appropriate treatment should be provided to manage the infection and prevent complications. |
37. A 24 y.o. patient 13 months after the first labour consulted a doctor about amenorrhea. Pregnancy has concluded by a Cesarean section concerning to a premature detachment of normally posed placenta hemorrhage has made low fidelity 2000 ml owing to breakdown of coagulability of blood. Choose the most suitable investigation:
A. Determination of the level of Gonadotropins
B. USI of organs of a small pelvis
C. Progesteron assay
D. Computer tomography of the head
E. Determination of the contents of Testosteron-Depotum in Serum of blood
Answer: Determination of the level of Gonadotropin
Explanation
| The patient’s symptoms, including amenorrhea 13 months after the first labor, suggest a possible hormonal imbalance or disruption of the hypothalamic-pituitary-ovarian axis, which can be evaluated by determining the level of gonadotropins. Gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are hormones that regulate the menstrual cycle and control the production of estrogen and progesterone. Abnormal levels of gonadotropins can indicate a problem with the hypothalamic-pituitary-ovarian axis, which can lead to amenorrhea. USI of organs of a small pelvis (option B) may be helpful in evaluating the structure of the reproductive organs, but it may not provide information about hormonal imbalances. Progesterone assay (option C) may be helpful in evaluating the function of the corpus luteum and the timing of ovulation, but it may not provide information about hormonal imbalances. Computer tomography of the head (option D) may be helpful in evaluating pituitary tumors or other abnormalities of the hypothalamic-pituitary-ovarian axis, but it is not indicated in this case as there is no evidence of neurological symptoms. Determination of the contents of Testosteron-Depotum in Serum of blood (option E) is not indicated in this case as the patient is presenting with amenorrhea, which is more commonly associated with disruptions in the female sex hormones. Therefore, in this case, the most suitable investigation is determination of the level of gonadotropins, which can help to evaluate the function of the hypothalamic-pituitary-ovarian axis and identify any hormonal imbalances that may be causing the patient’s amenorrhea. |
38. 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
| After an accident at a nuclear object, the release of radioactive iodine isotopes into the environment can pose a significant risk to the thyroid gland, especially in people who live in hot areas or who consume contaminated food or water. The thyroid gland is particularly susceptible to radioactive iodine because it absorbs and concentrates it, and exposure to high levels of radioactive iodine can increase the risk of thyroid cancer. Skin cancer (option B) may be associated with exposure to ultraviolet radiation from the sun or other sources, but it is not directly related to exposure to radioactive materials. Reproductive system organ cancer (option C) may be associated with various risk factors, including genetics, lifestyle factors, and exposure to certain chemicals or toxins, but it is not directly related to exposure to radioactive materials. Breast cancer (option D) may be associated with various risk factors, including genetics, lifestyle factors, and exposure to certain chemicals or toxins, but it is not directly related to exposure to radioactive materials. Lung cancer (option E) may be associated with exposure to various environmental toxins, including radon gas and cigarette smoke, but it is not directly related to exposure to radioactive materials in the aftermath of a nuclear accident. Therefore, in people who live in hot areas after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of the thyroid gland due to exposure to radioactive iodine isotopes. |
39. A 34 y.o. woman in the 10-th week of gestation (the second pregnancy) consulted a doctor of antenatal clinic with purpose of statement on the dyspensary record. In the previous pregnancy there took place hydramnion, the child’s birth weight was 4086. What method of examination is necessary for carrying out, first of all?
A. The test for tolerance to glucose
B. Determination of the contents of fetoproteinum
C. Bacteriological investigation of discharge from the vagina
D. A cardiophonography of fetus
E. USI of the fetus 40. Patient
Answer: The test for tolerance to glucose
Explanation
| The patient’s history of hydramnios and a large birth weight in the previous pregnancy suggests a possible risk of gestational diabetes in the current pregnancy. Therefore, the most appropriate examination to perform first is the test for tolerance to glucose. The test for tolerance to glucose is a screening test used to diagnose gestational diabetes. It involves drinking a sugary solution and measuring blood glucose levels at specific intervals. Abnormal glucose levels may indicate the presence of gestational diabetes, which can lead to complications for both the mother and the fetus. Determination of the contents of fetoproteinum (option B) is a screening test for neural tube defects and other fetal abnormalities, but it is not indicated in this case as there is no indication of increased risk for these conditions. Bacteriological investigation of discharge from the vagina (option C) may be indicated if the patient has symptoms of a vaginal infection, but it is not indicated as a routine examination in a patient with a history of hydramnios and large birth weight. A cardiophonography of fetus (option D) is a diagnostic test used to evaluate the structure and function of the fetal heart, but it is not indicated in this case as there is no indication of fetal heart abnormalities. USI of the fetus (option E) may be indicated later in pregnancy to evaluate fetal growth and development, but it is not indicated as the first examination in a patient with a history of hydramnios and large birth weight. Therefore, in this case, the most appropriate examination to perform first is the test for tolerance to glucose to screen for gestational diabetes and prevent complications for both the mother and the fetus. |
22 y.o., was admitted to trauma center with complains of pain in the left ankle joint, which increased while movements and weight bearing. On the clinical examination it was found, that the patient had the closed fracture of medial malleolus without displacement. In which position the foot has to be fixed in plaster cast?
