Question From (1 To 50 )
1. Examination of the corpse of a man, who died by hanging, reveals that the spots of livor mortis disappear when pressed and reappear 50 seconds later. The rigor mortis is moderate and observed only in the masticatory muscles and muscles of neck and fingers. The body temperature is 31.0°C. What is the time of death in this case?
A. 6-7 hours
B. 8-10 hours
C. 1-2 hours
D. 10-18 hours
E. 16-24 hours
Answer: 6-7 hours
Explanation
| The presence of rigor mortis in the masticatory muscles and muscles of the neck and fingers suggest that the time since death is greater than 2-4 hours. The moderate state of rigor mortis indicates that the time since death is less than 12-14 hours. The fact that the spots of livor mortis disappear when pressed and reappear 50 seconds later suggests that the person has been dead for at least 4-6 hours, but less than 8-10 hours. The body temperature of 31.0°C is also consistent with a time of death of 6-7 hours, as the body temperature drops at a rate of approximately 1-1.5°C per hour after death. |
2. A 34-year-old multipara was brought to the labor ward with regular labor activity. Her pelvic size 26-29- 32-22 cm. Vaginal examination shows 6 cm cervical dilation, the amniotic sac is unbroken. The fetus is in the breech presentation, with buttocks pressed to the entrance into the lesser pelvis. The promontory cannot be reached, no exostoses. Feta heart rate is 140/min, expected fetal weight is 2800g. What labor tactics should be chosen?
A. Classic combined external-internal version of the fetus
B. Fetal extraction from the pelvic end
C. External obstetric version of the fetus
D. Urgent cesarean section
E. Delivery through the natural birth canal
Answer: Delivery through the natural birth canal
Explanation
| This patient has a term pregnancy with a breech presentation and normal fetal heart rate. The estimated fetal weight is within the normal range, and the pelvic measurements are also within normal limits. These factors suggest that a vaginal delivery may be appropriate and feasible. The decision to attempt a vaginal delivery in a breech presentation should be made after a careful assessment of the maternal and fetal risks and individualized counseling of the patient. In general, a vaginal delivery in a breech presentation can be attempted if the fetus is in a frank breech presentation, the estimated fetal weight is not too large, and the pelvis is adequate. In this case, the fetus is in a breech presentation with buttocks pressed to the entrance into the lesser pelvis, and the cervical dilation is 6 cm, indicating active labor. These factors suggest that the patient may be a good candidate for a vaginal delivery. However, the decision to proceed with a vaginal delivery should be made by an experienced obstetrician and should take into account any additional risk factors specific to the patient. |
3. After the pregnant woman’s waters broke, it was noted that they are significantly contaminated with meconium. Upon birth, the baby is not breathing, remains inert, the skin is cyanotic and covered in meconium, heart rate is 98/min. What resuscitation measures should be taken after the baby is born?
A. Tactile stimulation of the newborn
B. Give adrenaline intravenously
C. Artificial pulmonary ventilation with a mask and Ambu bag
D. Direct laryngoscopy, intubation, sanation of the trachea
E. Sanation of the upper respiratory tracts with a rubber balloon
Answer: Direct laryngoscopy, intubation, sanation of the trachea
Explanation
| Meconium-stained amniotic fluid is a sign that the baby may have experienced stress during labor, and there is a risk that the meconium may be aspirated into the lungs, which can cause respiratory distress and compromise the baby’s airway. Tactile stimulation (option A) can be used initially to stimulate breathing in a newborn who is not breathing, but it may not be effective if the airway is obstructed by meconium. Adrenaline (option B) is not indicated in this scenario, as there is no evidence of cardiac arrest. Artificial pulmonary ventilation with a mask and Ambu bag (option C) may be necessary if intubation is unsuccessful, but suctioning of the meconium from the airway should be attempted first. Sanation of the upper respiratory tracts with a rubber balloon (option E) is not recommended, as it may not effectively remove the meconium and may cause further trauma to the airway. |
4. A 9-year-old boy fell off a tree and hit the back of his head. A brief loss of consciousness was observed. The child’s condition is satisfactory, he has a headache and vertigo. Skull X-ray scans shows depressed fracture of the occipital bone in the area of the external occipital protuberance. What treatment tactics is indicated for this patient?
A. Complex conservative treatment
B. Lumbar puncture to relieve the pressure
C. Surgical intervention
D. Anti-inflammatory therapy
E. Hemostatic therapy
Answer: Surgical intervention
Explanation
| In this scenario, the patient has suffered a head injury and has a depressed fracture of the occipital bone, which is a serious condition that requires immediate medical attention. The symptoms of headache and vertigo may indicate raised intracranial pressure, which is a medical emergency. Conservative treatment, such as observation and rest, may be an option for some types of head injuries, but a depressed fracture of the skull requires surgical intervention to remove the bone fragments, relieve pressure on the brain and prevent complications such as infection or bleeding. Lumbar puncture is not indicated in this case, as it is used to diagnose conditions such as meningitis or subarachnoid hemorrhage, and not to relieve pressure caused by a depressed skull fracture. Anti-inflammatory therapy and hemostatic therapy may be used as adjuncts in the treatment of head injuries, but they are not the primary treatment for a depressed skull fracture. |
5. A 23-year-old woman without visible cause developed a conflicting behavior at the workplace. She accused the management of underestimating her, claimed that she can be a deputy director, because she speaks four languages, is very attractive, and can make useful connections for the company. She has been dressing extravagantly, flirting with her colleges, and singing loudly in her office. In fact, she has only the training of a computer operator and speaks no foreign languages. What is the likely clinical diagnosis?
A. Schizophrenia
B. Mild mental retardation
C. Manic episode
D. Depressive disorder
E. Epilepsy
Answer: Manic episode
Explanation
| The scenario described is suggestive of a manic episode, which is a period of abnormally elevated or irritable mood, energy, and activity levels that lasts for at least one week and is often associated with a decreased need for sleep. The patient’s behavior, such as claiming to be qualified for a higher position based on false credentials, dressing extravagantly, flirting with colleagues, and singing loudly in her office, are all suggestive of a manic episode. The patient’s belief that she speaks four languages and can make useful connections for the company, despite lacking the necessary training and skills, is also consistent with grandiose delusions, which can occur in manic episodes. Schizophrenia is a chronic mental disorder characterized by a range of symptoms, including delusions, hallucinations, disorganized speech and behavior, and a lack of motivation. Mild mental retardation is a condition characterized by an intellectual functioning level that is below average, with an IQ score between 50-70. Depressive disorder is a mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities. Epilepsy is a neurological disorder characterized by recurrent seizures. |
6. A 21-year-old man was hospitalized on the 2nd day of the disease. His general condition is severe, body temperature is 39°C. On his skin there are numerous irregular shaped hemorrhagic elements. The diagnosis of meningococcemia was made. The next day his body temperature suddenly decreased, blood pressure was 80/40 mm Hg, pulse was 120/min. Acrocyanosis was detected. What complication did the patient develop?
