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1. A patient suddenly felt an acute chest pain irradiating to the left arm. Objectively: the patient is excited, with pale skin. Breathing rate – 38/min, AP – 180/110 mm Hg. Later the patient lost consciousness and fell down. Pulse on the great vessels was absent, the pupils were equally dilated. What is the most likely diagnosis?

A. Clinical death

B. Agonal state

C. Coma

D. Heart attack

E. Disorder of the cerebral circulation


Answer: Clinical deat

Explanation

The provided symptoms, including acute chest pain radiating to the left arm, excited behavior, pale skin, high blood pressure, loss of consciousness, absent pulse on the great vessels, and equally dilated pupils, are indicative of a severe medical emergency but not clinical death.   Clinical death refers to the complete cessation of vital functions, including the absence of heartbeat, breathing, and brain function. It is a state from which a person cannot be revived.

However, the symptoms described in the scenario do not suggest clinical death. Instead, they suggest a medical condition that requires immediate attention and intervention.   Given the symptoms provided, the most likely diagnosis is D. Heart attack (myocardial infarction). A heart attack occurs when there is a blockage in the blood vessels supplying the heart muscle, leading to a sudden decrease or cessation of blood flow to a certain part of the heart.

The symptoms of chest pain, radiation to the left arm, pale skin, elevated blood pressure, loss of consciousness, absent pulse on the great vessels, and equally dilated pupils are consistent with a heart attack.   It is important to recognize the severity of these symptoms and seek emergency medical care immediately if someone experiences them. Prompt medical intervention can help minimize damage to the heart and improve the chances of a positive outcome. enhance the breakdown or elimination of other substances from the body.

As a result, the presence of one chemical may decrease the concentration or duration of action of another chemical, reducing its overall effect.   It is important to recognize antagonistic interactions because they can impact the efficacy and safety of drugs, environmental exposures, and overall human health. Understanding these interactions helps in evaluating the potential risks and benefits associated with exposure to multiple chemicals or when designing combination therapies in medicine..


2. A 62-year-old patient complaining of enlargement of cervical, supraclavicular and axillary lymph nodes, subfebrile temperature for the last 3 months has been admitted to a hospital. In blood: WBCs – 64 · 109/l, lymphocytes – 72%. What method of study should be used to specify the diagnosis?

A. Myelogram

B. Lymphography

C. Lymphoscintigraphy

D. X-rays

E. Thermography


Answer: Myelogram

Explanation

A myelogram is a diagnostic procedure used to evaluate the spinal cord and spinal canal by injecting a contrast agent into the cerebrospinal fluid. It is primarily used to detect abnormalities such as spinal cord compression or herniated discs, and it is not typically employed to assess lymph node enlargement or lymphatic system disorders.  

Given the patient’s symptoms of enlarged cervical, supraclavicular, and axillary lymph nodes, along with a subfebrile temperature (slightly elevated temperature), a more suitable diagnostic method would be B. Lymphography.   Lymphography is an imaging technique that involves the injection of a contrast agent into the lymphatic system to visualize and assess the lymph nodes and lymphatic vessels.

It is particularly useful in identifying abnormalities, such as lymphadenopathy (enlarged lymph nodes) or lymphatic system disorders. Lymphography can provide valuable information regarding the location and extent of lymph node enlargement, helping to establish a specific diagnosis.  

The elevated white blood cell count (WBCs – 64 · 10^9/l) and increased percentage of lymphocytes (72%) in the blood suggest possible involvement of the lymphatic system. Therefore, lymphography would be a more appropriate method for further evaluation and diagnosis in this case.


3. A child is 2 years old. The child complains of hoarse voice, dyspnea with obstructed inspiration. The disease started 3 days ago from dry cough and nose stuffi- ness. Objectively: general condition is unbalanced, stridor is present. The child’s skin is pale. Body temperature is 37, 7oC. The palatine arches are hyperemic. There is no deposit. Heart sounds are rhythmic. Auscultation of lungs reveals rough breathing sounds, crepitation is absent. Parainfluenza virus has been detected in nasopharynx lavage. What is the most likely diagnosis?

A. Acute laryngotracheitis

B. Epiglottitis

C. Foreign body

D. Diphtheria

E. Laryngospasm


Answer: Acute laryngotracheitis

Explanation

The symptoms described, including hoarse voice, dyspnea with obstructed inspiration, and the disease starting from dry cough and nose stuffiness, are consistent with the clinical presentation of acute laryngotracheitis, commonly known as croup.   Let’s analyze the given information to understand the reasoning: General condition is unbalanced: This indicates that the child’s overall well-being is compromised, possibly due to respiratory distress caused by the condition.  

Stridor is present: Stridor refers to a harsh, high-pitched sound heard during inspiration and is a hallmark sign of upper airway obstruction. Pale skin: Pale skin can be a result of decreased oxygenation due to respiratory compromise.   Body temperature is 37.7°C: A slightly elevated temperature may be present in viral infections.  

Hyperemic palatine arches: Redness and inflammation of the palatine arches (back of the throat) can be observed in viral infections affecting the upper airway. No deposit: The absence of deposits suggests that there is no characteristic pseudomembrane formation, which is seen in conditions like diphtheria. Heart sounds are rhythmic:

This finding suggests no significant cardiac abnormalities.   Auscultation of lungs reveals rough breathing sounds, crepitation is absent: Rough breathing sounds can be heard due to inflammation of the upper airway, which is characteristic of acute laryngotracheitis.

The absence of crepitation (a crackling sound) indicates the absence of lung involvement, differentiating it from lower respiratory tract conditions.   Parainfluenza virus detected: Parainfluenza virus is a common viral cause of croup, supporting the diagnosis.


4. A teacher of a secondary school was diagnosed with pulmonary tuberculosis. What is the maximum duration of his medical certificate?

A. Ten months

B. Five months

C. Four months

D. Two months

E. A month


Answer: Ten months

Explanation

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs (pulmonary tuberculosis). The treatment for pulmonary tuberculosis involves a combination of antibiotics taken over an extended period to ensure complete eradication of the bacteria.  

In most cases, the treatment for pulmonary tuberculosis lasts for a minimum of six months. This treatment duration is essential to effectively eliminate the bacteria and prevent the development of drug-resistant strains. It also helps reduce the risk of transmission to others.  

Considering the treatment duration of six months and allowing for a recovery period, the maximum duration of a medical certificate for a teacher diagnosed with pulmonary tuberculosis is typically extended to ten months.

This duration allows the teacher sufficient time to complete the treatment course, recover fully, and ensure that they are no longer contagious before returning to work.   The other options listed:   B. Five months, C. Four months, D. Two months, E. A month: These durations are shorter than the standard treatment duration for pulmonary tuberculosis and may not provide adequate time for the teacher to complete treatment, recover, and be deemed non-contagious before returning to work.


5. A schizophrenic patient considers himself to be “an outstanding scientist, a brilliant composer and an unrivalled artist”. He complains that “family and friends are always jealous of him and want to poison him”. Determine the psychopathological syndrome:

A. Paranoiac

B. Paranoid

C. Manic

D. Paratrophic

E. Hebephrenic


 Answer: Paranoiac

Explanation

BParanoia is a type of delusional disorder characterized by persistent and unfounded beliefs that others are plotting against or persecuting the individual. The key features of paranoia include grandiose delusions (belief in one’s exceptional abilities or importance) and persecutory delusions (belief that others are jealous, plotting, or trying to harm the person).  

In the case described, the patient considers themselves to be an outstanding scientist, a brilliant composer, and an unrivaled artist, demonstrating grandiose delusions.

Additionally, the complaint of the family and friends being jealous of the patient and wanting to poison them represents persecutory delusions.   These delusions of grandeur and persecution are indicative of a paranoid mindset, which aligns with the symptoms of a paranoiac psychopathological syndrome.


6. Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?

A. Defect of interventricular septum

B. Defect of interatrial septum

C. Coarctation of aorta

D. Fallot’s tetrad

E. Pulmonary artery stenosis


Answer: Defect of interventricular septum

Explanation

The provided clinical findings suggest the presence of a congenital heart defect in the 9-month-old girl. Let’s analyze the given information to understand the reasoning:   Skin pallor and cyanosis during excitement: These symptoms indicate poor oxygenation of the blood, suggesting the presence of a right-to-left shunt, where oxygen-poor blood is bypassing the lungs and mixing with oxygenated blood.  

Percussion reveals transverse dilatation of cardiac borders: This finding suggests enlargement of the heart, which can occur in response to increased blood flow and volume. Auscultation reveals a continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space, conducted above the whole cardiac region to the back: A continuous systolic murmur, audible throughout the cardiac cycle, is a characteristic finding in defects that involve abnormal communication between the ventricles or the great vessels.

The location and radiation of the murmur suggest involvement of the interventricular septum.   Based on these findings, the most likely congenital cardiac pathology is A. Defect of interventricular septum, commonly known as ventricular septal defect (VSD).