A. At right angle with varus positioning of the foot
B. In position of planter flexion of foot
C. In position of pronation
D. In position of supination
E. In position of dorsal flexion of foot
Answer: At right angle with varus positioning of the foot
Explanation
| In a patient with a closed fracture of the medial malleolus without displacement, the foot should be fixed in a plaster cast at a right angle with varus positioning of the foot. Varus positioning of the foot involves positioning the foot so that it is turned inward, which helps to stabilize the ankle joint and prevent displacement of the fractured bone. Placing the foot in a position of planter flexion (option B) or dorsal flexion of the foot (option E) is not indicated in this case as it may compromise the stability of the ankle joint and increase the risk of displacement of the fractured bone. Positioning the foot in pronation (option C) or supination (option D) is also not indicated in this case as these positions do not provide the necessary stability to prevent displacement of the fractured bone. Therefore, in a patient with a closed fracture of the medial malleolus without displacement, the foot should be fixed in a plaster cast at a right angle with varus positioning of the foot to provide the necessary stability and promote healing of the fracture. |
41. The 10 y.o. boy has complains on headache, weakness, fever 400, vomiting, expressed dyspnea, pale skin with flush on right cheek, lag of right hemithorax respiratory movement, dullness on percussion over low lobe of right lung, weakness of vesicular respiration in this zone. The abdomen is painless and soft at palpati-on. Which disease lead to these symptoms and signs?
A. Pneumonia croupousa
B. Intestinal infection
C. Acute appendicitis
D. Acute cholecystitis
E. Flu
Answer: Pneumonia croupousa
Explanation
| The patient’s symptoms, including headache, weakness, high fever, vomiting, dyspnea, pale skin with a flush on the right cheek, and respiratory findings, such as decreased respiratory movement and dullness on percussion over the lower lobe of the right lung, suggest a diagnosis of pneumonia crouposa. Pneumonia crouposa is a bacterial infection of the lungs that typically presents with symptoms such as fever, cough, chest pain, and shortness of breath. In severe cases, it can lead to respiratory failure and sepsis. Intestinal infection (option B) may cause symptoms such as abdominal pain, diarrhea, and vomiting, but it would not typically present with respiratory symptoms or findings. Acute appendicitis (option C) typically presents with abdominal pain, fever, and nausea, but it would not typically cause respiratory symptoms or findings. Acute cholecystitis (option D) typically presents with abdominal pain, fever, and nausea, but it would not typically cause respiratory symptoms or findings. Flu (option E) may cause symptoms such as fever, headache, and cough, but it would not typically present with respiratory findings such as decreased respiratory movement and dullness on percussion. Therefore, in this case, the most likely diagnosis is pneumonia crouposa based on the patient’s symptoms and respiratory findings. Appropriate treatment should be provided promptly to manage the infection and prevent complications. |
42. The patient with acute respiratory viral infection (3-rd day of disease) has complaints on pain in lumbar region, nausea, dysuria, oliguria. Urinalysis – hematuria (100-200 RBC in eyeshot spot), specific gravity – 1002. The blood creatinin level is 0,18 mmol/L, potassium level – 6,4 mmol/L. Make the diagnosis:
A. Acute interstitial nephritis
B. Acute renal failure
C. Acute glomerylonephritis
D. Acute cystitis
E. Acute renal colic
Answer: Acute interstitial nephritis
Explanation
| The patient’s symptoms, including pain in the lumbar region, nausea, dysuria, and oliguria, along with the presence of hematuria and a low specific gravity on urinalysis, suggest a diagnosis of acute interstitial nephritis. Acute interstitial nephritis is an acute inflammatory disorder of the kidneys that can be caused by various drugs, infections, or autoimmune diseases. It typically presents with symptoms such as fever, rash, and arthralgia, as well as renal symptoms such as hematuria, proteinuria, and decreased urine output. Acute renal failure (option B) may also present with similar symptoms, but it typically involves a more significant decrease in urine output and may be associated with other laboratory abnormalities such as an elevated blood urea nitrogen and serum creatinine. Acute glomerulonephritis (option C) typically presents with symptoms such as edema, hypertension, and hematuria with red blood cell casts, while acute cystitis (option D) typically presents with lower urinary tract symptoms such as dysuria, urinary frequency, and urgency. Acute renal colic (option E) typically presents with severe flank pain, nausea, vomiting, and hematuria, but it is not associated with the other symptoms mentioned in this case. Therefore, in this case, the most likely diagnosis is acute interstitial nephritis based on the patient’s symptoms and laboratory findings. Appropriate treatment should be provided promptly to manage the underlying cause and prevent further kidney damage. |
43. The 7 m.o. infant is suffering from acute pneumonia which was complicated by cardiovascular insufficiency and respiratory failure of II degree. The accompanied diagnosis is malnutrition of II degree. Choose the best variant of therapy:
A. Ampiox and Amicacin
B. Macropen and Penicillin
C. Penicillin and Ampiox