A. Acute liver failure
B. Acute heart failure
C. Cerebral coma
D. Acute adrenal insufficiency
E. Acute hemorrhage
Answer: Acute adrenal insufficiency
Explanation
| The patient in this scenario has been diagnosed with meningococcemia, which is a severe bacterial infection caused by the bacterium Neisseria meningitidis that can cause sepsis and meningitis. Hemorrhagic elements on the skin are a common feature of meningococcemia. The sudden decrease in body temperature, along with hypotension, tachycardia, and acrocyanosis, suggest the development of septic shock, which is a life-threatening complication of meningococcemia. Acute adrenal insufficiency, also known as Addisonian crisis, can occur as a complication of septic shock. In this condition, the adrenal glands are unable to produce enough cortisol and other hormones, which can lead to hypotension, dehydration, and electrolyte imbalances. The symptoms of acute adrenal insufficiency, such as hypotension and acrocyanosis, are consistent with those seen in the patient in this scenario. Acute liver failure, acute heart failure, cerebral coma, and acute hemorrhage are all possible complications of meningococcemia, but they do not explain the specific symptoms seen in this patient, such as the sudden decrease in body temperature and the presence of acrocyanosis. |
7. Examination detected vesicles with seropurulent content on the neck, back of the head, and buttocks of an infant on the 4th day of life. The patient’s condition is satisfactory, the child is active, all newborn reflexes can be fully induced, the umbilical cord is at the stage of mummification, the umbilical area is without any peculiarities. What disease can be suspected?
A. Phlegmon
B. Neonatal pemphigus
C. Miliaria
D. Vesiculopustulosis
E. Epidermolysis bullosa
Answer: Vesiculopustulosis
Explanation
| The other options, such as phlegmon, neonatal pemphigus, miliaria, and epidermolysis bullosa, are less likely based on the information provided. Phlegmon is a bacterial infection that causes inflammation and pus formation in the soft tissue, but it typically presents with redness, warmth, and tenderness of the affected area, which was not mentioned in the case. Neonatal pemphigus is a rare autoimmune disorder that causes blistering of the skin and mucous membranes, but it usually presents with blisters on the oral mucosa and skin folds, not on the neck, back of the head, and buttocks. Miliaria is a heat rash that presents with small, itchy papules or blisters, but it typically occurs in areas of the body that are covered by clothing, such as the neck, chest, and back. Epidermolysis bullosa is a rare genetic disorder that causes blistering of the skin and mucous membranes in response to minor trauma, but it typically presents at birth or in infancy with blisters on multiple areas of the body, not just on the neck, back of the head, and buttocks. |
8. A 16-year-old teenager complains of weakness, dizziness, and heaviness in the left subcostal region. Objectively, the skin and visible mucosa are icteric. The tower skull syndrome is observed. The liver is +2 cm. The lower edge of the spleen is at the level of the navel. In the complete blood count: erythrocytes — 2.7 * 1012/L, Hb — 88 g/L, leukocytes — 5.6-109 /L, ESR — 15 mm/hour. What is the most likely change in the bilirubin levels in this patient?
A. Decrease in conjugated bilirubin levels
B. Increase in conjugated bilirubin levels
C. Increase in unconjugated bilirubin levels
D. Increase in unconjugated and conjugated bilirubin levels
E. Decrease in unconjugated bilirubin Levels
Answer: Increase in unconjugated bilirubin levels
Explanation
| The patient presents with symptoms and signs of jaundice, including icteric skin and visible mucosa, and the tower skull syndrome, which is indicative of elevated bilirubin levels. The laboratory tests show a low red blood cell count (erythrocytes), low hemoglobin levels (Hb), and normal white blood cell count (leukocytes) and erythrocyte sedimentation rate (ESR), which could suggest hemolysis as the underlying cause of the jaundice. The liver is slightly enlarged (liver +2 cm), which could be a sign of hepatomegaly, and the lower edge of the spleen is at the level of the navel, which is suggestive of splenomegaly. These findings could be consistent with hemolytic anemia, which can lead to an increase in unconjugated bilirubin levels due to the breakdown of red blood cells. |
9. During regular examination of a 2-year-old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cystoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
A. Agenesis of the right ureter
B. Ectopic right ureteral orifice
C. Agenesis of the right kidney
D. Hypoplasia of the right kidney
E. Dystopia of the right kidney
Answer: Agenesis of the right kidney
Explanation
| The patient presents with an enlarged left kidney and an undetectable right kidney on palpation, which could indicate the absence of the right kidney (agenesis) or severe hypoplasia. The excretory urography shows no contrast on the right, which is consistent with the absence of a functional right kidney. The cystoscopy detected hemiatrophy of the urinary bladder trigone, which may be due to the absence of the right ureteral orifice. Therefore, based on these findings, the most likely diagnosis is agenesis of the right kidney, which is a rare congenital anomaly that results from the failure of the right kidney to develop during embryonic development. Agenesis of the kidney may be accompanied by other urological anomalies, such as an ectopic ureter or hemiatrophy of the bladder trigone, as seen in this case. Other possible diagnoses, such as ectopic right ureteral orifice, hypoplasia of the right kidney, or dystopia of the right kidney, are less likely based on the information provided. Ectopic ureteral orifice may cause urinary incontinence or recurrent urinary tract infections, but it is unlikely to cause an undetectable right kidney. Hypoplasia of the right kidney may be associated with a small or poorly functioning kidney, but it is unlikely to cause an undetectable kidney. Dystopia of the right kidney is a condition in which the kidney is located in an abnormal position, but it is not typically associated with an undetectable kidney. |
10. For a week a 42-year-old patient has been suffering from fever attacks which occur every 48 hours. Body temperature raises up to 40°C and decreases in 3-4 hours with excessive sweating. The patient presents with loss of appetite and general fatigue. The skin is pale and sallow. The liver and spleen are enlarged and dense on palpation. What method of diagnosis verification would be most efficient?