VSD is a defect in the septum that separates the left and right ventricles, allowing blood to flow between them. This results in a shunting of blood from the left ventricle (oxygenated blood) to the right ventricle (deoxygenated blood) and a subsequent mixing of oxygenated and deoxygenated blood.


7. A 42-year-old patient complains of back pain, darkened urine, general weakness, dizziness that occurred after treating a cold with aspirin and ampicillin. Objectively: the patient is pale, with subicteric sclerae. HR – 98 bpm. Liver – +2 cm, spleen – +3 cm. In blood: RBCs – 2, 6 · 1012/l, Hb – 60 g/l, CI – 0,9, WBCs – 9, 4 · 109/l, basophils – 0,5%, eosinophils – 3%, stab neutrophils – 6% segmented neutrophils – 58%, lymphocytes – 25%, monocytes – 7%, ESR – 38 mm/hour, reticulocytes – 24%. Total bilirubin – 38 millimole/l. What complication occurred in the patient?

A. Acquired hemolytic anemia

B. Toxic hepatitis

C. Cholelithiasis

D. Agranulocytosis

E. Paroxysmal nocturnal hemoglobinuria


Answer: Acquired hemolytic anemia

Explanation

Acquired hemolytic anemia is a condition characterized by the destruction of red blood cells (hemolysis) caused by various factors. Let’s analyze the provided information to understand the reasoning: Back pain, darkened urine, general weakness, dizziness: These symptoms are indicative of anemia, which is a condition characterized by a decrease in the number of red blood cells or hemoglobin levels.  

Pale appearance and subicteric sclerae: These findings suggest a decrease in red blood cell count and an increase in bilirubin levels. Bilirubin is a byproduct of red blood cell breakdown and its elevation can lead to jaundice.   Enlarged liver and spleen: Hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen) can occur due to increased destruction of red blood cells and congestion in these organs.  

Abnormal blood test results: The blood test results indicate significant abnormalities, including a low red blood cell count (RBCs – 2.6 × 10^12/l) and hemoglobin level (Hb – 60 g/l), elevated reticulocyte count (24%), increased total bilirubin (38 millimole/l), and an elevated erythrocyte sedimentation rate (ESR – 38 mm/hour).  

Based on these findings, the most likely complication is acquired hemolytic anemia. The patient’s symptoms, physical examination findings, and blood test results are consistent with hemolysis, resulting in a decreased red blood cell count, elevated bilirubin levels, and characteristic signs of anemia. The use of aspirin and ampicillin may have triggered an immune-mediated reaction leading to the destruction of red blood cells.


8. A hospital has admitted a 52-yearold patient with disseminated pulmonary tuberculosis, complaints of acute pain in the right half of chest, that developed after going upstairs to the 3rd floor; cough, dyspnea at rest, marked cyanosis. What kind of complication should suspected first of all?

A. Spontaneous pneumothorax

B. Cardiac failure

C. Pulmonary failure

D. Pleuritis

E. Acute myocardial infarction


Answer: Spontaneous pneumothorax

Explanation

Spontaneous pneumothorax refers to the sudden accumulation of air in the pleural space, causing the lung to collapse. Let’s analyze the provided information to understand the reasoning:   Disseminated pulmonary tuberculosis: The patient has a history of disseminated pulmonary tuberculosis, which can weaken the lung tissue and increase the risk of complications.   Acute pain in the right half of the chest: The sudden onset of chest pain suggests a possible acute event, such as a pneumothorax.  

Development of pain after physical exertion (going upstairs to the 3rd floor): Exertion-related activities can increase the intrathoracic pressure, potentially leading to the development of a pneumothorax.   Cough, dyspnea at rest, marked cyanosis: These symptoms indicate respiratory distress and impaired oxygenation, which can occur due to lung collapse and compromised lung function.  

Based on these findings, the most likely complication is A. Spontaneous pneumothorax. The patient’s symptoms, including acute chest pain, dyspnea, and cyanosis, are consistent with a pneumothorax. The physical exertion may have triggered the event due to increased stress on weakened lung tissue.  

Technologies or determine their impact on public health indicators. D. Calculation of statistical significance of the difference between two estimates: This method focuses on comparing two estimates to determine if the difference between them is statistically significant.

While it can be useful in certain contexts, it may not be the most appropriate method for assessing the overall effectiveness of medical technologies and their impact on public health indicators.   Therefore, in this case, calculating the correlation coefficient would be the most suitable method of statistical analysis to assess the relationship between immunization rates and measles incidence rates and determine the effectiveness of medical technologies on public health indicators


9. A 44-year-old patient has been admitted to a hospital with complaints of dull, aching pain in the left lumbar region, the admixture of pus in the urine. Examination revealed a grade II staghorn calculus on the left. What method of treatment is indicated for this patient?

A. Surgery

B. Contact lithotripsy

C. Distance lithotripsy

D. Conservative therapy

E. Ascending litholysi


Answer: Surgery

Explanation

Staghorn calculi are large, branching kidney stones that occupy a significant portion of the renal pelvis and renal calyces. They can cause symptoms such as pain and can lead to complications such as urinary tract infections. Let’s analyze the provided information to understand the reasoning:  

Complaints of dull, aching pain in the left lumbar region and the admixture of pus in the urine: These symptoms indicate a urinary tract infection, which can be caused by the presence of the staghorn calculus. The infection and the stone can lead to pain and discomfort.  

Examination revealed a grade II staghorn calculus on the left: The presence of a staghorn calculus indicates a large stone that occupies the renal pelvis and calyces, causing significant obstruction and potential damage to the kidney.  

Based on these findings, the most appropriate method of treatment for this patient is A. Surgery. Surgical intervention is typically required for the removal of staghorn calculi due to their large size and potential complications.   The specific surgical approach may vary depending on the patient’s condition and the expertise of the healthcare provider, but it commonly involves techniques such as percutaneous nephrolithotomy (PNL) or open surgery to remove the stone.


10. On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child developed ataxia, nystagmus, intention tremor, muscle hypotonia. Liquor analysis shows a low-grade lymphocytic pleocytosis, slightly increased protein rate. What complication is it?

A. Encephalitis

B. Purulent meningitis

C. Pneumonitis

D. Acute nephritis

E. Postherpetic neuralgia


Answer:  Encephalitis

Explanation

Encephalitis refers to inflammation of the brain, often caused by viral infections. In this case, the symptoms of ataxia, nystagmus, intention tremor, and muscle hypotonia, along with the findings in the cerebrospinal fluid (CSF) analysis, suggest a neurological complication.

Let’s analyze the given information to understand the reasoning:   On the 21st day after the appearance of vesicular chickenpox rash: This timeline suggests a delayed neurological complication following chickenpox (varicella) infection.  

Ataxia, nystagmus, intention tremor, muscle hypotonia: These symptoms indicate dysfunction in the coordination and control of voluntary movements, which are commonly associated with involvement of the cerebellum or other areas of the brain.  

CSF analysis shows a low-grade lymphocytic pleocytosis (increased lymphocytes in the CSF) and slightly increased protein rate: These findings are consistent with the presence of inflammation in the central nervous system, supporting the diagnosis of encephalitis.  

Based on these findings, the most likely complication in this case is A. Encephalitis. The neurological symptoms and the presence of lymphocytic pleocytosis and slightly increased protein in the CSF indicate an inflammatory process affecting the brain.


11. A 38-year-old male patient has been taking alcohol for 3 years. 3 days after a regular drinking period he felt anxiety and fear. It appeared to him that he was surrounded by spiders and worms, pursued by some “condemnatory voices”. His behaviour became aggressive. The patient demonstrated correct selfawareness but impairment of temporal and spatial orientation. What is the most likely diagnosis?

A. Delirium alcoholicum

B. Alcoholic paranoia

C. Alcoholic hallucinosis

D. Alcoholic encephalopathy

E. Pathologic intoxication


Answer: Delirium alcoholicum

Explanation

Delirium alcoholicum, also known as alcohol withdrawal delirium or delirium tremens, is a severe form of alcohol withdrawal syndrome that typically occurs in individuals with a history of heavy, chronic alcohol use. It usually develops within 2-4 days after the abrupt cessation of alcohol consumption or a significant reduction in alcohol intake.  

The patient in the scenario has been consuming alcohol regularly for 3 years and experienced anxiety, fear, hallucinations (perceiving spiders and worms), and persecutory auditory hallucinations (condemnatory voices).

These symptoms are consistent with delirium, which is characterized by a disturbance in consciousness and a change in cognition that develops over a short period of time.   Impairment of temporal and spatial orientation, as mentioned in the scenario, is also a common feature of delirium.