D. Gentamycin and Macropen
E. Ampiox and Polymixin
Answer: Ampiox and Amicacin
Explanation
| In an infant with acute pneumonia complicated by cardiovascular insufficiency and respiratory failure of II degree, along with malnutrition of II degree, the most appropriate therapy would be a combination of antibiotics that provide broad-spectrum coverage against the likely pathogens involved. Ampiox (ampicillin and oxacillin) is a combination of antibiotics that provides coverage against gram-positive organisms, such as Streptococcus pneumoniae, as well as some gram-negative organisms. Amicacin is an aminoglycoside antibiotic that provides coverage against gram-negative organisms. Macropen (option B) is a macrolide antibiotic that provides coverage against some gram-positive and gram-negative organisms, but it may not provide adequate coverage in severe cases of pneumonia. Penicillin (options C) is effective against some gram-positive organisms, but it may not provide adequate coverage against the likely pathogens involved in severe cases of pneumonia. Gentamycin (option D) is an aminoglycoside antibiotic that provides coverage against gram-negative organisms, but it may not provide adequate coverage against gram-positive organisms. Polymixin (option E) is an antibiotic that provides coverage against some gram-negative organisms, but it is not typically used as a first-line therapy in severe cases of pneumonia. Therefore, in this case, the most appropriate therapy would be a combination of antibiotics that provide broad-spectrum coverage against the likely pathogens involved, such as Ampiox and Amicacin. The patient should also receive appropriate supportive care to manage the cardiovascular and respiratory complications and address the malnutrition. |
44. 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 of low-grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks, and enlarged occipital lymph nodes are consistent with a diagnosis of rubella. Rubella is a viral infection that is characterized by a mild fever, a rash, and swollen lymph nodes. The rash typically starts on the face and spreads to the rest of the body, including the buttocks. The rash is usually maculopapular, which means it consists of small, raised bumps that may be red or pink in color. Other symptoms of rubella may include cough, runny nose, and red and inflamed eyes. Rubella is typically a self-limited illness, and treatment is focused on relieving symptoms such as fever and rash. Scarlet fever (option B) is a bacterial infection that is characterized by a fever, sore throat, and a rash that is typically red and feels like sandpaper. The rash usually starts on the chest and abdomen and spreads to the rest of the body, but it does not typically involve the buttocks. Measles (option C) is a viral infection that is characterized by a high fever, cough, runny nose, and a rash that usually starts on the face and spreads to the rest of the body. The rash is typically maculopapular and may be confluent. Adenoviral infection (option D) is a viral infection that can cause symptoms such as fever, cough, runny nose, and conjunctivitis. It is typically a self-limited illness that does not cause a rash. Pseudotuberculosis (option E) is a bacterial infection that can cause symptoms such as fever, abdominal pain, and diarrhea. It does not typically cause a rash. Therefore, in this case, the most likely diagnosis is rubella based on the patient’s symptoms and clinical presentation. Appropriate management should be provided to relieve symptoms and prevent complications. |
45. 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 of headache, weakness, vertigo, tremor of her limbs, ataxia, mental confusion, in a child with mild varicella, suggest a diagnosis of encephalitis. Encephalitis is an inflammation of the brain that can be caused by various viral, bacterial, or fungal infections. In children, it is commonly caused by viral infections such as herpes simplex virus, varicella-zoster virus, or enteroviruses. The symptoms of encephalitis can vary depending on the severity and location of the inflammation in the brain. Common symptoms include headache, fever, altered mental status, seizures, and focal neurological deficits such as weakness, ataxia, or tremors. Meningitis (option B) is an inflammation of the membranes that surround the brain and spinal cord, and it typically presents with symptoms such as headache, fever, neck stiffness, and photophobia. Meningoencephalitis (option C) is a combination of both meningitis and encephalitis and presents with symptoms of both conditions. Myelitis (option D) is an inflammation of the spinal cord and typically presents with symptoms such as weakness, sensory loss, and bowel or bladder dysfunction. Neurotoxic syndrome (option E) is a condition that can occur as a result of exposure to certain toxins or chemicals and is characterized by symptoms such as confusion, hallucinations, and seizures. Therefore, in this case, the most likely diagnosis is encephalitis, which can be caused by varicella-zoster virus in a child with mild varicella. Appropriate management should be provided promptly to manage the inflammation in the brain and prevent complications. |
46. A 7 y.o. girl fell ill abruptly: fever, headache, severe sore throat, vomiting. Minute bright red rash appear in her reddened skin in 3 hours. It is more intensive in axillae and groin. Mucous membrane of oropharynx is hyperemic. Greyish patches is on the tonsills. Submaxillary lymph nodes are enlarged and painful. What is your diagnosis?