A. Complete blood count
B. Microscopy of hanging blood drop
C. Bacteriological analysis
D. Microscopy of blood smear and thick blood film
E. Enzyme-linked immunosorbent assay
Answer: Microscopy of blood smear and thick blood film
Explanation
| Based on the clinical presentation, the most likely diagnosis in this case is malaria, which is a parasitic infection transmitted by the bite of infected mosquitoes. The characteristic pattern of fever every 48 hours, along with other symptoms such as fatigue, loss of appetite, and enlarged liver and spleen, are consistent with malaria. The most efficient method of diagnosis verification for malaria is microscopy of blood smear and thick blood film. This method involves staining a drop of blood with a special stain and examining it under a microscope to look for the presence of the malaria parasite in the red blood cells. The thick blood film is a more sensitive method for detecting the parasite, while the thin blood film is more useful for identifying the specific species of the parasite. Other diagnostic methods, such as complete blood count (option A), bacteriological analysis (option C), and enzyme-linked immunosorbent assay (option E), may be useful in some cases, but they are less specific for malaria and may not provide a definitive diagnosis. Microscopy of hanging blood drop (option B) is not a commonly used method for diagnosing malaria. |
11. Throughout the last year a 27- year-old man notes fatigue, excessive sweating, and heaviness in his left subcostal region, especially after eating. Objectively, his spleen and liver are enlarged. In clinical blood test: erythrocytes — 3.2 * 1012/L, Hb — 100 g/L, color index — 0.87, leukocytes — 100 * 109 /L, basophils — 7%, eosinophils — 5%, monocytes — 15%, juvenile — 16%, band neutrophils — 10%, segmented neutrophils — 45%, lymphocytes — 2%, monocytes — 0%, reticulocytes — 0.3%, platelets — 400 * 109/L, ESR — 25 mm/hour. Make the diagnosis:
A. Chronic myelogenous leukemia
B. Acute leukemia
C. Hepatic cirrhosis
D. Chronic lymphocytic leukemia
E. Erythremia (polycythemia vera)
Answer: Chronic myelogenous leukemia
Explanation
| Based on the clinical presentation and laboratory findings, the most likely diagnosis in this case is chronic myelogenous leukemia (CML). The patient presents with fatigue, excessive sweating, and splenomegaly, which are common symptoms of CML. The enlarged liver is also suggestive of the disease. The complete blood count shows leukocytosis with a left shift in the differential count, including an increase in basophils and eosinophils, which are characteristic of CML. The platelet count is normal, and there is no evidence of anemia. Hepatic cirrhosis (option C) is less likely given the absence of other associated symptoms such as jaundice, ascites, or gastrointestinal bleeding. Acute leukemia (option B) is less likely given the chronic course of symptoms and absence of blast cells in the peripheral blood smear. Chronic lymphocytic leukemia (option D) is less likely given the absence of lymphocytosis and a characteristic left shift in the differential count. Erythremia (polycythemia vera) (option E) is less likely given the normal red blood cell count and hemoglobin levels. |
12. A patient 1 year ago had a Q wave myocardial infarction of the posterior wall of the left ventricle. For the last 2 weeks he has been suffering from daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo. What tactics is the most advisable in this case?
A. Pacemaker implantation
B. Prescription of procainamide
C. Prescription of amiodarone
D. Prescription of bisoprolol
E. Prescription of digoxin
Answer: Pacemaker implantation
Explanation
| The patient has a history of Q wave myocardial infarction of the posterior wall of the left ventricle, which may have damaged the conduction system of the heart. The current symptoms of daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo, suggest that the patient may have developed symptomatic bradycardia, which can be a life-threatening condition. Pacemaker implantation is the most effective treatment for symptomatic bradycardia, as it can restore normal heart rhythm and prevent dangerous complications such as syncope, heart failure, or sudden cardiac death. Prescription of antiarrhythmic medications such as procainamide (option B), amiodarone (option C), or digoxin (option E) may be indicated in some cases of atrial fibrillation, but they are less effective in treating bradycardia and may even exacerbate the condition. Bisoprolol (option D) is a beta-blocker that can be used to control heart rate in patients with atrial fibrillation, but it may also exacerbate bradycardia and is not a definitive treatment for symptomatic bradycardia. |
13. During a regular examination, an 8-year-old girl with type I diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?
A. Formation of a post-injection abscess
B. Allergic response
C. Formation of a post-injection infiltration
D. Development of hypertrophic lipodystrophy
E. Development of atrophic lipodystrophy
Answer: Development of hypertrophic lipodystrophy
Explanation
| Hypertrophic lipodystrophy is a rare complication of insulin injection therapy that can occur in patients with type I diabetes mellitus. It is characterized by the formation of painless, firm, and well-defined nodules or plaques at the sites of insulin injection. The nodules can range in size from a few millimeters to several centimeters and can persist for months to years. The pathophysiology of hypertrophic lipodystrophy is not fully understood, but it is thought to be related to local insulin resistance, chronic inflammation, and fibrosis. The condition is more common in children than in adults and is more likely to occur in patients who have been on insulin therapy for a long time. In contrast, post-injection abscess (A) would present with a painful, tender, and erythematous swelling, often associated with fever and systemic symptoms. An allergic response (B) would present with symptoms such as itching, redness, swelling, and hives at the injection site, often occurring immediately or within a few hours after the injection. A post-injection infiltration (C) would present with a soft, non-tender, and poorly-defined swelling at the injection site. Atrophic lipodystrophy (E) is another potential complication of insulin injection, but it is characterized by the loss of subcutaneous fat at the injection site, rather than the development of a firm nodule. |
14. In the demographic structure of a region, the persons aged from 0 to 14 make up 31% of the population, while the 50+ age group makes up 20% of the population. What population structure characterizes this demographic situation most accurately?
A. Stationary population
B. Migration of the population
C. Constrictive population
D. Emigration of the population
E. Expansive population
Answer: Expansive population
Explanation
| An expansive population is characterized by a high proportion of young people under the age of 15 and a relatively low proportion of elderly people over the age of 50. In this scenario, the population aged 0-14 makes up 31% of the population, which is relatively high, while the population aged 50+ makes up only 20% of the population, which is relatively low. This suggests that the population is younger and is likely growing, as there are more people in the reproductive age range. In contrast, a stationary population (A) is characterized by a relatively even distribution of age groups, with similar proportions of people in each age group. A constrictive population (C) is characterized by a low proportion of young people and a high proportion of elderly people, which may be indicative of a declining population. Migration (B) and emigration (D) refer to the movement of people between different regions or countries and are not directly related to population structure. |
15. A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. The disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work he is often away on business trips. What is the most likely etiological factor of this disease?