This refers to the patient’s difficulty in recognizing and understanding the time and place.   Other features often associated with delirium include restlessness, agitation, sleep disturbances, tremors, and autonomic hyperactivity (elevated heart rate, elevated blood pressure, sweating). Aggressive behavior can also be observed in some cases.

It is important to note that delirium alcoholicum is a medical emergency and requires immediate medical attention. Without appropriate treatment, it can lead to potentially life-threatening complications.


12. An 8-year-old boy suffering from haemophilia was undergoing transfusion of packed red cells. Suddenly he felt pain behind the breastbone and in the lumbar area, dyspnea, cold sweat. Objectively: pale skin, heart rate – 100/min, AP – 60/40 mm Hg; oliguria, brown urine. For the treatment of this complication the following drug should be administered.

A. Prednisolone

B. Lasix

C. Adrenaline

D. Aminophylline

E. Analgine


Answer:  Prednisolone

Explanation

The symptoms mentioned, such as pain behind the breastbone and in the lumbar area, dyspnea (difficulty breathing), cold sweat, pale skin, low blood pressure (60/40 mm Hg), oliguria (reduced urine output), and brown urine, are suggestive of a serious and potentially life-threatening condition called anaphylactic reaction or anaphylaxis.  

Anaphylaxis is a severe allergic reaction that can occur in response to certain triggers, such as blood transfusions in this case. It involves the release of histamine and other chemicals in the body, leading to widespread inflammation and constriction of blood vessels, resulting in decreased blood pressure and organ perfusion.  

The drug of choice for the treatment of anaphylaxis is an intravenous corticosteroid, such as prednisolone. Prednisolone is a glucocorticoid with potent anti-inflammatory and immunosuppressive effects. It helps to counteract the inflammatory response and stabilize blood vessels, reducing symptoms such as low blood pressure.   The other options listed in the question are not appropriate for the treatment of anaphylaxis in this scenario:  

Lasix (B) is a diuretic and would not directly address the underlying cause of the symptoms or stabilize blood vessels.   Adrenaline (C) is typically used as the initial treatment for anaphylaxis, but in this specific case, the patient has hemophilia, a bleeding disorder. Adrenaline can worsen bleeding in patients with hemophilia, so it should be used with caution or avoided.  


Aminophylline (D) is a bronchodilator and would primarily be used for the treatment of respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). It would not directly address the anaphylactic reaction or stabilize blood vessels.  

Analgine (E) is an analgesic (pain reliever) but would not address the underlying cause of the symptoms or provide the necessary treatment for anaphylaxis.   professional is necessary to confirm the diagnosis and determine the appropriate management plan.


13. A 16-year-old patient who has a history of intense bleedings from minor cuts and sores needs to have the roots of teeth extracted. Examination reveals an increase in volume of the right knee joint, limitation of its mobility. There are no other changes. Blood analysis shows an inclination to anaemia (Hb- 120 g/l). Before the dental intervention it is required to prevent the bleeding by means of.

A. Cryoprecipitate

B. Epsilon-aminocapronic acid

C. Fibrinogen

D. Dried blood plasma

E. Calcium chloride


Answer: Cryoprecipitate

Explanation

The clinical presentation of increased knee joint volume and limited mobility in this patient is suggestive of a joint bleed, which is a common manifestation of hemophilia. Hemophilia is a genetic disorder characterized by a deficiency or dysfunction of clotting factors, specifically factors VIII or IX.   To prevent bleeding in patients with hemophilia during dental interventions or surgical procedures, replacement therapy with clotting factors is necessary.

Cryoprecipitate is a blood product that contains high levels of clotting factors, including factor VIII and fibrinogen.   Cryoprecipitate is obtained from fresh frozen plasma and undergoes further processing to concentrate clotting factors. It is administered intravenously and provides the necessary clotting factors to promote hemostasis and prevent bleeding in patients with hemophilia.   The other options listed in the question are not appropriate for preventing bleeding in this patient:  

Epsilon-aminocaproic acid (B) is an antifibrinolytic agent that helps prevent the breakdown of blood clots. While it can be used to control bleeding in some situations, it is not the primary choice for prophylaxis in patients with hemophilia.  

Fibrinogen (C) is one of the clotting factors that are deficient in patients with hemophilia, so providing fibrinogen alone would not address the underlying clotting factor deficiency and may not be effective in preventing bleeding.  

Dried blood plasma (D) may contain some clotting factors, but cryoprecipitate is a more concentrated and specific source of clotting factors, making it the preferred choice for hemophilia treatment.   Calcium chloride (E) is not directly involved in the management of bleeding in hemophilia. While calcium is necessary for the clotting process, the primary focus in hemophilia treatment is on providing the deficient or dysfunctional clotting factors.

14. A 3-year-old child has been diagnosed with type I diabetes mellitus, hyperosmolar coma. The laboratory confirmed the diagnosis. Which laboratory findings are characteristic for such condition?

A. High hyperglycemia without ketonemia

B. Hyperglycemia and ketonemia

C. Hyperglycemia and glucosuria

D. Hyperglycemia and ketonuria

E. Hyperglycemia and high indicators of

acid-base balance


Answer:  High hyperglycemia without ketonemia

Explanation

Hyperosmolar coma, also known as hyperosmolar hyperglycemic state (HHS), is a severe complication of diabetes mellitus, usually occurring in type II diabetes but can also occur in type I diabetes. It is characterized by extremely high blood glucose levels (hyperglycemia) and severe dehydration.  

In contrast to diabetic ketoacidosis (DKA), which is more commonly associated with type I diabetes, hyperosmolar coma does not typically involve significant ketone production (ketonemia) or the presence of ketones in the urine (ketonuria). Ketones are formed when the body breaks down fatty acids for energy in the absence of sufficient insulin, as seen in DKA.  

In hyperosmolar coma, the blood glucose levels are extremely elevated, often exceeding 600 mg/dL (33.3 mmol/L), leading to a hyperosmolar state and dehydration. This occurs because insulin deficiency prevents glucose from being adequately taken up by cells, resulting in high blood glucose levels.  

Glucosuria (presence of glucose in the urine) is a common finding in both hyperosmolar coma and DKA. However, the absence of ketonemia and ketonuria distinguishes hyperosmolar coma from DKA.  

High indicators of acid-base balance (E) may be seen in DKA, where the presence of ketones can lead to acidosis. However, in hyperosmolar coma, acidosis is typically not as prominent, and the acid-base balance may not be significantly affected.  

In summary, the laboratory findings characteristic of a 3-year-old child with type I diabetes mellitus and hyperosmolar coma are high hyperglycemia without ketonemia (A).   The absence of ketonemia and ketonuria differentiates hyperosmolar coma from diabetic ketoacidosis. It’s important to consult a healthcare professional for accurate diagnosis and management of these conditions.


15. A 58-year-old female patient came to the antenatal clinic with complaints of bloody light-red discharges from the genital tracts. Menopause is 12 years. Gynaecological examination found externalia and vagina to have age involution; uterine cervix was unchanged, there were scant bloody discharges from uterine cervix, uterus was of normal size; uterine appendages were not palpable; parametria were free. What is the most likely diagnosis?

A. Uterine carcinoma

B. Atrophic colpitis

C. Abnormalities of menstrual cycle with

climacteric character

D. Cervical carcinoma

E. Granulosa cell tumor of ovary


Answer:  Atrophic colpitis

Explanation

Atrophic colpitis, also known as vaginal atrophy, is a condition that commonly occurs in postmenopausal women due to decreased estrogen levels. It is characterized by the thinning, drying, and inflammation of the vaginal walls, leading to symptoms such as vaginal dryness, itching, and sometimes, light bleeding or spotting.   In this case, the patient’s age of 58 years and 12 years since menopause are consistent with the timeframe when menopausal symptoms and atrophic changes are expected to occur.

The gynecological examination findings of externalia and vagina with age involution suggest normal changes associated with menopause.   The unchanged uterine cervix and scant bloody discharges from the cervix are indicative of cervix involvement, which is a common feature of atrophic colpitis. The uterus of normal size and absence of palpable uterine appendages and free parametria are not suggestive of other significant pathology such as uterine or cervical carcinoma.  

Uterine carcinoma (A) and cervical carcinoma (D) are less likely in this case due to the absence of significant abnormalities in the gynecological examination findings. While it’s important to consider the possibility of any malignancy, the clinical presentation and examination findings in this scenario are more consistent with atrophic colpitis.  

Abnormalities of the menstrual cycle with climacteric character (C) would not fully explain the specific symptom of bloody light-red discharges in this postmenopausal patient. Granulosa cell tumor of the ovary (E) is less likely since the gynecological examination did not reveal palpable uterine appendages or any other suggestive findings related to ovarian pathology.


16. A 3-year-old child was playing in a playpen when he suddenly developed paroxysmal cough and shortness of breath. Objectively: dry cough, mixed dyspnea. Lung auscultation revealed some wheezes. Breathing sounds on the right are diminished. The child doesn’t mix with other children. Immunization is age-appropriate. What pathological condition can be suspected?

