Question From (1 To 50 )
1. A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?
A. Ultrasound
B. Hysteroscopy
C. Hromohydrotubation
D. Colposcopy
E. Cystoscopy
Answer: Ultrasound
Explanation
| The clinical presentation of slight dark bloody discharges and mild pains in the lower part of the abdomen, combined with a positive pregnancy test and a bimanual examination revealing a soft, painless uterus indicating a 5-6 week pregnancy, suggest that the patient may be experiencing early pregnancy complications such as an ectopic pregnancy or a threatened miscarriage. The presence of a retort-like formation in the left appendage, which is mobile and painless, may be indicative of an ovarian cyst or a tubal pregnancy. An ultrasound is the most appropriate diagnostic test to determine the location of the fetus and assess its viability, as well as to identify any abnormalities or complications such as an ectopic pregnancy or a miscarriage. Therefore, option A (ultrasound) is the correct answer. |
2. A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:
A. Labour stimulation after preparation
B. Absolute bed rest for 1 month
C. Complex therapy of gestosis for 2 days
D. Caesarian section immediately
E. Complex therapy of gestosis for 7 days
Answer: Labour stimulation after preparation
Explanation
| The patient is in her 40th week of pregnancy, which is the normal gestational age for delivery. Additionally, the cervix is undeveloped, and the oxytocin test is negative, which suggests that the patient is not in active labor. The patient’s history reveals that she had elevated blood pressure, proteinuria, and peripheral edema at 32 weeks of pregnancy, which indicates the presence of gestational hypertension or preeclampsia. However, the absence of abnormal reflexes suggests that the condition is not severe. Bed rest or complex therapy of gestosis may be appropriate for managing gestational hypertension or preeclampsia, but since the patient is already at term and the cervix is undeveloped, labor induction is the most appropriate tactic in this case. Therefore, option A (labor stimulation after preparation) is the correct answer. The preparation may involve cervical ripening agents such as prostaglandins or mechanical methods to soften and open the cervix before labor induction is initiated. |
3. A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:
A. Atony of the uterus
B. Injury of cervix of the uterus
C. Hysterorrhexis
D. Delay of the part of placenta
E. Hypotonia of the uterus
Answer: Atony of the uterus
Explanation
| Based on the information provided, the most probable cause of the bleeding is atony of the uterus. Atony of the uterus is a common cause of postpartum hemorrhage and occurs when the uterus fails to contract effectively after delivery of the placenta, leading to excessive bleeding. In this case, the patient had a second labor within the last 2 years and received oxytocin during labor, which increases the risk of uterine atony. Additionally, the child’s weight of 4080 g is considered large for gestational age, which is another risk factor for postpartum hemorrhage. Despite the injection of contractive agents and good contraction of the uterus, the bleeding continues, which suggests that the uterus is not contracting effectively. The absence of any cervical or vaginal disorders indicates that the bleeding is not caused by a cervical or vaginal injury. Hysterorrhexis (rupture of the uterus) is a rare complication of childbirth and is not likely in this case. Delay of the part of placenta may also cause postpartum hemorrhage, but it typically occurs before the delivery of the placenta, whereas the bleeding in this case occurred after the placenta was delivered. Hypotonia of the uterus is a less severe form of atony and is not likely to cause massive bleeding. Therefore, option A (atony of the uterus) is the most probable cause of the bleeding in this case. |
4. A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:
A. Infectious contamination of the urinary system
B. Thrombophlebitis of veins of the pelvis
C. Infectious hematoma
D. Endometritis
E. Apostasis of sutures after episiotomy
Answer: Infectious contamination of the urinary system
Explanation
| The patient has a history of chronic pyelonephritis, which puts her at increased risk for urinary tract infections (UTIs). After delivery, she complains of fever, loin pains, and frequent urination, which are common symptoms of UTIs. Additionally, the onset of symptoms on the day after delivery suggests that the infection was likely acquired during or shortly after delivery. Thrombophlebitis of veins of the pelvis and infectious hematoma are less likely in this case, as they typically present with localized pain and swelling, rather than fever and urinary symptoms. Endometritis is also a possible complication after delivery, but it typically presents with fever, lower abdominal pain, and foul-smelling vaginal discharge, rather than loin pains and frequent urodynia. Apostasis of sutures after episiotomy may cause local discomfort and pain but is unlikely to cause fever and urinary symptoms. Therefore, option A (infectious contamination of the urinary system) is the most probable complication in this case. The patient should be evaluated by a healthcare provider and treated with appropriate antibiotics to prevent the spread of the infection and potential complications such as sepsis or kidney damage. |
5. In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics – anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:
A. Computer tomography of the head
B. Determination of the level of gonadotropins
C. USI of organs of small pelvis
D. Progesterone assay
E. Determination of the contents of testosteron-depotum in blood serum
Answer: Computer tomography of the head
Explanation
| The most suitable investigation in this case is computer tomography (CT) of the head. The patient is a 24-year-old woman who has previously had normal menstrual function but is now experiencing irregular cycles and anovulatory cycles, as well as elevated prolactin levels in her blood. These findings suggest that the patient may have a pituitary adenoma, which is a benign tumor of the pituitary gland that can cause elevated prolactin levels and disrupt normal menstrual function. CT of the head is the most appropriate diagnostic test to evaluate for the presence of a pituitary adenoma. It can detect the size and location of the adenoma, as well as any potential complications such as compression of adjacent structures. Determination of the level of gonadotropins and progesterone assay may also be useful in evaluating the patient’s hormonal status, but they are less specific for detecting a pituitary adenoma. USI of organs of small pelvis may be useful in evaluating the patient’s reproductive organs but is less specific for detecting a pituitary adenoma. Determination of the contents of testosterone-depotum in blood serum is not likely to be useful in this case, as it is not typically elevated in patients with pituitary adenomas. Therefore, option A (computer tomography of the head) is the most suitable investigation in this case. |
6. A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture should be made in:
A. In the 2nd intercostal space along the middle clavicular line
B. In the 6th intercostal space along the posterior axillary line
C. In the 7th intercostal space along the scapular line
D. In the projection of pleural sinus
E. In the point of the greatest dullness on percussion
Answer: In the 2nd intercostal space along the middle clavicular line
Explanation
| The puncture for drainage of pleural cavity in this case should be made in the 2nd intercostal space along the middle clavicular line. The patient in this case has a right-sided pneumothorax, which is a collection of air in the pleural cavity that can cause lung collapse and respiratory distress. The most appropriate treatment for pneumothorax is thoracostomy or insertion of a chest tube to drain the air from the pleural cavity. The 2nd intercostal space along the middle clavicular line is the preferred site for pleural puncture in patients with pneumothorax. This location provides access to the pleural cavity while minimizing the risk of injury to neurovascular structures and other vital organs. Option B (in the 6th intercostal space along the posterior axillary line) is a site for drainage of pleural effusion, while option C (in the 7th intercostal space along the scapular line) is a site for drainage of empyema. Option D (in the projection of pleural sinus) is not a recognized site for pleural puncture. Option E (in the point of greatest dullness on percussion) is a less specific method for identifying the site of pleural puncture and may not always be reliable. Therefore, option A (in the 2nd intercostal space along the middle clavicular line) is the correct answer. |
7. 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 concentration in blood
E. –
Answer: Increased potassium concentration in blood
Explanation
| The treatment tactics for arrhythmia resulting from cardiac glycoside overdose in a patient taking diuretics is to increase the potassium concentration in the blood. Cardiac glycosides such as digoxin are commonly used to treat heart failure, but they can cause arrhythmias such as atrial fibrillation and ventricular tachycardia when taken in excessive amounts. Diuretics, on the other hand, can cause hypokalemia (low potassium levels) by increasing the excretion of potassium in the urine. Hypokalemia can increase the risk of arrhythmias in patients taking cardiac glycosides. To treat the arrhythmia in this case, it is important to correct the hypokalemia by increasing the potassium concentration in the blood. This can be achieved by administering potassium supplements or increasing the dietary intake of potassium-rich foods. Option B (increased sodium concentration in blood) is not likely to be helpful in this case and may exacerbate the arrhythmia by increasing the workload on the heart. Option C (reduced magnesium concentration in blood) may also contribute to arrhythmias, but correcting magnesium levels is not the primary treatment in this case. Option D (increased calcium concentration in blood) is not likely to be helpful in this case and may even worsen the arrhythmia. Therefore, option A (increased potassium concentration in blood) is the correct answer. |
8. A 20 year old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First medical aid involved aplication of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?