A. Adenovirus
B. Candida
C. Staphylococci
D. Streptococci
E. Chlamydia
Answer: Chlamydia
Explanation
| Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. It can cause a range of symptoms, including joint pain, conjunctivitis with purulent discharge from the eyes, and painful urination. The onset of symptoms is usually acute, and the infection can be easily transmitted through sexual contact. Risk factors for chlamydia infection include unprotected sex, multiple sexual partners, and a history of sexually transmitted infections. In this scenario, the patient’s history of excessive alcohol consumption and smoking may also increase his risk for chlamydia infection, as these behaviors can weaken the immune system and make the body more susceptible to infections. Adenovirus (A) can cause a range of respiratory and gastrointestinal symptoms, but it is less likely to be associated with joint pain and urinary symptoms. Candida (B) can cause genital and urinary tract infections, but it is less likely to be associated with joint pain and conjunctivitis. Staphylococcus (C) and Streptococcus (D) are bacteria that can cause a range of infections, but they are less likely to be associated with the combination of symptoms described in this scenario. |
16. A 55-year-old woman complains of pain and popping sounds in her left knee joint, which occur when she climbs the stairs. Occasionally during movements her joint becomes” stuck”. 5 years ago, she suffered a trauma of her left knee. Complete blood count and biochemical blood analysis show normal results. X-ray shows marked osteosclerosis and osteophytes. The joint space is narrowed. Make the provisional diagnosis:
A. Rheumatoid arthritis
B. Osteoarthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Gouty arthritis
Answer: Osteoarthritis
Explanation
| Osteoarthritis is a degenerative joint disease that is characterized by the breakdown and loss of cartilage in the joints. It is a common cause of joint pain and stiffness, particularly in weight-bearing joints such as the knees. Risk factors for osteoarthritis include age, obesity, previous joint injury, and repetitive stress on the joints. In this scenario, the patient is a 55-year-old woman with a history of trauma to her left knee and complains of pain, popping sounds, and joint stiffness when climbing stairs. X-ray findings of marked osteosclerosis and osteophytes, as well as narrowed joint spaces, suggest degenerative changes in the joint consistent with osteoarthritis. Rheumatoid arthritis (A) is an autoimmune disease that causes inflammation and destruction of the joints, often affecting multiple joints symmetrically. Psoriatic arthritis (C) is a type of arthritis that can occur in people with psoriasis, causing joint pain and stiffness, as well as skin and nail changes. Reactive arthritis (D) is a type of arthritis that occurs as a reaction to an infection, often affecting the joints and causing inflammation and pain. Gouty arthritis (E) is caused by the deposition of uric acid crystals in the joints, resulting in severe pain, swelling, and inflammation. |
17. A 48-year-old woman was delivered into the surgical unit with wounds in her thigh. On examination the wound surface has a dirty-gray coating with unpleasant sweet smell. The wound content resembles a raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What bacteria is the most likely to cause such inflammation?
A. Anaerobic non-clostridial
B. Staphylococci
C. Anaerobic clostridial
D. Streptococci
E. Blue pus bacillus
Answer: Anaerobic clostridial
Explanation
| The description of the wound — dirty-gray coating with an unpleasant sweet smell, raspberry jelly-like content, glossy and turgid skin tissues, and moderate crepitation in the tissues — is consistent with the clinical presentation of gas gangrene, which is a severe and potentially life-threatening infection caused by anaerobic clostridial bacteria. The bacteria produce gas and toxins that can cause tissue destruction and necrosis, leading to a characteristic foul odor and discharge. Common species of anaerobic clostridial bacteria that can cause gas gangrene include Clostridium perfringens, Clostridium septicum, and Clostridium novyi. These bacteria are commonly found in soil and can enter the body through a contaminated wound, such as the one described in this scenario. Anaerobic non-clostridial bacteria (A) can also cause wound infections, but they are less likely to cause the severe tissue destruction and gas production seen in gas gangrene. Staphylococci (B) and Streptococci (D) can cause a range of skin and soft tissue infections, but they are less likely to produce the characteristic symptoms of gas gangrene. Blue pus bacillus (E) is a rare cause of skin and soft tissue infections, and it is not typically associated with gas production or tissue destruction. |
18. The body of a 24-year-old woman with probable signs of poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the Criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
A. Time of death
B. Manner of death
C. Mode of death
D. Cause of death
E. Mechanism of death
Answer: Cause of death
Explanation
| Forensic medical examination is a specialized field of medicine that involves the application of medical knowledge and techniques to legal issues. In cases of suspicious or unnatural death, a forensic medical examination is often necessary to determine the cause of death, which refers to the medical reason that led to the person’s death. The cause of death can include various medical conditions, injuries, or poisoning. In this scenario, the 24-year-old woman was found dead with probable signs of poisoning. A forensic medical examination would be necessary to determine the cause of death, which could help identify the type of poison or toxin that was responsible for her death. This information can be crucial in identifying potential suspects and bringing criminal charges against those responsible. The other options listed – time of death (A), manner of death (B), mode of death (C), and mechanism of death (E) – are also important aspects in forensic medicine and may be determined during a forensic medical examination. However, in this scenario, the most likely reason for requesting a forensic medical examination is to determine the cause of death. |
19. A 17-year-old girl has been suffering from hepatic cirrhosis for 3 years. Lately her periods of excitation have been intermittent with depression, she does not sleep enough. Objectively, her condition is severe, the girl is sluggish, gives one-word responses, has tremor in her extremities, her skin is icteric, with single hemorrhagic rashes. Name the likely complication of her disease:
A. Bipolar affective disorder
B. Sepsis
C. Hepatic encephalopathy
D. Kidney failure
E. Reye syndrome
Answer: Hepatic encephalopathy
Explanation
| Hepatic encephalopathy is a neuropsychiatric syndrome that can occur as a complication of liver disease, particularly in the setting of cirrhosis. It is caused by the accumulation of toxins in the blood, which can affect brain function and lead to a range of neurological symptoms, including confusion, lethargy, tremors, and psychiatric symptoms such as depression, anxiety, and irritability. The description of the girl’s symptoms — intermittent periods of excitation with depression, poor sleep, sluggishness, tremors, icteric skin, and hemorrhagic rashes — is consistent with the clinical presentation of hepatic encephalopathy. The icteric skin and hemorrhagic rashes may also indicate liver failure and the inability of the liver to produce clotting factors, leading to a tendency to bleed. Bipolar affective disorder (A) is a psychiatric disorder characterized by episodes of depression and mania or hypomania. Sepsis (B) is a potentially life-threatening condition caused by an infection that has spread throughout the body. Kidney failure (D) is a condition in which the kidneys are no longer able to properly filter waste products from the blood. Reye syndrome (E) is a rare but serious condition that can occur in children who have recently had a viral infection, particularly influenza or chickenpox, and have been treated with aspirin. |
20. A 35-year-old man complains of rapidly increasing fatigue, palpitations, “visual snow”, dizziness. He has a history of peptic ulcer of the stomach. Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic murmur is detected over the cardiac apex, heart rate is 100/min., BP is 100/70 mm Hg. The epigastrium is slightly tender on palpation. Blood test: erythrocytes — 3.2 • 1012/L, Hb — 100 g/L, color index — 0.94. What type of anemia is it?