A. Foreign body in the respiratory tracts

B. Pneumonia

C. Acute respiratory viral infection

D. Pertussis

E. Bronchial asthma


Answer:  Foreign body in the respiratory tracts

Explanation

The sudden onset of paroxysmal cough and shortness of breath, along with the presence of wheezes, suggests airway obstruction. The diminished breathing sounds on the right further support this suspicion. A foreign body in the respiratory tracts, such as a small object or food particle, can cause partial or complete obstruction of the airway, leading to respiratory symptoms.   Young children are known to explore their environment and may put small objects or food into their mouths.

Accidental inhalation or aspiration of these objects can occur, causing obstruction in the respiratory tract. The symptoms described in the scenario, including sudden onset and unilateral findings, are consistent with airway obstruction caused by a foreign body.  

Pneumonia (B) typically presents with symptoms such as fever, productive cough, and abnormal lung sounds on auscultation. The scenario does not mention these typical signs and symptoms of pneumonia.  

Acute respiratory viral infection (C) is a common condition in children and can cause cough and respiratory symptoms. However, the sudden onset, paroxysmal cough, and unilateral diminished breathing sounds are not typically associated with viral infections.  

Pertussis (D), also known as whooping cough, is characterized by paroxysmal coughing spells, but it usually has a more prolonged course with distinct coughing fits and a characteristic “whooping” sound during inspiration. The absence of the “whoop” sound and the unilateral diminished breathing sounds make pertussis less likely.


17. A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2×3 cm large that was changing its position during the examination. What conclusion can be made?

A. Concrement

B. Malignant tumour of the urinary bladder

C. Urinary bladder polyp

D. Prostate adenoma

E. Primary ureter tumour


Answer:  Concrement

  Explanation

The presence of an oval well-defined hyperechogenic formation suggests the presence of a stone or concrement within the urinary bladder. Stones can form in various parts of the urinary system, including the bladder. They are typically composed of minerals and can vary in size.  

The symptoms of difficult urination and incomplete bladder emptying are consistent with the presence of a stone in the bladder, as the stone can obstruct the flow of urine and interfere with complete bladder emptying.  

The fact that the hyperechogenic formation changes its position during the examination indicates that it is mobile within the bladder. This mobility is commonly seen with bladder stones, as they can move and change position with changes in bladder filling and patient positioning.


18. A 10-year-old child has been folowedup for the dilated cardiomyopathy. The child presents with dyspnea, cardialgia. There are dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac borders are extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein – 58.6 g/l. In urine: protein – 0,025 g/l, WBCs – 2-4 in the field of vision, RBCs – 2-3 in the field of vision. What is the main mechanism of edema syndrome development:

A. Venous congestion of greater circulation

B. Venous congestion of lesser circulation

C. Peripheral circulation disorder

D. Secondary nephropathy development

E. Hypoproteinemia


Answer:  Venous congestion of greater circulation

Explanation

Dilated cardiomyopathy is a condition characterized by the enlargement and weakened function of the heart muscle, leading to impaired cardiac output. In this case, the child presents with dyspnea, cardialgia, dense nonmobile edema on the lower extremities and sacrum, and signs of congestive heart failure.  

The extended transverse cardiac borders, muffled heart sounds, and blowing systolic murmur at the apex and over the xiphoid process are indicative of cardiac enlargement and impaired cardiac function. These findings suggest that the child’s heart is unable to effectively pump blood, resulting in congestion within the greater circulation, which includes the systemic veins.  

The presence of dense, nonmobile edema on the lower extremities and sacrum is consistent with venous congestion. When the heart is unable to pump blood efficiently, the blood backs up in the veins, leading to increased pressure and fluid leakage into the surrounding tissues, causing edema.


19. A 69-year-old female patient complains of temperature rise up to 38, 3oC, haematuria. ESR – 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?

A. Renal cancer

B. Polycystic renal disease

C. Renal amyloidosis

D. Urolithiasis

E. Chronic glomerulonephritis


Answer:  Renal cancer

Explanation

Renal cancer, also known as renal cell carcinoma, can present with various symptoms, including haematuria (blood in the urine), fever, and constitutional symptoms such as weight loss and fatigue. The presence of a temperature rise and haematuria in the given scenario raises suspicion for an underlying malignancy.  

The elevated ESR is a non-specific marker of inflammation in the body. In the context of the patient’s symptoms and ineffective antibacterial therapy, it suggests an ongoing inflammatory process that could be related to an underlying malignancy, such as renal cancer.


20. A 47-year-old patient complains of insomnia, heaviness over his entire body, constantly depressed mood. He considers himself good-for-nothing, inadequate. Believes that he is a burden to his family, wants to die. The patient is depressed, inactive, has a hypomimic face with sorrowful expression. He speaks quietly and monotonely,gives short answers. What is the most likely diagnosis?

A. Major depressive disorder

B. Atherosclerotic depression

C. Initial stage of Alzheimer’s disease

D. Late-onset schizophrenia

E. Neurotic depression


Answer:  Major depressive disorder

Explanation

Major depressive disorder is a common mental health condition characterized by persistent feelings of sadness, loss of interest or pleasure in activities, and a range of physical and emotional symptoms. It is diagnosed when these symptoms persist for at least two weeks and significantly impair daily functioning.  

In the case described, the patient displays several hallmark symptoms of major depressive disorder. Insomnia, or difficulty sleeping, is a common symptom, along with a depressed mood and anhedonia (loss of interest or pleasure).

The patient also exhibits feelings of worthlessness, excessive guilt, and thoughts of death or suicide, which are typical features of major depressive disorder.   The patient’s presentation of psychomotor retardation, such as reduced activity level, slow movements, and monotonous speech, is consistent with the psychomotor symptoms often observed in major depressive disorder.


21. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m3 of air was 7200. What is the permissible number of microorganisms for the air to be characterized as “pure”?

A. Up to 4500

B. Up to 2500

C. Up to 3500

D. Up to 5500

E. Up to 7500


Answer:  Up to 4500

Explanation

The term “pure” in this context refers to the air being considered clean or free from excessive microbial contamination. Bacterial analysis of air is commonly conducted to assess the quality of indoor air, particularly in environments such as living spaces.  

In the scenario provided, the total number of microorganisms in 1m3 of air was found to be 7200. To determine the permissible number of microorganisms for the air to be considered “pure,” we need to refer to the given options.   Among the given options, option A states that the permissible number of microorganisms is up to 4500.

This means that if the total number of microorganisms in 1m3 of air is equal to or below 4500, the air can be considered “pure” or relatively clean.


22. A 48-year-old patient got a job-related injury of a hypodermic varicose vein on his shin that was accompanied by the intensive phleborrhagia. Choose the optimal variant of first aid:

A. Pressure bandage and limb strapping

B. Application of Esmarch’s tourniquet above the injury

C. Application of Esmarch’s tourniquet beneath the injury

D. Occlusion of femoral artery in a typical place

E. Maximal limb flexion in knee joint


Answer:  Pressure bandage and limb strapping

Explanation

When dealing with bleeding from a vein, the primary goal is to control the bleeding and prevent further blood loss. The recommended approach in this situation is to apply direct pressure to the site of bleeding using a pressure bandage.   A pressure bandage helps to compress the injured vein and restrict blood flow, which promotes clotting and stops the bleeding.

By applying pressure, it also helps to support the damaged blood vessels and reduce the risk of further bleeding.   Limb strapping, or immobilizing the injured limb, can provide additional support and minimize movement, which can further help in controlling the bleeding and preventing aggravation of the injury.


23. A patient who had eaten mushrooms in the morning was delivered to the infectious diseases hospital at night. The disease development was rapid. The patient presented with stomach pain, frequent diarrhea, intractable vomiting, burning thirst, headache and dizziness. He died on the third day. What mushrooms are most likely to have caused mycetismus?

A. Deadly amanita

B. Morels

C. Fly agarics

D. Sulfur-tufts

E. Russules


Answer:  Deadly amanita

Explanation

The symptoms described by the patient, including stomach pain, frequent diarrhea, intractable vomiting, burning thirst, headache, and dizziness, followed by a rapid disease progression leading to death, are consistent with the effects of consuming poisonous mushrooms.  

The deadly amanita, scientifically known as Amanita phalloides, is one of the most toxic and dangerous mushrooms. It contains deadly toxins such as amatoxins, which can cause severe damage to the liver, kidneys, and other organs. The symptoms typically appear several hours after ingestion and can rapidly progress to multiple organ failure and death.  

The timing of the patient’s symptoms aligns with the ingestion of mushrooms in the morning and the onset of severe symptoms later that night. This quick onset and progression of symptoms are characteristic of amatoxin poisoning caused by deadly amanita.  