A. 120 minutes
B. 15 minutes
C. 30 minutes
D. 60 minutes
E.
Answer: 120 minutes
Explanation
| A tourniquet is a device used to temporarily stop bleeding from a limb by compressing the underlying blood vessels. It is typically used in emergency situations when direct pressure or other measures are not effective in controlling bleeding. However, tourniquet use can cause tissue damage, nerve injury, and other complications if left in place for too long. The maximal exposure time for a tourniquet depends on various factors such as the patient’s age, overall health, and the location and severity of the injury. In general, the maximal exposure time for a tourniquet is around 2 hours or 120 minutes. However, it is important to monitor the patient for signs of tissue damage or other complications throughout the tourniquet application. Option B (15 minutes) and option C (30 minutes) are too short of a time frame for maximal exposure of the tourniquet and may not be effective in controlling bleeding in some cases. Option D (60 minutes) may be appropriate in some cases but is still shorter than the generally accepted maximal exposure time. Option E is not a valid answer. Therefore, option A (120 minutes) is the correct answer. |
180 minutes 9. The average body lenth of newborn boys is 50,9 cm at a sigma 1,66; and average mass – 3432 at a sigma 5,00. What criterion is necessary in order to compare degree of variability of these signs?
A. Coefficient of variation
B. Sigma
C. Limit
D. Amplitude
E. Coefficient of association
Answer: Coefficient of variation
Explanation
| To compare the degree of variability of these signs (body length and mass of newborn boys), the most appropriate criterion to use is the coefficient of variation. The coefficient of variation (CV) is a statistical measure that expresses the standard deviation (sigma) as a percentage of the mean. It is useful for comparing the variability of different variables that may have different units of measurement or scales. In this case, the standard deviation (sigma) for body length is 1.66 cm, while the sigma for mass is 5.00 g. However, since the mean values are also different (50.9 cm for body length and 3432 g for mass), it is not possible to directly compare the standard deviations. By calculating the CV for each variable, we can express the variability as a percentage of the mean and make a meaningful comparison. The formula for calculating the CV is: CV = (standard deviation / mean) x 100% Using this formula, the CV for body length is: CV = (1.66 / 50.9) x 100% = 3.27% And the CV for mass is: CV = (5.00 / 3432) x 100% = 0.15% Therefore, we can see that the body length of newborn boys has much higher variability (as a percentage of the mean) than their mass. This information is important for understanding the distribution of these variables and may have implications for clinical practice and research. Option B (sigma) is not a suitable criterion for comparing variability between variables with different units of measurement. Option C (limit) is not a statistical measure of variability. Option D (amplitude) is a measure of the range of values but does not take into account the mean or standard deviation. Option E (coefficient of association) is a measure of the strength and direction of the relationship between two variables and is not relevant to comparing variability. Therefore, option A (coefficient of variation) is the correct answer. |
10. Indicate the registration medical document for the patient, who 21.02. was addressed to the doctor with diagnosis ARVD for the first time in this year:
A. The statistical coupon is to be filled in and it is necessary to deliver on a sign (+)
B. The statistical coupon for registration of final diagnosis is not necessary
C. The statistical coupon is to be filled in, but a sign (+) is not necessary to be put in
D. It is necessary to fill in the emergency notice on a case of a contagion
E. The necessary registration form is not indicated
Answer: The statistical coupon is to be filled in and it is necessary to deliver on a sign (+)
Explanation
| ARVD (Arrhythmogenic Right Ventricular Dysplasia) is a medical condition that affects the heart. Whenever a patient is diagnosed with a medical condition for the first time, it is necessary to fill out a statistical coupon in order to register the patient’s health status. The statistical coupon is a document used for recording medical information about a patient, including demographic data, diagnosis, treatment, and outcomes. In this case, since the patient has been diagnosed with ARVD for the first time in the current year, it is necessary to fill out a statistical coupon and mark it with a plus sign (+) to indicate a new case. This is important for tracking the incidence and prevalence of different diseases and for planning healthcare services and resources. Option B (the statistical coupon for registration of final diagnosis is not necessary) is incorrect, as a statistical coupon is necessary for the registration of any new diagnosis. Option C (the statistical coupon is to be filled in, but a sign (+) is not necessary to be put in) is also incorrect, as the plus sign is necessary to indicate a new case. Option D (it is necessary to fill in the emergency notice on a case of a contagion) is not relevant to this case, as ARVD is not a contagious disease. Option E (the necessary registration form is not indicated) is incorrect, as the necessary form in this case is the statistical coupon. Therefore, option A (the statistical coupon is to be filled in and it is necessary to deliver on a sign (+)) is the correct answer. |
11. Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST − T wave changes. The most likely diagnosis is:
A. Pulmonary thromboembolism
B. Acute myocardial infarction
C. Aortic dissection
D. Pericarditis
E. Aspiration
Answer: Pulmonary thromboembolism
Explanation
| Pulmonary thromboembolism (PTE) is a serious medical condition that occurs when a blood clot (thrombus) forms in a deep vein, usually in the leg, and then travels to the lungs where it can block blood flow and cause respiratory distress, chest pain, and hypotension. Total hip joint replacement is a known risk factor for the development of deep vein thrombosis (DVT) and PTE due to immobility and vascular injury. The symptoms in this case, including acute shortness of breath, diaphoresis, and hypotension, are consistent with a diagnosis of PTE. The physical examination findings of mild jugular venous distension with prominent A waves and normal heart sounds are also suggestive of right heart strain, which can occur in PTE. The ECG findings of sinus tachycardia with a new right bundle branch block and minor nonspecific ST-T wave changes are also consistent with PTE. Option B (acute myocardial infarction) is less likely in this case because the ECG findings do not show significant ST-segment elevation or Q waves, which are typically seen in acute myocardial infarction. Option C (aortic dissection) is less likely because the physical examination findings do not suggest aortic regurgitation or other signs of aortic dissection. Option D (pericarditis) is less likely because there are no signs of pericardial friction rub or other characteristic features of pericarditis. Option E (aspiration) is less likely because there are no signs of respiratory distress or aspiration pneumonia. Therefore, option A (pulmonary thromboembolism) is the most likely diagnosis in this case. |
12. A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:
A. Leftsided renal colic
B. Herpes zoster
C. Sigmoid diverticulitis
D. Torsion of the left testicle
E. Retroperitoneal haemorrhage
Answer: Leftsided renal colic
Explanation
| Renal colic is a type of pain that occurs when a kidney stone or other obstruction causes blockage of the urinary tract. The pain is typically severe and may radiate from the flank or loin to the groin or genital area. Other symptoms may include nausea, vomiting, and frequent urination. The onset of pain is usually sudden and may be accompanied by restlessness and agitation. In this case, the patient’s symptoms of severe left-sided abdominal pain radiating to the groin, accompanied by nausea, perspiration, and the need for frequent urination, are typical of renal colic. The absence of abnormal findings on physical examination is also consistent with renal colic, as the pain is caused by an internal obstruction rather than an external injury or inflammation. Option B (herpes zoster) is less likely in this case, as it typically causes a localized rash or blisters in addition to pain. Option C (sigmoid diverticulitis) is less likely because the pain in diverticulitis is usually located in the left lower quadrant and is associated with fever and leukocytosis. Option D (torsion of the left testicle) is less likely because it typically causes unilateral scrotal pain and swelling, not abdominal pain. Option E (retroperitoneal hemorrhage) is less likely because it usually causes pain and other symptoms related to bleeding and hemodynamic instability. Therefore, option A (left-sided renal colic) is the most likely diagnosis in this case. |
13. A 40 year old woman has a selfdetected hard breast mass. The procedure of choice for confirming the diagnosis is:
A. Excision biopsy
B. Mammography
C. Thermography
D. Ultrasonography
E. Aspiration biopsy with cytology
Answer: Excision biopsy
Explanation
| Excision biopsy is a surgical procedure that involves removing the entire breast mass for examination under a microscope. It is the gold standard for diagnosing breast cancer and is considered the most accurate method for determining whether a breast mass is benign or malignant. Mammography and ultrasonography are imaging techniques that can help detect and characterize breast masses, but they are not definitive diagnostic tests and cannot distinguish between benign and malignant masses with certainty. Mammography is typically recommended as a screening tool for breast cancer in women over the age of 50, while ultrasonography is often used to evaluate suspicious breast masses in younger women. Thermography is a non-invasive imaging technique that uses infrared technology to detect changes in skin temperature, which may indicate the presence of a breast mass. However, it is not considered a reliable diagnostic tool and is not recommended as a primary method of breast cancer screening or diagnosis. Aspiration biopsy with cytology is a minimally invasive procedure that involves using a needle to extract a sample of cells from a breast mass for examination under a microscope. It can be useful for diagnosing some types of benign breast masses, but it is not as accurate as excision biopsy for diagnosing breast cancer. Therefore, option A (excision biopsy) is the most appropriate procedure for confirming the diagnosis of a breast mass in a 40-year-old woman. |