A. Scarlet fever
B. Measles
C. Rubella
D. Pseudotuberculosis
E. Enteroviral infection
Answer: Scarlet fever
Explanation
| The symptoms of fever, headache, severe sore throat, vomiting, and minute bright red rash that appears in the skin within a few hours, along with enlarged and painful submaxillary lymph nodes, are consistent with a diagnosis of scarlet fever. Scarlet fever is a bacterial infection caused by group A streptococcus bacteria. It typically presents with a fever, sore throat, and a rash that is typically red and feels like sandpaper. The rash usually starts on the chest and abdomen and spreads to the rest of the body, but it is more intense in the axillae and groin. The tongue may also become swollen and red, with a “strawberry” appearance. Other symptoms of scarlet fever may include headache, vomiting, and greyish patches on the tonsils. Scarlet fever is typically treated with antibiotics to prevent complications such as rheumatic fever. Measles (option B) is a viral infection that is characterized by a high fever, cough, runny nose, and a rash that usually starts on the face and spreads to the rest of the body. The rash is typically maculopapular and may be confluent. Rubella (option C) is a viral infection that is characterized by a mild fever, a rash, and swollen lymph nodes. The rash typically starts on the face and spreads to the rest of the body, including the buttocks. The rash is usually maculopapular, which means it consists of small, raised bumps that may be red or pink in color. Pseudotuberculosis (option D) is a bacterial infection that can cause symptoms such as fever, abdominal pain, and diarrhea. It does not typically cause a rash. Enteroviral infection (option E) is a viral infection that can cause symptoms such as fever, headache, and rash. The rash is typically maculopapular and may be present on the trunk and extremities. Therefore, in this case, the most likely diagnosis is scarlet fever based on the patient’s symptoms and clinical presentation. Appropriate management should be provided to prevent complications and to manage the symptoms. |
47. The child has complains of the “night”and “hungry”abdominal pains. At fibroscopy in area a bulbus ofa duodenum the ulcerrative defect of 4 mms diameter is found, the floor is obtected with a fibrin, (H.p +). Administer the optimum schemes of treatment:
A. Omeprasole – Trichopolum – Claritromicin
B. De-nol
C. Maalox – Ranitidin
D. Vicalinum – Ranitidin
E. Trichopolum
Answer: Omeprasole – Trichopolum – Claritromicin
Explanation
| The presentation of “night” and “hungry” abdominal pains along with the presence of an ulcerative defect in the duodenal bulb and the presence of H. pylori infection suggest a diagnosis of peptic ulcer disease. Peptic ulcer disease is a condition characterized by the presence of ulcers in the lining of the stomach or duodenum. H. pylori infection is a common cause of peptic ulcer disease, and it is typically treated with a combination of antibiotics and acid-suppressing medications. The most effective treatment for H. pylori infection is a combination of a proton pump inhibitor (such as omeprazole), along with two antibiotics, metronidazole and clarithromycin. De-nol (option B) is a medication that contains bismuth subsalicylate and is used as part of the treatment for H. pylori infection. However, it is typically used in combination with antibiotics and acid-suppressing medications. Maalox – Ranitidine (option C) is a combination of an antacid (Maalox) and an H2 blocker (ranitidine), which can help relieve symptoms of peptic ulcer disease, but it is not effective for eradicating H. pylori infection. Vicalinum – Ranitidine (option D) is a combination of an antacid (Vicalinum) and an H2 blocker (ranitidine), which can help relieve symptoms of peptic ulcer disease, but it is not effective for eradicating H. pylori infection. Trichopolum (option E) is metronidazole, which is one of the antibiotics used in the treatment of H. pylori infection, but it should be used in combination with a proton pump inhibitor and clarithromycin. Therefore, the most appropriate treatment for this patient is a combination of omeprazole, metronidazole, and clarithromycin to eradicate the H. pylori infection and promote healing of the ulcerative defect in the duodenal bulb. |
48. 6 m.o. infant was born with body’s mass 3 kg and length 50 cm. He is given natural feeding. How many times per day the infant should be fed?