The other mushroom options listed in the question (morels, fly agarics, sulfur-tufts, russules) are not typically associated with such severe and rapid toxicity. While some mushrooms may cause gastrointestinal discomfort or mild poisoning, the described symptoms and fatal outcome are highly indicative of poisoning by deadly amanita.


24. A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age of 34 from a cardiac disease with similar symptoms. Objectively: the patients skin is pale. Heart borders display no significant deviations. Heart sounds are loud, there is a systolic murmur above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should be administered in order to prevent the disease progression?

A. Metoprolol

B. Digoxin

C. Nitroglycerin

D. Captopril

E. Furosemide


Answer:  Metoprolol

Explanation

The patient’s symptoms, including periodic compressing heart pain and a family history of cardiac disease with similar symptoms leading to the death of the brother, raise suspicion of a genetic cardiac condition.

The objective findings, such as pale skin, loud heart sounds, systolic murmur above all the points with a peak above the aorta, and echocardiographic findings of interventricular septal thickening and reduced left ventricular cavity, further support the diagnosis of hypertrophic cardiomyopathy (HCM).  

HCM is a genetic disorder characterized by abnormal thickening of the heart muscle, particularly the interventricular septum. It can lead to various symptoms, including chest pain, palpitations, and shortness of breath. In some cases, it can also lead to life-threatening complications such as arrhythmias and sudden cardiac death.  

Metoprolol is a beta-blocker medication commonly used in the management of HCM. It helps by reducing the workload on the heart, controlling heart rate, and improving diastolic function. It can help alleviate symptoms, prevent arrhythmias, and slow the progression of the disease.


25. A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic fever, active phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for prevention of rheumatism recurrence?

A. Bicillinum-5

B. Bicillinum-1

C. Erythromycin

D. Ampicillin

E. Oxacillin


Answer:  Bicillinum-5

Explanation

Rheumatic fever is an inflammatory condition that can occur as a complication of untreated or inadequately treated streptococcal throat infection. It primarily affects the heart, joints, skin, and central nervous system. Recurrences of rheumatic fever can lead to further damage to the heart valves and other complications.  

Bicillinum-5, also known as Benzathine Penicillin G, is a long-acting penicillin antibiotic. It is the drug of choice for secondary prophylaxis (prevention) of rheumatic fever. It is administered as an intramuscular injection and provides sustained levels of penicillin in the body, preventing the growth of streptococcal bacteria that can trigger rheumatic fever.


26. Examination of a 13-year-old boy reveals that his body length is 147 сm (+2), body weight – 38 kg (+1,5), circumference of chest – 72 cm (+0,2). Estimate the harmonicity of the child’s physical development:

A. Disharmonious

B. Harmonious

C. Above the average

D. Sharply disharmonious

E. Supernormal


Answer: Disharmonious

Explanation

Harmonicity in physical development refers to the proportional growth and development of various body parts in relation to each other. In a harmonious development, different body measurements tend to correspond to each other in terms of growth rate and proportion.  

In this case, the measurements of the boy’s body length, body weight, and chest circumference are given along with their respective deviations from the average values. The deviations indicate how the measurements compare to the average values for children of the same age and gender.  

The deviations mentioned in the question (+2 for body length, +1.5 for body weight, and +0.2 for chest circumference) indicate that these measurements are slightly above the average for the boy’s age group. However, the fact that the deviations are not consistent (e.g., +2 for body length but only +0.2 for chest circumference) suggests a lack of proportionality in his physical development.   cause cough and respiratory symptoms.

However, the sudden onset, paroxysmal cough, and unilateral diminished breathing sounds are not typically associated with viral infections.   Pertussis (D), also known as whooping cough, is characterized by paroxysmal coughing spells, but it usually has a more prolonged course with distinct coughing fits and a characteristic “whooping” sound during inspiration. The absence of the “whoop” sound and the unilateral diminished breathing sounds make pertussis less likely.


27. A children’s health camp received a party of tinned food. External examination of the tins revealed that they had deep dents, could be easily concaved when pressed and wouldn’t immediately return to the initial state; rust was absent; the tins were greased with inedible fat. Specify the bloat type:

A. Physical

B. Chemical

C. Biological

D. Combined

E. Physicochemical


Answer: Physical

Explanation

Physical bloat refers to the expansion or swelling of a container or packaging due to changes in pressure or temperature. In this case, the tins of food have deep dents and can be easily concaved when pressed. They do not immediately return to their initial state, indicating that the tins are swollen or bloated.  

The absence of rust and the presence of inedible fat on the tins suggest that there is no chemical or biological reaction causing the bloat. The greasing with inedible fat does not contribute to the bloat itself but may be an additional observation made in the scenario.   Therefore, based on the information provided, the bloat type observed in the tins of food is physical.


28. 2 weeks after recovering from angina a 29-year-old patient noticed face edemata, weakness, decreased work performance. There was gradual progress of dyspnea, edemata of the lower extremities, lumbar spine. Objectively: pale skin, weakening of the heart sounds, anasarca. AP- 160/100 mm Hg. In urine: the relative density – 1021, protein – 5 g/l, erythrocytes – 20-30 in the field of vision, hyaline cylinders – 4-6 in the field of vision. What is the most likely diagnosis?

A. Acute glomerulonephritis

B. Essential hypertension

C. Acute pyelonephritis

D. Infectious allergic myocarditis

E. Myxedema


Answer: Acute glomerulonephritis

Explanation

Acute glomerulonephritis is an inflammation of the glomeruli, the filtering units of the kidneys. It can occur following an infection, such as streptococcal infection (which can cause angina). The symptoms and findings described in the scenario are consistent with acute glomerulonephritis.

The patient’s presentation of face edema, weakness, decreased work performance, dyspnea, edema of the lower extremities and lumbar spine, and anasarca (generalized edema) are common manifestations of fluid retention and impaired kidney function in acute glomerulonephritis.  

The elevated blood pressure (160/100 mm Hg) is also indicative of renal involvement. Proteinuria (protein in the urine), hematuria (presence of red blood cells in the urine), and the presence of hyaline cylinders (indicating renal tubular damage) further support the diagnosis of acute glomerulonephritis.  

Therefore, based on the symptoms, physical findings, and urinary analysis results, the most likely diagnosis for the patient is acute glomerulonephritis. It is important for the patient to seek medical attention for proper evaluation and management of the condition.


29. A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. The pain lasts for up to 10 minutes and can be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of T wave in V4−5. What disease might be suspected?

A. Stable FC III stenocardia

B. Instable stenocardia

C. Stable FC I stenocardia

D. Stable FC II stenocardia

E. Stable FC IV stenocardia


Answer: Stable FC III stenocardia

Explanation

Stable angina is characterized by recurring episodes of chest pain or discomfort that are triggered by physical exertion or emotional stress and relieved by rest or nitroglycerine. The retrosternal constricting pain experienced by the patient during walking, lasting up to 10 minutes and relieved by nitroglycerine, is consistent with the typical symptoms of stable angina.

The patient’s overweight status and the absence of abnormalities in heart borders and heart sounds are also consistent with stable angina. The heart rate of 78 bpm and blood pressure of 130/80 mm Hg are within normal ranges.   The presence of low amplitude T waves in leads V4-5 on the ECG can be indicative of myocardial ischemia, which is characteristic of stable angina.  

The classification of “Stable FC III” refers to the Canadian Cardiovascular Society (CCS) classification system for angina, which is based on the severity of symptoms and their impact on physical activity.   FC III indicates moderate limitation of activity, where the patient experiences angina symptoms with ordinary walking or climbing stairs. The patient’s symptoms of chest pain while walking for 100-150 m align with this classification.


30. In autumn a 25-year-old patient developed stomach ache arising 1,5-2 hours after having meals and at night. He complains of pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis?

A. Duodenal ulcer

B. Chronic cholecystitis

C. Diaphragmatic hernia

D. Stomach ulcer

E. Chronic pancreatitis


Answer:  Duodenal ulcer

Explanation

Duodenal ulcers are a type of peptic ulcer that occurs in the first part of the small intestine called the duodenum. The characteristic symptoms of a duodenal ulcer include stomach pain that typically arises 1.5-2 hours after eating, nocturnal pain (pain at night), and relief of pain with alkaline substances like soda.


The patient’s complaint of pain worsening after consuming spicy, salty, and sour food is also consistent with duodenal ulcer symptoms.   The presence of pyrosis (heartburn) can be attributed to the backflow of stomach acid into the esophagus, which is a common symptom associated with peptic ulcers.

The patient’s history of suffering from this disease for a year suggests a chronic condition. Duodenal ulcers are known to have a chronic course with periods of remission and exacerbation.   The objective findings of a furred moist tongue and epigastric pain on the right, along with the resistance of abdominal muscles in the same region, can be indicative of duodenal ulcer. These findings may result from inflammation and irritation in the affected area.