14. What is the maximum duration of medical certificate in case of tuberculosis?
A. 2 months
B. Week
C. 2 weeks
D. Month
E. 10 months
Answer: 2 months
Explanation
| Tuberculosis (TB) is a serious infectious disease caused by the bacterium Mycobacterium tuberculosis. TB can affect different parts of the body, including the lungs, and it is treated with a combination of antibiotics for several months. In many countries, a medical certificate is required for employees who are absent from work due to illness. The duration of the certificate may vary depending on the type of illness and local regulations. In the case of tuberculosis, the maximum duration of a medical certificate is typically 2 months. This is because treatment for tuberculosis usually involves a combination of antibiotics taken for at least 6 months, and patients are usually able to return to work once they have completed the initial phase of treatment and are no longer contagious. Option A (2 months) is therefore the correct answer. Options B, C, D, and E are incorrect as they suggest shorter or longer durations than the maximum allowed for a medical certificate in case of tuberculosis. |
15. The student has the following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?
A. Krotov’s apparatus
B. Ebert’s counter
C. Geiger’s counter
D. Mischuk’s device
E. Ebert’s device
Answer: Krotov’s apparatus
Explanation
| Krotov’s apparatus is a device used for microbiological air monitoring. It works by drawing air through a small opening and collecting particles on a nutrient medium, which can then be analyzed to determine the presence of microorganisms. This device is commonly used in healthcare facilities, food processing plants, and other settings where air quality and hygiene are important. Geiger counters and Ebert counters are devices used to detect ionizing radiation and are not suitable for assessing air germ pollution. Mischuk’s device is a device used for measuring the concentration of carbon dioxide in the air and is not designed for detecting microorganisms. Ebert’s device is not a specific device, so it is unclear whether it would be suitable for assessing air germ pollution. Therefore, the correct answer is A (Krotov’s apparatus). |
16. Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?
A. 160-200 l
B. 10-15 l
C. 50-100 l
D. 300-400 l
E. 500 l
Answer: 160-200 l
Explanation
| The typical water consumption for a person living in a canalized house with a complete set of sanitary equipment (WC, bath, shower, local water heater) is 160-200 liters per day. This estimate includes water usage for a variety of activities such as bathing, flushing the toilet, washing dishes, and doing laundry. However, water consumption can vary depending on factors such as the number of people in the household, their habits, and the efficiency of the water fixtures and appliances. Option A (160-200 l) is therefore the correct answer. Options B, C, D, and E are incorrect as they suggest much lower or higher water consumption than what is typically expected for a person living in a canalized house with complete sanitary equipment. |
17. 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
| The guarantees against preconceived attitudes to the physician in cases of professional law violations include the sanction of the public prosecutor, inquiry by the preliminary investigator of the prosecutor’s office, and the committee of experts. In cases where a physician is accused of violating professional law, it is important to ensure that the investigation is conducted fairly and impartially. The involvement of the public prosecutor and the preliminary investigator of the prosecutor’s office can help to ensure that the investigation is conducted in accordance with the law and without bias. The committee of experts is also an important safeguard against preconceived attitudes, as it is typically made up of independent medical professionals who can provide an objective assessment of the physician’s actions and the evidence presented in the case. Option A (sanction of public prosecutor, inquiry by preliminary investigator of prosecutor’s office, committee of experts) is therefore the correct answer. Options B, C, D, and E are not relevant to the question, as they do not address the issue of preconceived attitudes towards physicians in cases of professional law violations. |
18. A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent mediastinitis?
A. Cervical lymphadenitis
B. Deep neck phlegmon
C. Perforation of the cervical part of the oesophagus
D. Perforation of the thoracic part of the oesophagus
E. Iatrogenic injury of the trachea
Answer: Cervical lymphadenitis
Explanation
| Cervical lymphadenitis is not a cause of purulent mediastinitis. Purulent mediastinitis is a serious medical condition that occurs when pus accumulates in the mediastinum, the space in the chest between the lungs. It can be caused by a variety of factors, including infections, trauma, and iatrogenic injuries. Deep neck phlegmon, perforation of the cervical or thoracic part of the esophagus, and iatrogenic injury of the trachea can all lead to the development of purulent mediastinitis. These conditions can cause the spread of infection or inflammation to the mediastinum, leading to the accumulation of pus. Cervical lymphadenitis, on the other hand, is an infection of the lymph nodes in the neck and does not typically involve the mediastinum. While it is possible for infections to spread from the cervical lymph nodes to the mediastinum, this is not a common cause of purulent mediastinitis. Therefore, option A (cervical lymphadenitis) is the correct answer. Options B, C, D, and E are all possible causes of purulent mediastinitis. |
19. A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?
A. Surgical treatment: drainage of the pleural cavity
B. Antiinflammation therapy
C. Symptomatic therapy
D. Pleural puncture
E. Thoracotomy
Answer: Surgical treatment: drainage of the pleural cavity
Explanation
| The treatment indicated for a patient diagnosed with right-sided pneumothorax is surgical treatment, specifically drainage of the pleural cavity. Pneumothorax is a condition in which air enters the space between the lung and the chest wall, causing the lung to collapse. Treatment for pneumothorax depends on the size and severity of the condition, as well as the patient’s overall health and medical history. In the case of a right-sided pneumothorax, the standard treatment is to insert a chest tube through the chest wall into the pleural cavity to remove the air and allow the lung to re-expand. This procedure is commonly referred to as drainage of the pleural cavity or thoracostomy. Anti-inflammatory therapy and symptomatic therapy are not typically indicated for the treatment of pneumothorax, as they do not address the underlying cause of the condition. Pleural puncture may be used as a diagnostic tool to confirm the presence of pneumothorax, but it is not a treatment for the condition. Thoracotomy, which involves open surgery on the chest, may be necessary in some cases of pneumothorax that are not amenable to chest tube drainage, but it is not typically the first-line treatment. Therefore, option A (surgical treatment: drainage of the pleural cavity) is the correct answer. |
20. It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?
A. Digital examination of rectum
B. Rectoromanoscopy
C. Laparoscopy
D. Percussion and auscultation of stomach
E. R-scopy of abdominal cavity
Answer: Digital examination of rectum
Explanation
| The diagnostic method of choice for suspected abscess of Douglas pouches in a 34-year-old patient is digital examination of the rectum. The Douglas pouch, also known as the recto-uterine pouch, is a small space between the rectum and the back of the uterus in women. Abscesses in this area can occur as a result of infections, such as pelvic inflammatory disease or diverticulitis, and can cause symptoms such as pelvic pain and fever. Digital examination of the rectum is a simple and non-invasive diagnostic method that involves inserting a gloved finger into the rectum to feel for any abnormalities, such as swelling or tenderness, in the area near the Douglas pouch. This method can help to identify the presence of an abscess and determine its location and size. Other diagnostic methods that may be used in addition to, or instead of, digital examination of the rectum include imaging studies such as ultrasound, CT scan, or MRI, as well as laparoscopy or other surgical procedures. However, digital examination of the rectum is typically the first diagnostic step in evaluating suspected abscesses of the Douglas pouch. Therefore, option A (digital examination of rectum) is the correct answer. |
21. A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:
A. Herniotomy by Mayo-Sapezhko
B. Herniotomy by Mayo
C. Herniotomy by Sapezhko
D. Herniotomy by Lekser
E. Herniotomy by Grenov
Answer: Herniotomy by Mayo-Sapezhko
Explanation
| In the case of a restrained umbilical hernia complicated by a phlegmon hernia, the recommended course of action is herniotomy by the Mayo-Sapezhko technique. Umbilical hernias occur when a portion of the intestine or other abdominal contents protrude through a weak spot in the abdominal muscles near the navel. If the hernia becomes trapped, or incarcerated, it can cut off blood supply to the affected tissue and become complicated by infection or inflammation, resulting in a phlegmon hernia. Herniotomy is a surgical procedure that involves removing the hernia sac and repairing the abdominal wall defect. The Mayo-Sapezhko technique is a modification of the standard herniotomy procedure that involves using a combination of transverse and longitudinal incisions to access the hernia sac and surrounding tissues. This technique is particularly well-suited for cases of complex or recurrent hernias, or for cases where the hernia is complicated by infection or inflammation. Options B, C, D, and E are all variations of the standard herniotomy procedure, but they are not specifically indicated for cases of umbilical hernia complicated by phlegmon hernia. Therefore, option A (herniotomy by Mayo-Sapezhko) is the correct answer. |