A. 5
B. 7
C. 6
D. 8
E. 4
Answer: 5
Explanation
| According to the World Health Organization (WHO), a 6-month-old infant who is exclusively breastfed should be fed approximately 5 times per day. Breast milk provides all the necessary nutrients for infants up to 6 months of age, and frequent feedings ensure that the infant’s nutritional needs are met. As an infant grows, the frequency of feedings may decrease, but the duration of each feeding may increase. It is important to note that the recommended number of feedings per day may vary depending on the infant’s individual needs and feeding patterns. Infants who are formula-fed may also have different feeding patterns than breastfed infants. Therefore, in this case, the 6-month-old infant who is being exclusively breastfed should be fed approximately 5 times per day, but the actual frequency may vary depending on the infant’s individual needs and feeding patterns. |
49. A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weight, 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 around the 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 presentation of anorexia, weakness, weight loss, breathlessness, and swelling of feet, along with a diastolic murmur in the mitral area, petechiae around the clavicle, and a palpable spleen, suggest a diagnosis of subacute bacterial endocarditis. Subacute bacterial endocarditis is an infection of the heart valves caused by bacteria that enter the bloodstream and settle on the heart valves. The symptoms of SBE are often nonspecific and can develop gradually over several weeks or months. The most common symptoms include fever, fatigue, weight loss, and night sweats, as well as signs of heart failure, such as shortness of breath and peripheral edema. In this case, the presence of a diastolic murmur in the mitral area suggests involvement of the mitral valve, which is commonly affected in SBE. The presence of petechiae around the clavicle and a palpable spleen are also characteristic features of SBE. Recurrence of rheumatic fever (option B) is less likely in this case since the patient has rheumatic heart disease and is presenting with symptoms of subacute bacterial endocarditis. Thrombocytopenic purpura (option C) is a condition characterized by low platelet counts and the formation of small purple spots on the skin. It is unlikely to be the underlying cause of the patient’s symptoms. Mitral stenosis (option D) is a condition characterized by narrowing of the mitral valve, which can cause symptoms such as fatigue, shortness of breath, and edema. However, in this case, the presence of a diastolic murmur suggests involvement of the mitral valve due to SBE. Aortic stenosis (option E) is a condition characterized by narrowing of the aortic valve, which can cause symptoms such as chest pain, dizziness, and fainting. However, the presence of a diastolic murmur in the mitral area suggests involvement of the mitral valve in this case. Therefore, based on the patient’s symptoms, clinical examination findings, and medical history, the most likely diagnosis is subacute bacterial endocarditis. Appropriate management should be initiated promptly to prevent complications and to manage the infection. |
50. A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied with collapse?
A. Septic shock
B. Exudative pleuritis
C. Bronchial obstruction
D. Toxic hepatitis
E. Emphysema
Answer: Septic shock
Explanation
| Pneumonia can lead to various complications, including septic shock, exudative pleuritis, bronchial obstruction, toxic hepatitis, and emphysema. However, among these complications, septic shock is most likely to be accompanied by collapse. Septic shock is a life-threatening condition that can occur as a complication of severe pneumonia. It is characterized by a systemic inflammatory response to infection, which can lead to hypotension, decreased tissue perfusion, and organ failure. The decrease in tissue perfusion and oxygen delivery can result in shock and collapse. Exudative pleuritis (option B) is inflammation of the pleura that can occur as a complication of pneumonia, but it is less likely to cause collapse than septic shock. Bronchial obstruction (option C) can occur due to inflammation, edema, or mucus accumulation in the airways, but it is also less likely to cause collapse than septic shock. Toxic hepatitis (option D) is a liver inflammation that can occur as a complication of pneumonia, but it is not likely to cause collapse. Emphysema (option E) is a chronic lung disease characterized by damage to the alveoli, which can lead to shortness of breath and respiratory failure. However, it is less likely to cause collapse than septic shock. Therefore, based on the information provided in the question, septic shock is the complication of pneumonia that is most likely to be accompanied by collapse. Prompt recognition and management of septic shock are essential to improve the patient’s outcome. |