31. A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky’s symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?

A. Exfoliative dermatitis

B. Phlegmon of newborn

C. Finger’s pseudofurunculosis

D. Impetigo neonatorum

E. Mycotic erythema


Answer: Exfoliative dermatitis

Explanation

Exfoliative dermatitis, also known as erythroderma, is a severe inflammatory skin condition characterized by widespread erythema (redness), erosions, peeling of the skin, and loss of the outer layer of the epidermis. It can affect large areas of the body and is typically associated with a generalized rash.  

Nikolsky’s sign refers to the ability to induce blistering or sloughing of the skin by applying pressure or friction to the affected area. A positive Nikolsky’s sign indicates a loss of cohesion between the layers of the skin, which is a characteristic feature of exfoliative dermatitis.  

The grave general condition, including anxiety, hyperesthesia (increased sensitivity to touch), and febrile temperature, suggests a severe and potentially life-threatening condition. Exfoliative dermatitis can be associated with systemic manifestations such as fever and malaise.   Other options such as phlegmon of newborn, Finger’s pseudofurunculosis, impetigo neonatorum, and mycotic erythema do not typically present with the combination of symptoms described in the case.


32. A 7-year-old boy has been managed for a month. Immediately after hospitalization there were apparent edemata, proteinuria – 7,1 g/l, daily urine protein – 4,2 g. Biochemical blood test shows persistent hypoproteinemia (43,2 g/l), hypercholesterolemia (9,2 millimole/l). The patient is most likely have the following type of glomerulonephritis:

A. Nephrotic

B. Nephritic

C. Isolated urinary

D. Hematuric

E. Combined


Answer: Nephrotic

Explanation

Nephrotic syndrome is characterized by the presence of significant proteinuria (greater than 3.5 grams per day in adults or greater than 40 milligrams per hour per square meter in children), hypoalbuminemia (low levels of serum albumin), edema, and hyperlipidemia.

The given case mentions proteinuria of 7.1 g/L and daily urine protein of 4.2 g, which are indicative of significant protein loss in the urine.   The presence of edema, along with hypoproteinemia (low serum protein levels) of 43.2 g/L and hypercholesterolemia (elevated cholesterol levels) of 9.2 millimole/L, further supports the diagnosis of nephrotic syndrome.

These findings are consistent with the classic manifestations of nephrotic syndrome, which occur due to increased permeability of the glomerular filtration barrier, leading to protein loss in the urine and subsequent hypoalbuminemia and edema formation.  

The other options, including nephritic, isolated urinary, hematuric, and combined types of glomerulonephritis, are less likely based on the given clinical presentation. Nephritic syndrome is characterized by hematuria, hypertension, and mild to moderate proteinuria.   Isolated urinary and hematuric types have specific features related to the presence of isolated urinary abnormalities or hematuria. A combined type may exhibit features of both nephrotic and nephritic syndromes.


33. A secundipara has regular birth activity. Three years ago she had cesarean section for the reason of acute intrauterine hypoxia. During parodynia she complains of extended pain in the area of postsurgical scar. Objectively: fetus pulse is rhythmic – 140 bpm. Vaginal examination shows 5 cm cervical dilatation. Fetal bladder is intact. What is the tactics of choice?

A. Cesarean section

B. Augmentation of labour

C. Obstetrical forceps

D. Waiting tactics of labor management

E. Vaginal delivery


Answer: Cesarean section

Explanation

The patient has a history of a previous cesarean section due to acute intrauterine hypoxia, which indicates a potential risk for uterine rupture during subsequent labor. The extended pain in the area of the postsurgical scar could be a sign of uterine scar dehiscence or rupture.

In such cases, there is an increased risk of fetal distress and maternal complications, including hemorrhage and uterine rupture.   The presence of intact fetal bladder and 5 cm cervical dilatation suggests that the labor process has already begun. Given the previous cesarean section and the potential risks associated with vaginal delivery, it is safer to proceed with a planned cesarean section rather than risk further complications and potential harm to the mother and the baby.  

While vaginal delivery may be a suitable option in some cases of prior cesarean section, certain factors need to be considered, such as the type of uterine incision in the previous cesarean section and the overall condition of the patient. In this particular case, the extended pain in the scar area raises concerns about scar integrity, making a repeat cesarean section the most appropriate choice for ensuring the safety of both the mother and the baby.


34. A 54-year-old female patient consulted a doctor about bloody discharges from the genital tracts after 2 years of amenorrhea. USI and bimanual examination revealed no genital pathology. What is the tactics of choice?

A. Fractional biopsy of lining of uterus and uterine mucous membranes

B. Styptic drugs

C. Contracting drugs

D. Estrogenic haemostasia

E. Hysterectomy


Answer: Fractional biopsy of lining of uterus and uterine mucous membranes

Explanation

The patient is a 54-year-old female who has experienced bloody discharges from the genital tracts after 2 years of amenorrhea (absence of menstrual periods). The presence of postmenopausal bleeding requires a thorough evaluation to determine the underlying cause, as it can be associated with various gynecological conditions, including endometrial hyperplasia and endometrial cancer.   In this case, the initial steps of evaluation, such as transvaginal ultrasound imaging (USI) and bimanual examination, did not reveal any obvious genital pathology.

However, these examinations may not provide a definitive diagnosis of endometrial pathology.   To further investigate the cause of postmenopausal bleeding, a fractional biopsy of the lining of the uterus and uterine mucous membranes is recommended. This involves obtaining a small sample of tissue from the endometrium (lining of the uterus) for histopathological examination. This biopsy allows for a more accurate assessment of the endometrium and can help identify any abnormal changes, such as endometrial hyperplasia or cancer.


35. A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR – 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis? 

A. Ankylosing spondylitis

B. Coxarthrosis

C. Rheumatoid arthritis

D. Reiter’s disease

E. Spondylosis


Answer:  Ankylosing spondylitis

Explanation

Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the spine and sacroiliac joints. It commonly presents with symptoms such as lower back pain, stiffness, and limited mobility. In some cases, the condition can also affect other joints, including the hips (coxofemoral joints).  

The presence of bilateral sacroiliitis, as seen on the roentgenography, is a characteristic feature of ankylosing spondylitis. This inflammation of the sacroiliac joints is typically progressive and leads to pain and stiffness in the lower back and buttocks region.   The fact that the patient is a carrier of HLA-B27 antigen is also significant.

HLA-B27 is strongly associated with an increased risk of developing ankylosing spondylitis. Although not all individuals with HLA-B27 will develop the condition, its presence in this patient supports the diagnosis.  

Other conditions, such as coxarthrosis (hip osteoarthritis), rheumatoid arthritis, Reiter’s disease, and spondylosis, may present with similar symptoms, but the combination of sacroiliitis, HLA-B27 positivity, and the clinical presentation strongly suggests ankylosing spondylitis as the most likely diagnosis.  

It is important to note that a definitive diagnosis should be made by a healthcare professional based on a comprehensive evaluation, including a thorough medical history, physical examination, and potentially additional diagnostic tests such as blood tests or imaging studies.


36. A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?

A. Ihibitor of angiotensin converting enzyme

B. β-blocker

C. Calcium channel antagonist

D. Thiazide diuretic

E. α-blocker

Answer:  Ihibitor of angiotensin converting enzyme

Explanation

The patient, a 58-year-old female with diabetes mellitus, presents with symptoms of periodical headache, dizziness, and ear noise, along with elevated blood pressure (180/110 mm Hg). These findings indicate uncontrolled hypertension, which requires pharmacological treatment.  

Given the patient’s comorbidity of diabetes mellitus, an ACE inhibitor would be the drug of choice. ACE inhibitors not only help control blood pressure but also provide additional benefits for patients with diabetes. They have been shown to protect against diabetic nephropathy, a common complication of diabetes characterized by protein loss in the urine (proteinuria). In this case, the patient has a daily loss of 1.5 g of protein in the urine, indicating renal involvement.

ACE inhibitors reduce the production of angiotensin II, a potent vasoconstrictor, and also decrease the breakdown of bradykinin, leading to vasodilation and improved renal blood flow. They are known to have renal protective effects and can slow the progression of diabetic nephropathy.  

Other antihypertensive drug classes such as β-blockers, calcium channel antagonists, thiazide diuretics, and α-blockers may be used in the management of hypertension, but in this particular case, an ACE inhibitor is the most appropriate choice due to its additional benefits for patients with diabetes and renal involvement.