22. A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?
A. Staining test with 1% fluorescein
B. X-ray examination of orbit
C. Tonometria
D. Gonioscopia
E. Cornea sensation-test
Answer: Staining test with 1% fluorescein
Explanation
| In the case of a 10-year-old boy with left eye pain, photophobia, and a history of injury with a pencil, the additional method of choice would be staining test with 1% fluorescein. Fluorescein staining is a simple and non-invasive diagnostic test that involves placing a small amount of a fluorescent dye called fluorescein onto the surface of the eye and then examining the eye under blue light. The dye helps to highlight any damage or irregularities on the surface of the cornea, which is the clear outer layer of the eye. In this case, the boy’s left eye has symptoms such as blepharospasm, ciliary and conjunctival congestion, and photophobia, which could be indicative of corneal damage. However, the cornea is reported to be transparent on examination, which suggests that there may be no visible signs of damage. A fluorescein staining test can help to confirm or rule out corneal damage by highlighting any areas of the cornea that are not taking up the dye, indicating a loss of integrity in the corneal surface. Option A (staining test with 1% fluorescein) is therefore the correct answer. Options B, C, D, and E are not relevant to the case and are not indicated as the first step in evaluating a suspected corneal injury. |
23. A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?
A. Mastoidotomy
B. Paracentesis of the drum
C. Radical operation on the middle ear
D. Tympanoplasty
E. Cateterization of the Eustachian tube
Answer: Mastoidotomy
Explanation
| In the case of a patient with acute purulent otitis media complicated by mastoiditis, with a radiographic finding of shadowing of the cellular system on the lesion and absence of bone septa, the necessary therapeutic action at the second stage of mastoiditis is mastoidotomy. Mastoiditis is a complication of acute otitis media in which infection spreads from the middle ear to the air cells of the mastoid bone, causing inflammation and destruction of the bone tissue. Mastoidotomy is a surgical procedure that involves creating an opening in the mastoid bone to drain the infected fluid and relieve pressure on the surrounding tissues. In cases of mastoiditis that have progressed to the second stage, mastoidotomy is typically indicated to prevent further spread of the infection and potential complications such as meningitis or brain abscess. Other surgical procedures such as paracentesis of the drum, tympanoplasty, or catheterization of the Eustachian tube may be indicated for other conditions, but they are not appropriate for the treatment of mastoiditis at this stage. Radical operation on the middle ear, also known as radical mastoidectomy, may be indicated in some cases of chronic otitis media with extensive bone destruction or cholesteatoma, but it is not typically indicated for acute mastoiditis. Therefore, option A (mastoidotomy) is the correct answer. |
24. The most available and informative diagnostic method for closed trauma of the urinary bladder is:
A. Retrograde cystography
B. Pelvic arteriography
C. Cystography
D. Sonography of the urinary bladder
E. Palpation and percussion of abdomen
Answer: Retrograde cystography
Explanation
| Closed trauma of the urinary bladder can occur as a result of direct trauma to the lower abdomen or pelvic region, such as in a car accident or a fall. Symptoms of bladder trauma may include pain or tenderness in the lower abdomen, difficulty urinating, and blood in the urine. Retrograde cystography is a diagnostic imaging test that involves injecting a contrast agent through the urethra and into the urinary bladder, then taking X-ray images of the bladder to assess for any abnormalities or injuries. This test is considered the most informative and accurate method for diagnosing bladder trauma, as it can detect even small injuries to the bladder wall that may be missed by other diagnostic methods. Other diagnostic methods that may be used to evaluate bladder trauma include CT scan, MRI, and ultrasound. However, retrograde cystography is often considered the first-line diagnostic test for bladder trauma due to its high accuracy and availability. Therefore, option A (retrograde cystography) is the correct answer. |
25. Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:
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 the case of a closed fracture of the medial malleolus in a 45-year-old female patient with displacement up to 3 mm, the foot should be fixed with a plaster cast in a position of right angle with varus positioning of the foot. The medial malleolus is the bony prominence on the inside of the ankle, and fractures of this bone are a common type of ankle injury. The goal of immobilization with a plaster cast is to stabilize the fracture and promote healing. In cases of medial malleolus fractures with displacement up to 3 mm, immobilization in a position of right angle with varus positioning of the foot is typically recommended. This position helps to align the fracture fragments and promote healing, while also minimizing stress on the fracture site. Options B, C, D, and E are not typically indicated for immobilization of medial malleolus fractures. Plantar flexion, pronation, supination, and dorsal flexion of the foot may be used for other types of ankle injuries or fractures, but they are not appropriate for the specific case of a medial malleolus fracture with displacement. Therefore, option A (at right angle with varus positioning of the foot) is the correct answer. |
26. A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate – 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration and pulse – ratio is 1:2. The heart dullness under normal size. Such signs characterise:
A. Respiratory failure of III degree
B. Respiratory failure of I degree
C. Respiratory failure of II degree
D. Myocarditis
E. Congenital heart malformation
Answer: Respiratory failure of III degree
Explanation
| In the case of a 3-month-old infant suffering from acute segmental pneumonia with severe respiratory distress, dyspnea, paradoxical breathing, tachycardia, total cyanosis, and a respiratory-to-pulse ratio of 1:2, the signs indicate respiratory failure of III degree. Respiratory failure is a condition in which the respiratory system is unable to meet the oxygen and carbon dioxide exchange needs of the body. It is classified into three degrees based on the severity of the symptoms and blood gas abnormalities. In respiratory failure of III degree, the patient experiences severe respiratory distress with tachypnea (a respiratory rate of more than 60 breaths per minute) and the need for mechanical ventilation. The respiratory-to-pulse ratio of 1:2 indicates severe respiratory distress, and the presence of cyanosis suggests severe hypoxemia. Myocarditis and congenital heart malformation can cause similar symptoms, but in this case, there is no indication of heart enlargement or abnormal heart sounds on examination, which makes these conditions less likely. Therefore, option A (respiratory failure of III degree) is the correct answer. |
27. A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is your diagnosis?
A. Measles
B. Allergic rash
C. Rubella
D. Scarlet fever
E. Pseudotuberculosis
Answer: Measles
Explanation
| In the case of a 3-year-old child with fever, cough, coryza, conjunctivitis, and a maculopapular rash on the face after taking sulfadimethoxine, the diagnosis is likely to be measles. Measles is a highly contagious viral infection that is characterized by fever, cough, coryza (runny nose), conjunctivitis, and a rash that typically appears on the face and then spreads to the rest of the body. The rash is maculopapular in nature, which means it consists of flat and raised red spots. Sulfadimethoxine is an antibiotic that is not effective against viral infections like measles. The appearance of the rash after taking sulfadimethoxine could be a result of a drug reaction, but the combination of symptoms, including fever, cough, coryza, and conjunctivitis, strongly suggests measles. Therefore, option A (measles) is the correct answer. |
28. A 2 year old 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
| In the case of a 2-year-old girl with low-grade fever, severe catarrhal symptoms, a slight maculopapular rash on the buttocks, and enlarged occipital lymph nodes, the diagnosis is likely to be rubella. Rubella, also known as German measles, is a viral infection that is characterized by symptoms such as low-grade fever, sore throat, conjunctivitis, and a rash that typically begins on the face and then spreads to the rest of the body, including the buttocks. The rash is maculopapular and often described as “faint” or “slight.” Enlarged occipital lymph nodes are a common feature of rubella, and the catarrhal symptoms (nasal congestion, cough, and runny nose) are also consistent with the diagnosis. Scarlet fever, measles, and adenoviral infections can also cause similar symptoms, but they typically have different rash patterns and other distinguishing features. Pseudotuberculosis is not a common cause of respiratory symptoms and rash in children. Therefore, option A (rubella) is the correct answer. |
29. A 3 year old boy fell ill abruptly: fever up to 39oC, weakness, vomitng. Haemorrhagic rash of various size appeared on his lower limbs within 5 hours. Meningococcemia with infective – toxic shock of the 1 degree was diagnosed. What medications should be administered?