A. Hypoplastic anemia
B. Chronic iron-deficiency anemia
C. Posthemorrhagic anemia
D. Hemolytic anemia
E. Sideroblastic anemia
Answer: Posthemorrhagic anemia
Explanation
| Posthemorrhagic anemia is a type of anemia that occurs as a result of acute or chronic blood loss, leading to a decrease in the number of red blood cells and hemoglobin in the blood. The symptoms of posthemorrhagic anemia depend on the severity and duration of the bleeding, and can include fatigue, palpitations, dizziness, and pallor. In this scenario, the patient complains of rapidly increasing fatigue, palpitations, and dizziness, and is found to have pale skin, a low red blood cell count, and a low hemoglobin level. The presence of a systolic murmur over the cardiac apex and vesicular respiration in the lungs may indicate an underlying cardiac or pulmonary pathology, which can be a consequence of severe anemia. The patient’s history of peptic ulcer of the stomach raises the possibility of gastrointestinal bleeding as the cause of the anemia. The tenderness of the epigastrium on palpation may also suggest an underlying gastrointestinal pathology. Hypoplastic anemia (A) is a type of anemia characterized by a decrease in the number of red blood cells, white blood cells, and platelets, typically due to bone marrow damage or failure. Chronic iron-deficiency anemia (B) is a type of anemia caused by a deficiency of iron, which is necessary for the production of hemoglobin. Hemolytic anemia (D) is a type of anemia caused by the destruction of red blood cells, leading to a decrease in the number of red blood cells and hemoglobin in the blood. Sideroblastic anemia (E) is a type of anemia caused by a defect in the production of hemoglobin, typically due to a deficiency of vitamin B6 or an inherited genetic disorder. |
21. A 45-year-old man underwent a cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively his body temperature is hectic. His cardiac borders arc expanded, apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?
A. Acute pericarditis
B. Acute myogenic dilatation of the heart
C. Pulmonary embolism
D. Myocardial infarction
E. Acute cardiac aneurysm
Answer: Acute pericarditis
Explanation
| Acute pericarditis is an inflammation of the pericardium, the sac-like membrane that surrounds the heart. It can occur as a complication of cardiac surgery, particularly within the first few weeks following the surgery. The symptoms of acute pericarditis include chest pain, retrosternal pain that radiates to the neck or back, dyspnea, fever, and weakness. A pericardial friction rub may also be heard on auscultation. In this scenario, the patient underwent cardiac surgery one week ago and has been experiencing a deterioration in his general state, with symptoms of dyspnea, retrosternal pain, weakness, and a hectic body temperature. The presence of an expanded cardiac border, weakened apical beat, and pericardial friction rub on auscultation are consistent with the diagnosis of acute pericarditis. Acute myogenic dilatation of the heart (B) and acute cardiac aneurysm (E) are rare and unlikely diagnoses in this case, particularly given the recent cardiac surgery. Pulmonary embolism (C) is a condition in which a blood clot travels to the lungs, causing symptoms such as shortness of breath and chest pain. Myocardial infarction (D) is a medical emergency in which the blood flow to the heart is blocked, leading to damage to the heart muscle and symptoms such as chest pain and shortness of breath. While both pulmonary embolism and myocardial infarction are potential complications of cardiac surgery, the symptoms described in this case are more consistent with acute pericarditis. |
22. A 34-year-old man undergoes treatment in a psychiatry unit for exacerbation of his schizophrenia. Objectively, he stays in bed, his movements are inhibited, no contact. The patient does not respond to the questions. The position remains unchanged, the patient is hypomimic, such signs as puckering of the lips, waxy flexibility, “psychological pillow” are present. The patient has been remaining in this condition for a week. He is being fed parenterally. What psychomotor disorder is it?
A. Anergic stupor
B. Exogenous stupor
C. Psychogenic stupor
D. Depressive stupor
E. Catatonic stupor
Answer: Catatonic stupor
Explanation
| Catatonic stupor is a type of catatonic syndrome, which is a group of symptoms characterized by disturbances in motor behavior and other features, such as mutism, negativism, and echolalia. Catatonic stupor is a state of unresponsiveness and immobility, in which the patient may remain in the same position for long periods of time and may exhibit features such as waxy flexibility, in which the limbs can be manipulated into different positions, and the “psychological pillow” sign, in which the patient’s head can be placed in a position and will remain there. In this scenario, the patient is being treated for schizophrenia and is exhibiting symptoms of a catatonic stupor, including inhibition of movement, lack of contact, hypomimia, and the presence of waxy flexibility and the psychological pillow sign. The fact that the patient has been in this condition for a week suggests a significant degree of impairment. Anergic stupor (A) is a state of extreme apathy and lack of energy, typically seen in severe depression or other psychiatric disorders. Exogenous stupor (B) is a state of unresponsiveness caused by external factors, such as drugs or toxins. Psychogenic stupor (C) is a rare condition in which the patient becomes unresponsive due to psychological factors, such as a traumatic event. Depressive stupor (D) is a type of depression characterized by a state of immobility and unresponsiveness. |
23. Forensic autopsy of the body of a 59-year-old man, who died suddenly at home without signs of violent death, shows pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs. Forensic toxicology testing detected 1.44% of ethanol in the blood and carboxyhemoglobin levels of 55%. What is the cause of death?