37. A 62-year-old patient has been delivered to the surgical department with complaints of sudden pain in the umbilical region irradiating to the back and groin, which was accompanied by a syncope. Objectively: the patient is in grave condition, umbilical region is tender on palpation, bowel sounds are diminished. AP drop is present. USI reveals: free fluid in the abdomen, thickening of the wall of the abdominal aorta. The most likely diagnosis is:

A. Rupture of abdominal aortic aneurism

B. Stomach ulcer perforation

C. Acute pancreatitis

D. Peritonitis

E. Acute appendicitis


Answer:  Rupture of abdominal aortic aneurism

Explanation

The patient, a 62-year-old individual, presents with sudden severe pain in the umbilical region that radiates to the back and groin. This type of pain, along with accompanying syncope (fainting), is highly indicative of a ruptured abdominal aortic aneurysm (AAA).   AAA is a potentially life-threatening condition in which the wall of the abdominal aorta, the main blood vessel supplying the abdomen and lower limbs, becomes weakened and bulges outwards.  

Upon examination, the patient’s grave condition, tenderness in the umbilical region, diminished bowel sounds, and drop in blood pressure all point towards the diagnosis of a ruptured AAA. The presence of free fluid in the abdomen on ultrasound imaging and thickening of the abdominal aortic wall further support this diagnosis.  

A ruptured AAA is a surgical emergency that requires immediate intervention. The rupture leads to severe internal bleeding into the abdominal cavity, causing intense pain and potentially leading to hypovolemic shock. Prompt surgical repair is necessary to control the bleeding and prevent further complications.  

It’s important to note that the final diagnosis and appropriate treatment should be determined by a healthcare professional based on a thorough evaluation of the patient’s condition, medical history, and diagnostic tests.

38. A therapeutist needs to analyze adult health in the area of service. Which groups of indicators will be included into this analysis?

A. Demographic, sickness rates, disability

B. Demographic, sickness rates, physical development

C. Sickness rates, disability, death rates

D. Birth rates, sickness rates, disability

E. Sickness rates, death rates, physical development


Answer:  Demographic, sickness rates, disability

Explanation

When analyzing adult health in a specific area of service, it is essential to consider several key indicators:   Demographic indicators: These include population size, age distribution, gender distribution, and other demographic factors. Understanding the demographic characteristics of the population helps in identifying specific health needs and trends within the community.  

Sickness rates: These indicators provide information about the prevalence and incidence of various diseases and health conditions within the population. Sickness rates can be measured in terms of specific diseases, such as diabetes, cardiovascular diseases, or infectious diseases, or as overall morbidity rates.  

Disability rates: Assessing the prevalence and impact of disabilities is crucial for understanding the health status and quality of life of the population. Disability rates can indicate the burden of chronic conditions and impairments within the community.  

By analyzing demographic data, sickness rates, and disability rates, a therapeutist can gain insights into the health profile of the adult population in the area of service. This information can guide healthcare planning, resource allocation, and targeted interventions to address the specific health needs of the community.


39. A 54-year-old patient has an over 20-year history of femoral osteomyelitis. Over the last month she has developed progressing edemata of the lower extremities. Urine test reveals: proteinuria at the rate of 6,6 g/l; in blood: dysproteinemia in form of hypoalbuminemia, increase in α2- and γ-globulin rate, ESR – 50 mm/h. What is the most likely diagnosis?

A. Secondary renal amyloidosis

B. Acute glomerulonephritis

C. Myelomatosis

D. Chronic glomerulonephritis

E. Systemic lupus erythematosus


Answer:  Secondary renal amyloidosis

Explanation

Secondary renal amyloidosis is a condition characterized by the deposition of amyloid protein in the kidneys. It occurs as a complication of chronic inflammatory or infectious diseases, such as osteomyelitis in this case. The chronic inflammation triggers the production and accumulation of abnormal protein called amyloid in various organs, including the kidneys.  

The presenting symptoms of secondary renal amyloidosis often include proteinuria (as seen in this patient), hypoalbuminemia (low levels of albumin in the blood), and dysproteinemia (abnormal protein levels in the blood). The increase in α2- and γ-globulin rates and elevated ESR (erythrocyte sedimentation rate) are consistent with the underlying inflammatory process associated with chronic osteomyelitis.  

The development of edema in the lower extremities is also a common feature of renal amyloidosis, as the abnormal protein deposits impair the kidney’s ability to properly filter and regulate fluid balance.   It is important to note that further diagnostic tests, such as kidney biopsy or imaging studies, may be necessary to confirm the diagnosis of secondary renal amyloidosis. However, based on the patient’s history of chronic osteomyelitis, the presence of proteinuria, dysproteinemia, and edema, secondary renal amyloidosis is the most likely diagnosis in this case.


40. An emergency team deliverd a 83- year-old patient complaining of inability of her right leg to support the body after falling on her right side. Objectively: the patient lies on a gurney, her right leg is rotated outwards, the outside edge of foot touches the bed. There is positive straight leg raising sign. What is your provisional diagnosis?

A. Femoral neck fracture

B. Femoral diaphysis fracture

C. Hip dislocation

D. Hip joint contusion

E. Cotyloid cavity fracture


Answer:  Femoral neck fracture

Explanation

A femoral neck fracture is a common injury in older adults, especially in the elderly population. The presentation of an elderly patient with inability to bear weight on the affected leg, external rotation of the leg, and positive straight leg raising sign (pain when the leg is raised while keeping the knee straight) raises suspicion for a femoral neck fracture.  

The external rotation of the leg and the position of the foot touching the bed are indicative of a fractured femoral neck. This position is often referred to as “external rotation deformity.” The inability to bear weight on the affected leg is due to the pain and instability caused by the fracture.

The positive straight leg raising sign further supports the diagnosis of a femoral neck fracture. This test involves raising the leg while keeping the knee straight, and it elicits pain in cases of hip pathology, including femoral neck fractures.


41. 3 days ago a 29-year-old patient presented with pulsating pain in the region of rectum, fever, general weakness. Objectively: local tenderness in the anal region in the 6 o’clock position. Digital investigation of rectum revealed a painful infiltration reaching the pectinate line. What is the most likely diagnosis?

A. Acute periproctitis

B. Acute anal fissure

C. Acute haemorrhoids

D. Rectum tumour

E. Acute prostatitis


Answer: Acute periproctitis

Explanation

Acute periproctitis, also known as an anorectal abscess, is an infection that occurs in the tissues surrounding the rectum and anus. It typically presents with symptoms such as pulsating pain in the rectal region, fever, general weakness, and local tenderness in the anal region.

The presence of a painful infiltration reaching the pectinate line upon digital investigation of the rectum supports the diagnosis of periproctitis.   Periproctitis often occurs as a result of an infection that originates from an anal gland or a tear in the anal lining. The infection leads to the formation of an abscess, which can cause significant pain and discomfort.  

Treatment for acute periproctitis usually involves incision and drainage of the abscess to relieve the infection and pain. Antibiotics may also be prescribed to help clear the infection. In some cases, further evaluation and management may be necessary to address the underlying cause and prevent recurrence.   It is important for the patient to seek medical attention promptly for proper diagnosis and appropriate treatment.


42. A child is 7 months old. Birth weight was 3450, the child is breastfed. Supplemental feeding was introduced on time. Determine the daily protein requirements for the child:

A. 3,0 g/kg

B. 2,0 g/kg

C. 2,5 g/kg

D. 3,5 g/kg

E. 4,0 g/kg


Answer: 3,0 g/kg

Explanation

Acute periproctitis, also known as an anorectal abscess, is an infection that occurs in the tissues surrounding the rectum and anus. It typically presents with symptoms such as pulsating pain in the rectal region, fever, general weakness, and local tenderness in the anal region.

The presence of a painful infiltration reaching the pectinate line upon digital investigation of the rectum supports the diagnosis of periproctitis.   Periproctitis often occurs as a result of an infection that originates from an anal gland or a tear in the anal lining. The infection leads to the formation of an abscess, which can cause significant pain and discomfort.  

Treatment for acute periproctitis usually involves incision and drainage of the abscess to relieve the infection and pain. Antibiotics may also be prescribed to help clear the infection. In some cases, further evaluation and management may be necessary to address the underlying cause and prevent recurrence.   It is important for the patient to seek medical attention promptly for proper diagnosis and appropriate treatment.


43. A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour later the patient’s contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate – 30/min, heart rate – 130/min, AP- 90/60 mm Hg. Heart sounds were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with medium moist rales in the lower parts of lungs on the right and on the left. Body temperature – 36, 4oC. What drug should be given in the first place?

A. Promedol

B. Aminophylline

C. Dopamine

D. Heparin

E. Digoxin


Answer: Promedol

                                                             Explanation

The patient’s clinical presentation suggests that she is experiencing acute heart failure, possibly due to complications of acute transmural infarction. The symptoms of progressing dyspnea, dry cough, muffled heart sounds, diastolic shock on the pulmonary artery, and medium moist rales in the lower parts of the lungs indicate pulmonary congestion and fluid accumulation.   Heparin is a blood-thinning medication that helps prevent the formation of blood clots.

In the context of acute transmural infarction and the development of worsening symptoms, administering heparin would be a priority. Heparin helps prevent further clot formation and promotes blood flow, which can alleviate the strain on the heart and reduce the risk of further complications.  