A. Chloramphenicol succinate and prednisone
B. Penicillin and prednisone
C. Penicillin and immunoglobulin
D. Chloramphenicol succinate and interferon
E. Ampicillin and immunoglobulin
Answer: Chloramphenicol succinate and prednisone
Explanation
| In the case of a 3-year-old boy with sudden onset of fever, weakness, vomiting, and a hemorrhagic rash on the lower limbs within 5 hours, meningococcemia with infective-toxic shock of the 1 degree is diagnosed. The appropriate medications to administer in this case are chloramphenicol succinate and prednisone. Meningococcemia is a serious bacterial infection caused by Neisseria meningitidis, which can cause sepsis and septic shock, leading to organ failure and even death. Chloramphenicol is an antibiotic that is effective against Neisseria meningitidis, and it is commonly used for the treatment of meningococcemia. Prednisone is a corticosteroid that can help to reduce the inflammation and swelling associated with the infection. Penicillin is also effective against Neisseria meningitidis, but it may not be the best choice in cases of severe sepsis and shock, as it has a slower onset of action compared to chloramphenicol. Immunoglobulin may be used in some cases of meningococcal infection, but it is not typically a first-line treatment. Interferon and ampicillin are not typically used in the treatment of meningococcemia. Therefore, option A (chloramphenicol succinate and prednisone) is the correct answer. |
30. A woman delivered a child. It was her fifth pregnancy but the first delivery. Mother’s blood group is A(II)Rh−, newborn’s – A(II)Rh+. The level of indirect bilirubin in umbilical blood was 58 micromole/l, haemoglobin – 140 g/l, RBC3, 8 · 1012/l. In 2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (ictericanemic type, Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:
A. Replacement blood transfusion (conservative therapy)
B. Conservative therapy
C. Blood transfusion (conservative therapy)
D. Symptomatic therapy
E. Antibiotics
Answer: Replacement blood transfusion (conservative therapy)
Explanation
| In the case of a newborn with A(II)Rh+ blood and a mother with A(II)Rh- blood, and a diagnosis of hemolytic disease of the newborn (icteric-anemic type, Rh-incompatibility) based on the elevated level of indirect bilirubin in umbilical blood and the subsequent increase in this level after 2 hours, the appropriate therapeutic tactic is replacement blood transfusion (conservative therapy). Hemolytic disease of the newborn occurs when the mother and baby have incompatible blood types, such as in this case with Rh incompatibility. The mother’s Rh-negative immune system produces antibodies against the Rh-positive fetal blood cells, leading to their destruction and the subsequent release of bilirubin, which can cause jaundice and other complications in the newborn. In cases of severe hemolytic disease of the newborn, replacement blood transfusion is the standard treatment. This involves replacing the newborn’s blood with compatible donor blood to reduce the concentration of bilirubin and prevent further hemolysis. Conservative therapy may also be used in conjunction with blood transfusion, such as phototherapy to help break down bilirubin in the bloodstream. Symptomatic therapy may be used to manage complications of hemolytic disease of the newborn, such as respiratory distress or anemia, but it is not the primary treatment. Antibiotics are not indicated in the treatment of hemolytic disease of the newborn. Therefore, option A (replacement blood transfusion, conservative therapy) is the correct answer. |
31. Infant is 6,5 months now and is given natural feeding since birth. Body mass was 3,5 kg, with length 52 cm at birth. How many times per day the supplement (up feeding) should be given? A. 2 B. 3 C. 1 D. 0 E. 4 32. A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?
A. Intestinal bacillus
B. Helicobacter pylory
C. Salmonella
D. Lambliosis
E. Influenza
Answer: Intestinal bacillus
Explanation
| In the case of an infant who is 6.5 months old and has been exclusively breastfed since birth, the number of times per day the supplement (up feeding) should be given depends on the infant’s growth and nutritional needs. It is recommended to start introducing solid foods around 6 months of age, but breast milk should remain the main source of nutrition until at least 12 months of age. The frequency and amount of supplement (up feeding) will vary depending on the infant’s appetite, growth, and development. Generally, it is recommended to offer small amounts of food once or twice a day initially, gradually increasing the frequency and variety of foods as the infant gets older and more accustomed to eating solid foods. Therefore, without more information on the infant’s growth and nutritional needs, it is not possible to determine the specific number of times per day the supplement (up feeding) should be given. Options A, B, C, D, and E are all incorrect. Regarding the etiology of stomach ulcers in a 12-year-old child, it is most commonly caused by Helicobacter pylori, a type of bacteria that can infect the stomach lining and cause inflammation and ulcers. Intestinal bacillus, Salmonella, and Lambliosis are not typically associated with stomach ulcers. Influenza is a viral infection that primarily affects the respiratory system and is not typically associated with stomach ulcers. Therefore, the correct answer to question 32 is option B (Helicobacter pylori). |
33. A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?
A. Carbohydrates
B. Salt
C. Liquid
D. Proteins
E. Fats
Answer: Carbohydrates
Explanation
| In the case of a nine-year-old child with acute glomerulonephritis, the acute phase of the disease requires careful management of nutrition to prevent complications and promote recovery. During this period, it is important to limit certain nutrients, but carbohydrates must not be limited. Acute glomerulonephritis is an inflammatory disease of the kidneys that can affect their ability to filter waste products from the blood. It can lead to fluid retention, high blood pressure, and other complications. Nutritional management of acute glomerulonephritis typically involves limiting salt, protein, and liquid intake to reduce the workload on the kidneys and manage fluid balance. However, carbohydrates are an important source of energy for the body, and they should not be limited during the acute phase of glomerulonephritis. Carbohydrates provide energy for the body’s metabolic processes and help to maintain normal blood sugar levels. Limiting carbohydrates during the acute phase of glomerulonephritis can lead to malnutrition and negatively affect the healing process. Therefore, option A (carbohydrates) is the correct answer. |
34. Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?
A. Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)
B. Diaphanoscоpy
C. Palpation of the external inguinal ring
D. Punction of the scrotum
E. Examination of the formation in Trendelenburg’s position
Answer: Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)
Explanation
| In the case of a 3-month-old child with scrotum growth on the right that has an elastic consistency and changes in size during sleep and crying, the most helpful examination for making a correct diagnosis is palpation of the thickened cord crossing the pubic tubercle (sign of the silk glove). The most likely diagnosis in this case is a congenital inguinal hernia, which occurs when a portion of the intestine protrudes through a weakened area in the abdominal wall and into the scrotum. The hernia sac can be felt as a soft, elastic bulge in the scrotum, which may change in size with changes in intra-abdominal pressure, such as during crying or straining. Palpation of the thickened cord crossing the pubic tubercle (sign of the silk glove) is a useful diagnostic maneuver for differentiating between a hernia and other conditions that may cause scrotal swelling. This involves palpating the cord above the scrotum, which should feel like a “silk glove” or a soft, smooth, cylindrical structure. If the cord feels thickened or irregular, this suggests the presence of a hernia. Diaphanoscopy, palpation of the external inguinal ring, and examination of the formation in Trendelenburg’s position are also useful diagnostic maneuvers for evaluating scrotal swelling, but they may not be as specific for diagnosing a hernia. Punction of the scrotum is not typically indicated for the diagnosis of a hernia and may cause complications. Therefore, option A (palpation of the thickened cord crossing the pubic tubercle) is the correct answer. |