A. Alcohol poisoning
B. Aniline poisoning
C. Potassium cyanide poisoning
D. Carbon monoxide poisoning
E. Arsenic poisoning
Answer: Carbon monoxide poisoning
Explanation
| Carbon monoxide (CO) is a toxic gas that is generated by incomplete combustion of fossil fuels, such as those used in gas furnaces, wood stoves, and motor vehicles. CO binds to hemoglobin in the blood, forming carboxyhemoglobin, which prevents oxygen from binding to hemoglobin and being delivered to the body’s tissues. This can lead to tissue hypoxia and damage, and in severe cases, death. In this scenario, the autopsy findings of pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs are consistent with CO poisoning, which can cause a characteristic cherry-red color in the tissues due to the formation of carboxyhemoglobin. The detection of high levels of carboxyhemoglobin (55%) in the blood confirms the diagnosis of CO poisoning. The detection of ethanol (1.44%) in the blood suggests that the individual may have been drinking alcohol, which can increase the risk of CO poisoning by impairing judgment and increasing the likelihood of exposure to CO. Aniline poisoning (B) is a rare but serious condition caused by exposure to aniline, a toxic chemical used in the production of dyes, rubber, and other materials. Potassium cyanide poisoning (C) is a medical emergency that can occur as a result of exposure to cyanide, a toxic chemical that interferes with the body’s ability to use oxygen. Arsenic poisoning (E) is a rare but serious condition caused by exposure to arsenic, a poisonous substance found in some pesticides, wood preservatives, and other products. |
24. A 65-year-old woman for 5 weeks has been presenting with a progressing painless jaundice, skin itch, weight loss of 10 kg, and acholia. Palpation detects positive Courvoisier’s sign. Make the provisional diagnosis:
A. Liver cancer
B. Gallbladder cancer
C. Malaria
D. Pancreatic cancer
E. Viral hepatitis
Answer: Pancreatic cancer
Explanation
| Pancreatic cancer is a type of cancer that arises from the cells of the pancreas. It can cause a range of symptoms, including painless jaundice, skin itching, weight loss, and acholia (pale stools). A positive Courvoisier’s sign, which is the presence of a palpable, non-tender gallbladder, is a classic finding in patients with pancreatic cancer. In this scenario, the patient has been presenting with symptoms of progressing painless jaundice, skin itch, weight loss, and acholia for 5 weeks. The presence of a positive Courvoisier’s sign suggests that the cause of the jaundice is likely due to an obstruction of the common bile duct, which can occur as a result of pancreatic cancer. Liver cancer (A) can also cause jaundice, but it is less likely to present with the other symptoms described in this case, such as weight loss and acholia. Gallbladder cancer (B) can also cause jaundice, but it is less common than pancreatic cancer. Malaria (C) is a parasitic infection that can cause fever, chills, and other symptoms, but it is unlikely to cause the constellation of symptoms described in this case. Viral hepatitis (E) can cause jaundice, but it is typically associated with other symptoms such as fever, fatigue, and abdominal pain. |
25. During the study of pulmonary tuberculosis morbidity, the data on socioeconomic living conditions and harmful habits of the patients were obtained. What method allows the assessment of the extent to which these factors influence the tuberculosis morbidity?
A. Calculation of standardized indicators
B. Calculation of the agreement coefficient
C. Calculation of the confidence coefficient
D. Calculation of the regression coefficient
E. Calculation of the correlation coefficient
Answer: Calculation of the correlation coefficient
Explanation
| The correlation coefficient is a statistical measure that indicates the strength and direction of the relationship between two variables. In this case, the variables are socioeconomic living conditions and harmful habits, and their relationship with tuberculosis morbidity is being assessed. By calculating the correlation coefficient, it is possible to determine the degree to which these factors are associated with tuberculosis morbidity. A positive correlation coefficient indicates that the two variables are positively related, meaning that as one variable increases, the other variable also increases. A negative correlation coefficient indicates that the two variables are negatively related, meaning that as one variable increases, the other variable decreases. A correlation coefficient of zero indicates that there is no relationship between the two variables. Other methods listed in the answer choices, such as calculation of standardized indicators (A), agreement coefficient (B), confidence coefficient (C), and regression coefficient (D), may be useful in certain contexts but are not specifically designed to assess the relationship between two variables. |
26. A 19-year-old girl complains of moderate itching and hair loss on her head. Objectively, on the skin of her occipital region there is a single round erythematous focus 3 cm in diameter with clear margins. Asbestos-like scales can be observed on the surface of the lesion. The hair in the focus of the lesion is broken off at the length of 6-8 mm. What is the most likely diagnosis?
A. Trichophytosis
B. Seborrhea
C. Psoriasis
D. Microsporia
E. Scabies
Answer: Microsporia
Explanation
| Microsporia, also known as ringworm of the scalp, is a fungal infection of the scalp and hair that is caused by dermatophytes, a group of fungi that commonly infect human skin, hair, and nails. The infection typically presents with symptoms such as itching, hair loss, and the formation of red, scaly patches on the scalp. The patches may have a central clearing and a raised border, giving them a ring-like appearance. In this scenario, the patient is a 19-year-old girl who complains of moderate itching and hair loss on her head. The presence of a single round erythematous focus with clear margins and asbestos-like scales on the surface of the lesion is consistent with the characteristic appearance of a Microsporia lesion. The broken hair in the focus of the lesion is also a typical finding in Microsporia. Trichophytosis (A) is another name for ringworm, but it typically refers to an infection caused by a different type of fungus than Microsporia. Seborrhea (B) is a skin condition that causes excessive oiliness and scaling of the skin, but it typically does not cause hair loss. Psoriasis (C) is a chronic autoimmune skin condition that causes red, scaly patches on the skin, but it typically does not cause hair loss or ring-like lesions. Scabies (E) is a parasitic skin infection caused by the Sarcoptes scabiei mite, and it typically presents with intense itching and the formation of small, raised bumps on the skin. |
27. A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38 0 C. Examination shows him to be in a moderately severe condition; there are small Pale pink non-merging spots on the skin of is back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
A. Streptococcus
B. Rubella virus
C. Mumps virus
D. Meningococcus
E. Epslein-Barr virus
Answer: Rubella virus
Explanation
| Rubella, also known as German measles, is a viral infection caused by the rubella virus. It typically presents with symptoms such as chills, rhinitis, dry cough, and fever, as well as the presence of a characteristic rash consisting of small, pale pink non-merging spots on the skin of the back, abdomen, and extremities. Lymphadenopathy, or enlarged lymph nodes, is also a common finding in rubella. In this scenario, the patient is a 26-year-old man who presents with symptoms of chills, rhinitis, dry cough, and fever up to 38°C. The presence of small, pale pink non-merging spots on the skin and enlarged occipital and axillary lymph nodes is consistent with the characteristic rash and lymphadenopathy seen in rubella. Streptococcus (A) is a common bacterial cause of respiratory infections, but it typically presents with symptoms such as sore throat, fever, and swollen lymph nodes in the neck. Mumps virus (C) is a viral infection that typically presents with symptoms such as swelling and pain in the salivary glands, fever, and headache. Meningococcus (D) is a bacterial infection that can cause meningitis and sepsis, and it typically presents with symptoms such as fever, headache, and a characteristic rash that does not blanch under pressure. Epstein-Barr virus (E) is a viral infection that is associated with mononucleosis, and it typically presents with symptoms such as fever, sore throat, and fatigue. |
28. An employee has been sick for 4 months, further treatment is necessary, the patient is unable to work. Who is authorized to provide further disability examination of this patient?