Promedol, on the other hand, is an opioid analgesic that is used for pain relief. While pain management is important in the context of acute transmural infarction, it is not the primary concern in this case. The patient’s worsening symptoms and signs of acute heart failure require immediate attention and appropriate treatment, such as administering heparin.


44. A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart rate – 106/min, breathing rate – 22/min. Heart sounds are muffled, a gallop rhythm is present. How would you explain the AP drop?

A. Reduction in cardiac output

B. Reduction in peripheral resistance

C. Blood depositing in the abdominal cavity

D. Adrenergic receptor block

E. Internal haemorrhage


Answer: Reduction in cardiac output

                                                            Explanation

The patient’s symptoms, including retrosternal pain, muffled heart sounds, and gallop rhythm, suggest cardiac dysfunction or heart failure. In heart failure, the heart’s ability to effectively pump blood to meet the body’s demands is compromised, resulting in a reduced cardiac output.  

Cardiac output is the volume of blood pumped by the heart per minute. It is determined by two factors: heart rate (the number of times the heart beats per minute) and stroke volume (the amount of blood pumped by the heart with each beat). In this case, the patient’s heart rate is elevated (106/min), which may be a compensatory response to the decreased cardiac output.  

The drop in arterial pressure is a consequence of the reduced cardiac output. With a lower volume of blood being pumped by the heart, there is decreased pressure in the arteries. This can lead to symptoms such as hypotension (AP- 80/60 mm Hg) and inadequate perfusion of organs and tissues.


45. A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months. Who has the right to extend the duration of medical certificate for this patient?

A. Medical advisory commission after medico-social expert commission examination

B. Medical superintendent

C. Medical advisory commission after inpatient treatment

D. District doctor by agreement with a department chief

E. Medico-social expert commission


Answer: Medical advisory commission after medico-social expert commission examination

Explanation

When a patient is on sick leave and requires an extension of the medical certificate, the decision is typically made by a medical advisory commission after a medico-social expert commission examination.   In many countries, there are specific procedures and regulations in place for evaluating and extending sick leave.

A medico-social expert commission conducts an assessment of the patient’s condition, taking into account medical reports and other relevant information. Based on their evaluation, they provide a recommendation regarding the duration of the sick leave.  

The medical advisory commission, which consists of healthcare professionals, reviews the recommendation from the medico-social expert commission and determines whether an extension of the medical certificate is appropriate.

They consider factors such as the patient’s medical condition, treatment progress, and the anticipated duration of recovery.   Ultimately, it is the medical advisory commission’s decision to extend the duration of the medical certificate, as they have the expertise and authority to make such determinations based on the patient’s individual circumstances.


46. A child is 9 months old. The patient’s body temperature is 36, 7oC, the skin is pale, humid, there is pain in leg muscles. There is no extremities mobility, sensitivity is present. The child has been diagnosed with poliomyelitis. The causative agent of this disease relates to the following family:

A. Picornavirus

B. Paramyxovirus

C. Tohovirus

D. Adenovirus

E. Rotaviru


Answer: Picornavirus

Explanation

Poliomyelitis, also known as polio, is caused by the Picornavirus family, specifically the poliovirus. Poliovirus is a single-stranded RNA virus that primarily affects the nervous system, particularly the motor neurons of the spinal cord, brainstem, and motor cortex.  

The virus is typically transmitted through the fecal-oral route, often by contaminated food or water. It can also be spread through direct contact with respiratory secretions of an infected person.  

In the case described, the symptoms of pain in leg muscles, lack of mobility, and preserved sensitivity are characteristic of poliomyelitis. The pale and moist skin can be associated with general illness and compromised motor function.   It’s important to note that poliomyelitis can be prevented through vaccination. Vaccines have significantly reduced the incidence of this disease in many parts of the world.


47. Working conditions of a building company worker are characterized by cooling microclimate effect, silicacontaining dust, caustic alkali (quicklime) and noise. What medical expert should be the chief of the commission that periodically examines the workers of the mentioned category?

A. Therapeutist

B. Ophthalmologist

C. Neurologist

D. Dermatologist

E. Otolaryngologist


Answer: Therapeutist

                                                            Explanation

In the given scenario, the working conditions of the building company worker involve various occupational hazards such as cooling microclimate effect, silica-containing dust, caustic alkali (quicklime), and noise. To assess the health of workers in such conditions, a periodic medical examination is necessary.  

The role of the medical expert who should be the chief of the commission conducting these examinations would typically be a therapist. A therapist, also known as an occupational health physician or occupational medicine specialist, is trained in evaluating and managing the health of workers in occupational settings.  

Therapists are knowledgeable about the potential health risks associated with different occupational exposures and can conduct comprehensive medical examinations to assess the workers’ health status.   They are trained to identify any work-related health issues, provide appropriate advice, and recommend preventive measures to ensure the well-being of workers in their specific occupational environment.


48. A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a cephalogematoma. On the 2nd day there was jaundice, on the third the following changes in neurological status appeared: nystagmus, Graefe syndrome. Urine was yellow, feces were of goldenyellow colour. Mother’s blood group is A (II) Rh−, the baby’s one – A (II) Rh+. On the third day the child’s Hb was 200g/l, RBCs – 6, 1 · 1012/l, blood bilirubin – 58 micromole/l at the expense of unbound fraction. What caused the jaundice in the child?

A. Craniocerebral birth trauma

B. Physiological jaundice

C. Neonatal anaemia

D. Biliary atresia

E. Fetal hepatitis


Answer: Craniocerebral birth trauma

Explanation

In the given scenario, the newborn baby experienced a cephalohematoma, which is a collection of blood between the skull bone and the periosteal membrane. On the second day, jaundice appeared, and on the third day, neurological symptoms such as nystagmus and Graefe syndrome (abnormal movement of the eyelids) were observed.

The baby’s blood group is A (II) Rh+, while the mother’s blood group is A (II) Rh-. Based on these findings, the most likely cause of jaundice in the child is craniocerebral birth trauma. The trauma to the head during delivery can lead to the breakdown of red blood cells, resulting in an increased level of unconjugated bilirubin in the blood.

This unconjugated bilirubin can then cause jaundice, which is characterized by yellowing of the skin and eyes.   The presence of jaundice, along with the other neurological symptoms, suggests that the trauma to the head has also affected the baby’s neurological system. The combination of cephalohematoma, jaundice, and neurological signs is indicative of craniocerebral birth trauma as the underlying cause.


49. After birth a child was pale and had arrhythmical breathing. Oxygen therapy didn’t have any effect. Pulse was weak and rapid. It was difficult to measure arterial pressure accurately. There were no edemata. What is the most likely reason for these symptoms?

A. Asphyxia

B. Congestive heart failure

C. Intracranial haematoma

D. Intrauterine sepsis

E. Congenital pneumonia


Answer:  Asphyxia

Explanation

Asphyxia refers to a condition where there is a lack of oxygen supply to the body tissues, resulting in oxygen deprivation. The symptoms mentioned in the case, including paleness, arrhythmical breathing, weak and rapid pulse, and difficulty in accurately measuring arterial pressure, are consistent with the effects of asphyxia.  

During the process of birth, asphyxia can occur due to various reasons such as umbilical cord compression, placental insufficiency, or inadequate ventilation. The lack of oxygen leads to compromised oxygen delivery to the tissues, which can result in the symptoms observed.  

The ineffectiveness of oxygen therapy in improving the symptoms further supports the possibility of asphyxia as the underlying cause. Asphyxia requires prompt intervention and resuscitation measures to restore adequate oxygenation and prevent further complications.  

While congestive heart failure, intracranial hematoma, intrauterine sepsis, and congenital pneumonia can also present with some overlapping symptoms, the presence of weak and rapid pulse, as well as the ineffectiveness of oxygen therapy, points more strongly towards asphyxia as the most likely reason in this case.


50. 350 workers of a metalurgical plant had to undergo a yearly preventive examination. A territorial polyclinic carried out preventive examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive work of the polyclinic should be applied in this case?

A. Coverage of preventive medical examinations

B. Frequency of case detection during examinations

C. Percentage of people who underwent rehabilitation at an after-work sanatorium

D. Percentage of people who were provided with diet meal

E. Percentage of temporarily disabled people


Answer:  Coverage of preventive medical examinations

Explanation

Coverage of preventive medical examinations refers to the percentage of individuals who underwent the scheduled preventive examinations out of the total population eligible for the examination. In this case, there were 350 workers who were supposed to undergo the yearly preventive examination.

The polyclinic carried out examinations for 325 workers, which means they covered 325 out of the 350 eligible workers.  

Coverage of preventive medical examinations is an important indicator as it assesses the extent to which the target population is reached and examined for preventive purposes. It provides an understanding of the proportion of individuals who have received the recommended preventive healthcare services.
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