35. A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?
A. IHD. Unstable angina
B. Cardialgia due to spine problem
C. IHD. Functional Class II angina
D. Myocarditis
E. Myocardial dystrophy
Answer: IHD. Unstable angina
Explanation
| In the case of a 52-year-old patient with a history of functional Class II angina who presents with intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days, and angina that is less responsive to nitroglycerine, the most probable diagnosis is IHD (ischemic heart disease) with unstable angina. Unstable angina is a type of acute coronary syndrome that occurs when there is a sudden decrease in blood flow to the heart, usually due to a partially blocked coronary artery. This can lead to chest pain or discomfort that is more severe, prolonged, and less responsive to nitroglycerine than stable angina. Unstable angina is considered a medical emergency and requires prompt evaluation and treatment to prevent complications such as myocardial infarction. Cardialgia due to spine problem, myocarditis, and myocardial dystrophy are less likely in this case, as they typically present with different symptoms and are not typically associated with a history of functional Class II angina. Therefore, the correct answer to this question is option A (IHD. Unstable angina). |
36. A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
A. Hypothiazid
B. Dibazol
C. Clonidine
D. Kapoten
E. Nifedipin
Answer: Hypothiazid
Explanation
| In the case of a 52-year-old patient with hypervolemic type of essential hypertension, the medication that is typically prescribed either as monotherapy or in combination with other antihypertensive drugs is Hypothiazid. Hypothiazid, also known as hydrochlorothiazide, is a thiazide diuretic that works by increasing urine output and reducing blood volume, which helps to lower blood pressure. Thiazide diuretics are a first-line treatment for hypertension and are particularly effective in patients with hypervolemic hypertension, which is characterized by increased blood volume. Dibazol, clonidine, kapoten, and nifedipine are also antihypertensive medications, but they are not typically used as first-line treatments for hypervolemic hypertension. Dibazol, also known as bendroflumethiazide, is a thiazide-like diuretic, but it is less commonly used than hydrochlorothiazide due to its lower potency. Clonidine is a centrally acting alpha-agonist that works by reducing sympathetic activity in the nervous system, but it is typically reserved for patients with resistant hypertension or as a second-line treatment. Kapoten, also known as captopril, is an ACE inhibitor that works by blocking the production of angiotensin II, a hormone that increases blood pressure. ACE inhibitors are effective in many patients with hypertension, but they are less effective in patients with hypervolemic hypertension. Nifedipine is a calcium channel blocker that works by relaxing the smooth muscles in the blood vessels, which helps to lower blood pressure. It is effective in many patients with hypertension, but it is less effective in patients with hypervolemic hypertension. Therefore, the correct answer to this question is option A (Hypothiazid). |
37. A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps – 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
A. CHF- 2 B
B. CHF- 1
C. CHF- 2 А
D. CHF- 0
E. CHF- 3
Answer: CHF- 2 B
Explanation
| In the case of a 62-year-old patient who complains of rest dyspnea, heart pains, and has a history of myocardial infarction, the physical examination findings of orthopnea, acrocyanosis, swollen cervical veins, total heart enlargement, liver enlargement, and shin edema suggest the stage of chronic heart failure (CHF) to be CHF- 2 B. CHF is a progressive condition in which the heart is unable to pump enough blood to meet the body’s needs. It is typically classified into four stages based on the severity of symptoms and limitations on physical activity. The New York Heart Association (NYHA) functional classification system is commonly used to determine the stage of CHF. In this case, the patient’s symptoms and physical examination findings suggest a moderate degree of heart failure. The presence of orthopnea, acrocyanosis, swollen cervical veins, and liver enlargement indicate the development of right-sided heart failure, while the presence of shin edema indicates the development of left-sided heart failure. Based on the NYHA functional classification system, CHF- 2 B corresponds to moderate symptoms (Class II) with marked limitation of physical activity (Class B). This is consistent with the patient’s symptoms and physical examination findings. Therefore, the correct answer to this question is option A (CHF- 2 B). |
38. A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
A. Gastritis of type B
B. Gastritis of type A
C. Reflux-gastritis
D. Menetrier’s gastritis
E. Rigid antral gastritis
Answer: Gastritis of type B
Explanation
| In the case of a 27-year-old man who complains of epigastric pain that is relieved by food intake, and has antral erosive gastritis with Helicobacter pylori detected on biopsy, the most probable diagnosis is gastritis of type B. Gastritis is an inflammation of the lining of the stomach, which can have various causes. Gastritis can be classified into different types based on the underlying cause, histological features, and clinical manifestations. Gastritis of type B, also known as chronic atrophic gastritis, is a type of gastritis that is usually associated with Helicobacter pylori infection. It typically affects the antrum of the stomach and may be asymptomatic or present with symptoms such as epigastric pain, nausea, and bloating. The symptoms of gastritis of type B are often relieved by food intake, which can neutralize the gastric acid and reduce irritation of the stomach lining. The presence of antral erosive gastritis and Helicobacter pylori detected on biopsy support the diagnosis of gastritis of type B. Helicobacter pylori is a bacterial infection that can cause chronic inflammation of the stomach lining, which can lead to the development of erosive gastritis and other complications. Reflux gastritis, Menetrier’s gastritis, and rigid antral gastritis are less likely in this case, as they typically present with different symptoms and have different histological features. Therefore, the correct answer to this question is option A (Gastritis of type B). |
39. Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?
A. Focal
B. Disseminated
C. Miliary
D. Fibro-cavernous
E. Tuberculoma
Answer: Focal
Explanation
| In the case of a 25-year-old man who undergoes prophylactic photoroentgenography examination and is found to have focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung, the clinical form that can be suspected is focal tuberculosis. Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, which can affect various organs of the body, but most commonly affects the lungs. Tuberculosis can present in different clinical forms depending on the extent and severity of the infection. Focal tuberculosis is a type of pulmonary tuberculosis in which there are one or more localized areas of infection in the lung. The radiological findings of small and medium intensity focal shadowings with irregular contours are consistent with this diagnosis. Disseminated tuberculosis, miliary tuberculosis, fibro-cavernous tuberculosis, and tuberculoma are other clinical forms of tuberculosis that can present with different radiological findings and clinical manifestations. Disseminated tuberculosis is a type of tuberculosis in which the infection has spread to multiple organs and tissues, including the lungs, and can present with a wide range of symptoms and radiological findings. Miliary tuberculosis is a type of tuberculosis in which there are numerous small nodular lesions throughout the lung that resemble millet seeds and can also affect other organs. Fibro-cavernous tuberculosis is a type of tuberculosis in which there are fibrotic changes and cavities in the lung due to chronic inflammation and scarring. Tuberculoma is a type of tuberculosis in which there is a localized mass or nodule in the lung that is typically well-defined and surrounded by a fibrous capsule. Therefore, based on the radiological findings described, the most probable clinical form of tuberculosis in this case is focal tuberculosis, and the correct answer to this question is option A (Focal). |
40. A woman 26 years old has abused alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal syndrome. Drinks almost every day approximately 50-100 g of wine. She is in her 4-th week of pregnancy. Primary prevention of fetal alcohol syndrome requires:
A. Treatment of alcoholism and full abstinance from alcohol during all the period of pregnancy
B. Medical abortion
C. Decrease of alcohol use
D. Participation in the A-ANON group
E. Gyneacological observation
Answer: Treatment of alcoholism and full abstinance from alcohol during all the period of pregnancy
Explanation
| In the case of a 26-year-old woman who has abused alcohol for 7 years and is in her 4th week of pregnancy, the primary prevention of fetal alcohol syndrome requires treatment of alcoholism and full abstinence from alcohol during all the period of pregnancy. Fetal alcohol syndrome (FAS) is a condition that can occur in babies born to mothers who consume alcohol during pregnancy. It is characterized by a range of physical, behavioral, and cognitive abnormalities that can have lifelong consequences for the affected individual. Prevention of FAS requires primary prevention, which involves avoiding alcohol consumption during pregnancy. In this case, the woman has a history of alcohol abuse and is currently drinking almost every day, which puts her unborn child at risk of developing FAS. Treatment of alcoholism and full abstinence from alcohol during all the period of pregnancy is the most effective way to prevent FAS in this case. The woman should be referred to a specialist or a treatment program for alcoholism, which can provide counseling, support, and medication-assisted treatment if needed. Additionally, she should be advised to abstain from alcohol completely during pregnancy, as even small amounts of alcohol can have harmful effects on the developing fetus. Decrease of alcohol use, participation in the A-ANON group, and gynecological observation may be helpful for managing alcoholism and providing support during pregnancy, but they are not sufficient for preventing FAS. Medical abortion may be considered in cases where the pregnancy poses a significant risk to the mother’s health, but it is not a primary prevention strategy for FAS. Therefore, the correct answer to this question is option A (Treatment of alcoholism and full abstinence from alcohol during all the period of pregnancy). |
41. The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stiffens in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:
A. Catatonic stupor, schizophrenia
B. Depressive stupor, bipolar disorder
C. Apathetic stupor, schizophrenia
D. Psychogenic stupor, stress disorder
E. Dissociative stupor, dissociative psychosis
Answer: Catatonic stupor, schizophrenia
Explanation
| The probable disorder in the described case is catatonic stupor, which is often associated with schizophrenia. Catatonic stupor is a state of decreased reactivity to the environment, characterized by psychomotor retardation, mutism, and immobility. In this state, the patient may appear unresponsive to external stimuli, show a lack of spontaneous movement, and assume unusual postures or positions. The ability to maintain a position against gravity for a prolonged period is known as waxy flexibility, which is a characteristic feature of catatonic stupor. Schizophrenia is a mental disorder characterized by a range of symptoms, including delusions, hallucinations, disorganized speech, and abnormal behavior. Catatonic symptoms are a subtype of schizophrenia, which can present with a range of catatonic features, including stupor, waxy flexibility, and other unusual movements or postures. Other disorders, such as depressive stupor, apathetic stupor, psychogenic stupor, and dissociative stupor, may also present with symptoms of immobility and decreased reactivity, but they typically have different clinical features and underlying causes. Depressive stupor is a state of severe depression characterized by psychomotor retardation, withdrawal, and decreased responsiveness, which is often associated with major depressive disorder. Apathetic stupor is a state of emotional withdrawal and lack of responsiveness, which can be seen in various mental disorders, including schizophrenia, depression, and other conditions. Psychogenic stupor is a state of decreased reactivity that is thought to be caused by psychological factors, such as stress, trauma, or dissociation. Dissociative stupor is a state of decreased responsiveness that is associated with dissociative disorders, which are characterized by a disruption of normal integration of consciousness, memory, and identity. Therefore, based on the description provided, the most probable disorder in this case is catatonic stupor, which is often associated with schizophrenia. The correct answer to this question is option A (Catatonic stupor, schizophrenia). |
42. The man, aged 42, applied to the therapeutist with complaints of pricking pains in scapulas area, dyspnea on physical exertion, cough with discharge of small amount of sputum. During 10 years he works in coal mining. On percussionbox-note sound in the lower parts, on auscultation- a harsh breathing. There were no changes in the heart. Possible diagnosis?
A. Silicosis
B. Tuberculosis of lungs
C. Silicatosis
D. Bronchiectatic disease
E. Chronic bronchitis
Answer: Silicosis
Explanation
| In the case of a 42-year-old man with complaints of pricking pains in the scapular area, dyspnea on physical exertion, cough with discharge of small amounts of sputum, and a history of working in coal mining for 10 years, the possible diagnosis is silicosis. Silicosis is a lung disease caused by inhaling silica dust, which is a common occupational hazard in mining, construction, and other industries. The disease is characterized by the formation of nodules and fibrous tissue in the lungs, which can lead to progressive lung damage, respiratory symptoms, and other complications. The symptoms of silicosis can vary depending on the severity and duration of the exposure to silica dust. In the case described, the patient’s symptoms of respiratory distress, cough, and sputum production are consistent with silicosis. The presence of a harsh breathing sound on auscultation and percussion box-note sound in the lower parts of the lungs also suggests the presence of lung fibrosis. Tuberculosis of the lungs, bronchiectatic disease, chronic bronchitis, and silicatosis are other possible diagnoses that can present with similar respiratory symptoms, but they typically have different clinical features and underlying causes. Tuberculosis of the lungs is a bacterial infection caused by Mycobacterium tuberculosis, which can cause respiratory symptoms, cough, and sputum production, but may also present with other symptoms, such as fever, night sweats, and weight loss. Bronchiectatic disease is a condition characterized by irreversible dilation and scarring of the bronchi, which can lead to chronic cough, sputum production, and recurrent respiratory infections. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) characterized by persistent inflammation and narrowing of the airways, which can cause cough, sputum production, and shortness of breath. Silicatosis is a less common term for silicosis, which refers to the lung disease caused by inhalation of silica dust. Therefore, based on the clinical features and occupational history described, the most probable diagnosis in this case is silicosis. The correct answer to this question is option A (Silicosis). |
43. A man, aged 37, working on the collective farm on sowing, was admitted to the infectious hospital with the clinical symptoms: miosis, labored breathing, sweating.What kind of poisoning is it and what is the first aid?
A. Poisoning by POC. Treatment: atropine
B. Poisoning by lead. Treatment: tetacine Calcii
C. Poisoning by the methylic alcohol. Treatment: ethylic alcohol
D. Poisoning by vapours of mercury. Treatment: unithiol
E. –
Answer: Poisoning by POC. Treatment: atropine
Explanation
| In the case of a 37-year-old man who works on a collective farm and is admitted to an infectious hospital with symptoms of miosis, labored breathing, and sweating, the possible poisoning is due to organophosphate compounds (POC), and the first aid treatment is atropine. Organophosphate compounds are a class of chemicals commonly used as insecticides and herbicides in agricultural settings. Exposure to these compounds can cause a range of symptoms, including miosis (constriction of the pupils), sweating, labored breathing, and other signs of cholinergic excess. Atropine is an antidote for organophosphate poisoning and works by blocking the effect of acetylcholine, which is the neurotransmitter that is overstimulated in cases of organophosphate poisoning. Atropine can help to reverse the symptoms of cholinergic excess, including miosis, bronchoconstriction, and excessive sweating. Lead poisoning, methanol poisoning, and mercury poisoning can also cause a range of neurological and respiratory symptoms, but they typically have different clinical features and underlying causes. Lead poisoning is usually associated with exposure to lead-based paint, contaminated soil, or other sources of environmental lead. The symptoms of lead poisoning can include abdominal pain, constipation, anemia, and neurological symptoms, such as headache, fatigue, and confusion. Methanol poisoning can occur from ingestion, inhalation, or skin exposure to methanol-containing products, such as antifreeze or windshield washer fluid. The symptoms of methanol poisoning can include headache, dizziness, nausea, visual disturbances, and respiratory depression. Mercury poisoning is usually associated with exposure to elemental mercury or mercury-containing products, such as thermometers, batteries, or fluorescent light bulbs. The symptoms of mercury poisoning can include neurological symptoms, such as tremors, memory loss, and difficulty walking. Therefore, based on the clinical features described, the most probable poisoning in this case is due to organophosphate compounds, and the first aid treatment is atropine. The correct answer to this question is option A (Poisoning by POC. Treatment: atropine). |
44. The 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, difficult respiration. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?
A. Botulism
B. Yersiniosis
C. Leptospirosis
D. Salmonellosis, gastrointestinal form
E. Lambliasis
Answer: Botulism
Explanation
| In the case of a 25-year-old patient with complaints of double vision, difficult respiration, and a recent history of eating homemade mushrooms, the most likely diagnosis is botulism. Botulism is a rare but serious bacterial infection caused by Clostridium botulinum toxin, which is commonly found in soil and can contaminate certain foods, especially home-canned or fermented foods. The toxin can cause a range of symptoms, including double vision, difficulty swallowing, respiratory distress, bradycardia, and constipation. The symptoms of botulism typically appear within 6-36 hours after exposure to the toxin and can progress rapidly, leading to respiratory failure and other complications. Early diagnosis and treatment are critical in the management of botulism, as the toxin can be fatal if left untreated. Yersiniosis, leptospirosis, salmonellosis, and giardiasis are other possible diagnoses that can cause gastrointestinal symptoms, but they typically have different clinical features and underlying causes. Yersiniosis is a bacterial infection caused by Yersinia enterocolitica, which can cause diarrhea, abdominal pain, and fever. Leptospirosis is a bacterial infection caused by Leptospira spp., which can cause a range of symptoms, including fever, headache, muscle pain, and jaundice. Salmonellosis is a bacterial infection caused by Salmonella spp., which can cause diarrhea, abdominal pain, and fever. Giardiasis is a parasitic infection caused by Giardia lamblia, which can cause diarrhea, abdominal pain, and other gastrointestinal symptoms. Therefore, based on the clinical features and recent history of eating homemade mushrooms, the most probable diagnosis in this case is botulism. The correct answer to this question is option A (Botulism). |
45. A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39, 0oC, headache, weakness, constipation on the 9th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?
A. Typhoid fever
B. Leptospirosis
C. Brucellosis
D. Sepsis
E. Malaria
Answer: Typhoid fever
Explanation
| In the case of a 28-year-old patient with complaints of fever, headache, weakness, constipation, and roseola on the skin of the abdomen on the 9th day of the disease, the most probable diagnosis is typhoid fever. Typhoid fever is a bacterial infection caused by Salmonella enterica serovar Typhi, which is transmitted through contaminated food or water. The symptoms of typhoid fever can include high fever, headache, weakness, abdominal pain, constipation or diarrhea, and a characteristic rash of rose-colored spots on the trunk of the body. Enlargement of the liver (hepatomegaly) is also a common finding in typhoid fever. Leptospirosis, brucellosis, sepsis, and malaria can also cause fever and other systemic symptoms, but they typically have different clinical features and underlying causes. Leptospirosis is a bacterial infection caused by Leptospira spp., which can cause a range of symptoms, including fever, headache, muscle pain, and jaundice. Brucellosis is a bacterial infection caused by Brucella spp., which can cause fever, chills, sweats, weakness, and joint pain. Sepsis is a serious medical condition caused by an overwhelming immune response to an infection, which can cause fever, rapid heartbeat, low blood pressure, and other symptoms. Malaria is a parasitic infection transmitted by mosquitoes, which can cause fever, chills, headache, and other symptoms. Therefore, based on the clinical features and history of the disease, the most probable diagnosis in this case is typhoid fever. The correct answer to this question is option A (Typhoid fever). |
46. A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?
A. Hepatic encephlopathy
B. Meningitis
C. Relapse of viral hepatitis
D. Cholangitis
E. Infectious-toxic shock
Answer: Hepatic encephlopathy
Explanation
| In the case of a patient with a gradual onset of nausea, vomiting, dark urine, acholic stools, jaundice, and liver enlargement, which later diminished in size, the complication of viral hepatitis that caused deterioration of the patient’s condition is most likely hepatic encephalopathy. Hepatic encephalopathy is a serious complication that can occur in patients with liver disease, including viral hepatitis, and is characterized by a range of neurological symptoms, such as confusion, lethargy, and coma. The condition is caused by the accumulation of toxic substances, such as ammonia, in the blood, which can affect brain function and lead to neurological symptoms. In viral hepatitis, the liver is inflamed and damaged, which can impair its ability to function properly and result in the accumulation of toxins in the blood. As the disease progresses, the risk of hepatic encephalopathy increases, especially in severe cases of hepatitis. Meningitis, relapse of viral hepatitis, cholangitis, and infectious-toxic shock are other possible complications of viral hepatitis, but they typically have different clinical features and underlying causes. Meningitis is a bacterial or viral infection of the membranes surrounding the brain and spinal cord, which can cause fever, headache, and other neurological symptoms. Relapse of viral hepatitis can occur in some patients, especially those with chronic hepatitis B or C, and is characterized by a recurrence of symptoms, such as jaundice and liver enlargement. Cholangitis is an inflammation of the bile ducts, which can occur in patients with viral hepatitis and can cause abdominal pain, fever, and jaundice. Infectious-toxic shock is a serious medical condition caused by a bacterial infection, which can cause fever, low blood pressure, and other symptoms. Therefore, based on the clinical features and history of the disease, the most probable complication of viral hepatitis that caused deterioration of the patient’s condition in this case is hepatic encephalopathy. The correct answer to this question is option A (Hepatic encephalopathy). |
47. An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen – by 1 cm. In blood: leukocytosis, atypical lymphocytes – 15%. What is the most probable diagnosis?
A. Infectious mononucleosis
B. Acute lymphoid leukosis
C. Diphtheria
D. Angina
E. Adenoviral infection
Answer: Infectious mononucleosis
Explanation
| Infectious mononucleosis is a viral infection caused by the Epstein-Barr virus (EBV) that typically affects young adults and adolescents. The symptoms of infectious mononucleosis include fever, sore throat, headache, fatigue, and swollen lymph nodes. Enlargement of the liver and spleen is also common. In addition to these symptoms, the laboratory findings in infectious mononucleosis typically include leukocytosis (an increase in the number of white blood cells) and the presence of atypical lymphocytes. Atypical lymphocytes are abnormal white blood cells that are larger than normal lymphocytes and have an irregular shape. In summary, the combination of symptoms and laboratory findings described in this case (headache, weakness, high temperature, sore throat, enlarged lymph nodes, leukocytosis, and atypical lymphocytes) is highly suggestive of infectious mononucleosis, making option A the correct answer. |
48. A 4 year old girl was playing with her toys and suddenly she got an attack of cough, dyspnea. Objectively: respiration rate – 45/min, heart rate – 130/min. Percussion revealed dullness of percutory sound on the right in the lower parts. Auscultation revealed diminished breath sounds with bronchial resonance on the right. X-ray pictue showed shadowing of the lower part of lungs on the right. Blood analysis revealed no signs of inflammation. The child was diagnosed with foreign body in the right bronchus. What complication caused such clinical presentations?
A. Atelectasis
B. Emphysema
C. Pneumothorax
D. Bronchitis
E. Pneumonia
Answer: Atelectasis
Explanation
| Atelectasis is a condition in which one or more areas of the lung collapse or become partially or completely blocked. This can lead to symptoms such as cough, dyspnea, and diminished breath sounds on auscultation. In this case, the presence of dullness of percutory sound on the right in the lower parts, diminished breath sounds with bronchial resonance on the right, and shadowing of the lower part of the lungs on the right on X-ray are all highly suggestive of atelectasis. The foreign body in the right bronchus is likely causing obstruction of the airway, leading to collapse of the affected lung tissue. Option A, Atelectasis, is therefore the correct answer. Emphysema, pneumothorax, bronchitis, and pneumonia are all possible respiratory conditions, but they are less likely to be the cause of the symptoms described in this case given the clinical and radiological findings. |
49. A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas
B. Infectious hepatitis
C. Haemolytic jaundice
D. Malignant biliary stricture
E. Metastatic disease of liver
Answer: Carcinoma of the head of the pancreas
Explanation
| The most likely diagnosis in this case is carcinoma (cancer) of the head of the pancreas, making option A the correct answer. Pancreatic cancer is a malignant tumor that arises from the cells of the pancreas. The head of the pancreas is the most common location for pancreatic cancer to occur. Symptoms of pancreatic cancer can include jaundice, weight loss, and a palpable mass in the upper abdomen. The presence of jaundice in this patient suggests that there is obstruction of the bile duct, which can occur when the head of the pancreas is enlarged due to a tumor. The hard, globular mass in the right upper quadrant that moves during respiration is also consistent with a pancreatic tumor. The CT scan showing enlargement of the head of the pancreas and no filling defects in the liver is also highly suggestive of pancreatic cancer. In summary, the combination of symptoms, physical examination findings, and imaging results described in this case (jaundice, weight loss, hard globular mass in the right upper quadrant that moves during respiration, and enlargement of the head of the pancreas on CT) is highly suggestive of carcinoma of the head of the pancreas. |
50. A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:
A. Coronary artery bypass grafting
B. Intravenous streptokinase
C. Excercise testing
D. Oral aspirin
E. Antihypertensive therapy
Answer: Coronary artery bypass grafting
Explanation
| Unstable angina pectoris is a serious medical condition that requires prompt and effective treatment to prevent further damage to the heart. In this case, the patient has failed to respond to multiple medications, including heparin, nitroglycerin, beta-adrenergic blockers, and calcium channel antagonists, indicating that his condition is severe and warrants more aggressive intervention. Coronary artery bypass grafting (CABG) is a surgical procedure used to treat severe coronary artery disease by redirecting blood flow around a blocked or narrowed section of an artery. It is a highly effective treatment for unstable angina that has not responded to medication, as it can restore blood flow to the heart and reduce the risk of a heart attack. Intravenous streptokinase is a medication used to dissolve blood clots in the arteries and is not usually indicated in the treatment of unstable angina. Exercise testing may be useful in diagnosing unstable angina, but it is not a treatment for the condition. Oral aspirin is often prescribed to patients with unstable angina to prevent blood clots, but it is not a primary treatment for this condition. Antihypertensive therapy may be useful in treating high blood pressure, but it is not the primary treatment for unstable angina. |