A. Chief physician of a medical facility
B. Medical consultative board
C. Sociomedical expert committee
D. Deputy chief physician responsible for disability examination
E. Physician in charge and the head of the Department
Answer: Sociomedical expert committee
Explanation
| The sociomedical expert committee is a specialized body that is responsible for assessing the level of disability and determining the eligibility for social benefits of individuals who have a long-term or permanent disability. The committee consists of healthcare professionals, social workers, and representatives of relevant government agencies. In this scenario, the patient has been sick for 4 months and is unable to work, which suggests that the patient may have a long-term or permanent disability. Therefore, the sociomedical expert committee is the appropriate body to provide further disability examination and to determine the eligibility for social benefits, such as disability pension or rehabilitation services. The chief physician of a medical facility (A) is responsible for the overall management of the medical facility and may provide medical treatment and care to patients, but is not authorized to provide disability examination or determine eligibility for social benefits. The medical consultative board (B) is a group of medical experts who provide advice and consultation on medical issues, but may not be authorized to provide disability examination or determine eligibility for social benefits. The deputy chief physician responsible for disability examination (D) may be involved in the disability examination process, but may not be authorized to provide the final determination of eligibility for social benefits. The physician in charge and the head of the department (E) may be responsible for the medical treatment and care of the patient, but are not authorized to provide disability examination or determine eligibility for social benefits. |
29. A 58-year-old woman has type 2 diabetes mellitus that is compensated with diet and metformin. She prepares for cholecystectomy. Objectively, her height is 164 cm, weight is 90 kg, heart rate is 72/min., blood pressure is 130/80 mm Hg. Her abdomen is soft, painful in the right subcostal region. The liver is not enlarged. Fasting glucose — 6.2 mmol/L. Glycated hemoglobin — 6.5%. What further tactics of sugar-lowering therapy should be chosen in this case?
A. Prescription of a long-acting insulin
B. Prescription of an insulin mixture
C. Prescription of glurenorm (gliquidone)
D. Continue the present scheme of therapy
E. Prescription of a short-acting insulin
Answer: Prescription of a short-acting insulin
Explanation
| The patient in this scenario has type 2 diabetes mellitus that is compensated with diet and metformin, and is preparing for cholecystectomy. The fasting glucose level and glycated hemoglobin level suggest that the patient’s blood sugar is not well-controlled, and additional therapy may be necessary to optimize glycemic control before and after surgery. Surgery and anesthesia can cause stress to the body, which can lead to changes in blood sugar levels in patients with diabetes. Therefore, it is important to achieve good glycemic control before surgery to minimize the risk of perioperative complications. In this case, the most appropriate further tactic of sugar-lowering therapy is to prescribe a short-acting insulin, which can be used to control blood sugar levels before and after surgery. Short-acting insulin is typically administered before meals to control postprandial blood sugar spikes, and can be adjusted based on the patient’s blood sugar levels and carbohydrate intake. Prescribing a long-acting insulin (A) or an insulin mixture (B) may not be appropriate in this case, as these types of insulin are typically used for long-term glycemic control rather than short-term control around the time of surgery. Prescription of glurenorm (gliquidone) (C) may also not be appropriate, as it is an oral hypoglycemic agent that is not as effective as insulin in controlling blood sugar levels in the short term. Continuing the present scheme of therapy (D) may not be sufficient to achieve good glycemic control before and after surgery, and may increase the risk of perioperative complications. |
30. On the 5th day after giving birth a postparturient woman complains of a pain in her left mammary gland and temperature up to 38. PC’. Examination shows that her mammary gland is enlarged and painful on palpation, the nipple is edematous and has fissures, the upper external quadrant of the gland is hyperemic. Name the measures that would have prevented the development of this complication in the patient:
A. Feeding on demand, expression of breast milk, prevention of nipple fissures
B. Feeding no longer that 10 minutes through an overlay
C. Stop breastfeeding when fissures appear
D. Feeding on schedule
E. Constant expression of breast milk
Answer: Feeding on demand, expression of breast milk, prevention of nipple fissures
Explanation
| Mastitis is a common complication of breastfeeding that occurs as a result of inflammation and infection of the breast tissue. The symptoms typically include breast pain, tenderness, redness, and swelling, as well as fever and flu-like symptoms. In this case, the postpartum woman developed mastitis on the 5th day after giving birth, with symptoms such as pain in her left mammary gland and temperature up to 38°C, as well as enlargement, tenderness, and redness of the breast tissue. Feeding on demand and expression of breast milk are important measures to prevent the development of mastitis in breastfeeding women. Feeding on demand ensures that the baby is able to empty the breast completely and efficiently, which helps to prevent the buildup of milk in the ducts and the subsequent development of infection. Expression of breast milk can also help to relieve engorgement and prevent the buildup of milk, especially if the baby is unable to empty the breast completely. Prevention of nipple fissures is also an important measure to prevent the development of mastitis. Nipple fissures can occur as a result of improper attachment or positioning of the baby during breastfeeding, which can lead to trauma and damage to the nipple tissue. This can create a portal of entry for bacteria, leading to infection and inflammation of the breast tissue. Feeding no longer than 10 minutes through an overlay (B) or feeding on schedule (D) are not recommended measures to prevent mastitis, as they can lead to inadequate emptying of the breast and the subsequent development of milk stasis and infection. Stopping breastfeeding when fissures appear (C) is also not a recommended measure, as it can lead to engorgement and the buildup of milk, which can increase the risk of infection. Constant expression of breast milk (E) is not necessary for the prevention of mastitis, but it can be helpful in relieving engorgement and preventing the buildup of milk in the breast tissue. |
31. A 20-year-old woman complains of headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia. The signs appear 6-7 days before menstruation and disappear in the first days of menstruation. Make the diagnosis:
A. Premenstrual syndrome
B. Metabolic craniopathy
C. Diencephalic syndrome
D. Algomenorrhea
E. Stein-Leventhal syndrome
Answer: Premenstrual syndrome
Explanation
| PMS is a collection of physical, emotional, and behavioral symptoms that occur in women of reproductive age in the days preceding menstruation. Symptoms can include headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia, among others. These symptoms usually disappear in the first few days of menstruation. Metabolic craniopathy, diencephalic syndrome, algomenorrhea, and Stein-Leventhal syndrome are all distinct medical conditions that are not typically associated with the symptoms described in the scenario. It is important to note that while PMS is a common condition, it can still cause significant discomfort and impact a person’s quality of life. If a person’s PMS symptoms are severe or significantly affecting their daily functioning, they should consult a healthcare provider for potential treatment options. |
32. A 38-year-old patient has been delivered by an ambulance to a surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Complete blood count: Hb — 108 g/L, thrombocytopenia. Anamnesis states that similar condition was observed 1 year ago. Make the diagnosis:
A. Hemophilia
B. Rectal tumor
C. Thrombocytopenic purpura
D. Nonspecific ulcerative colitis
E. Ulcerative bleeding
Answer: Thrombocytopenic purpura
Explanation
| The patient presents with symptoms of bleeding, including black stool and skin hemorrhages, as well as thrombocytopenia (low platelet count), which is consistent with a diagnosis of thrombocytopenic purpura (TTP). TTP is a rare blood disorder characterized by the formation of small blood clots throughout the body, which can lead to decreased platelet count and bleeding symptoms. The black stool is a sign of gastrointestinal bleeding, which is a common complication of TTP. Hemophilia is a genetic disorder that affects blood clotting, but it typically presents with bleeding into joints and muscles, rather than skin hemorrhages and black stool. Rectal tumor, nonspecific ulcerative colitis, and ulcerative bleeding can also cause gastrointestinal bleeding, but they are less likely to cause thrombocytopenia or skin hemorrhages. It is important for the patient to receive prompt medical attention, as TTP can be a life-threatening condition if left untreated. Treatment may involve plasma exchange or immunosuppressive therapy, depending on the underlying cause of the disorder. |
33. A 31-year-old woman has been suffering from systemic scleroderma for 14 years. She underwent multiple inpatient treatment courses. She complains of intermittent dull pain in the area of her heart, palpitations, shortness of breath, headache, swollen eyelids, weight loss, and painful and deformed joints in her limbs. The prognosis of her condition will be worse if which of the following organs is affected?
A. Skin and joints
B. Lungs
C. Gastrointestinal tract
D. Kidneys
E. Heart
Answer: Kidneys
Explanation
| Systemic scleroderma is a connective tissue disorder that can affect multiple organs and systems in the body. The symptoms described in the scenario are consistent with various complications of systemic scleroderma, including cardiac involvement, pulmonary hypertension, joint and skin involvement, and gastrointestinal symptoms. However, the prognosis of the condition may be worse if the kidneys are affected. Kidney involvement, also known as scleroderma renal crisis, is a serious complication that can lead to renal failure and other severe consequences. Scleroderma renal crisis is characterized by sudden onset of high blood pressure, declining kidney function, and presence of protein in the urine. While skin and joint involvement, lung complications, gastrointestinal symptoms, and cardiac involvement can all have significant impacts on a person’s quality of life and prognosis, kidney involvement is generally considered to be one of the most serious complications of systemic scleroderma. |
34. Disease onset was acute. A child developed general weakness, pain in the joints, and elevated temperature. Later these signs became accompanied by itching skin rash manifested as erythematous spots 25 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen; pain attacks periodically occur in the paraumbilical area; there are signs ofintestinal hemorrhage. What is the most likely diagnosis?
A. Hemorrhagic vasculitis (HenochSchonlcin purpura)
B. Scarlet fever
C. Rheumatism
D. Streptococcal impetigo
E. Hemorrhagic meningoencephalitis
Answer: Hemorrhagic vasculitis (HenochSchonlcin purpura)
Explanation
| The symptoms described in the scenario are characteristic of Henoch-Schonlein purpura (HSP), which is a type of vasculitis, or inflammation of blood vessels. HSP commonly affects children and is typically characterized by the sudden onset of symptoms such as joint pain, fever, and skin rash, which can progress to hemorrhagic spots or purpura. Gastrointestinal symptoms such as abdominal pain and intestinal hemorrhage are also common in HSP. Scarlet fever, rheumatism, and streptococcal impetigo are all distinct conditions that can cause fever and skin rash, but they are less likely to cause joint pain and gastrointestinal symptoms, and they do not typically progress to hemorrhagic spots or purpura. Hemorrhagic meningoencephalitis is a rare condition characterized by inflammation of the brain and spinal cord, and it is not typically associated with the symptoms described in the scenario. |
35. A 14-year-old girl came to a general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after the previous delay of 2 months. Objectively, her skin is pale, heart rate is 90/min., BP is 110/70 mm Hg, Hb is 88 g/L. Rectal examination: the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
A. Migraine
B. Dysmenorrhea
C. Somatoform autonomic dysfunction of hypotonic type
D. Posthemorrhagic anemia
E. Gastritis
Answer: Posthemorrhagic anemia
Explanation
| The symptoms and clinical findings described in the scenario are consistent with posthemorrhagic anemia, which is a type of anemia that occurs as a result of blood loss. In this case, the patient’s profuse and prolonged menstrual bleeding has likely led to significant blood loss and subsequent anemia, which is characterized by symptoms such as weakness, fatigue, headache, and rapid heartbeat. The low hemoglobin level (88 g/L) is also indicative of anemia. Migraine, dysmenorrhea, somatoform autonomic dysfunction of hypotonic type, and gastritis are all distinct conditions that can cause symptoms similar to those described in the scenario, but they are less likely to cause anemia or be associated with profuse menstrual bleeding. |
36. A 68-year-old woman with congestive heart failure and left ventricular ejection fraction of < 40% receives the following pharmacotherapy scheme: ramipril, torasemidc, bisoprolol, clopidogrcl, and digoxin. During one of her regular examinations, frequent polymorphic ventricular extrasystoles were detected in the patient. What medicine should be removed from her therapy scheme?
A. Digoxin
B. Bisoprolol
C. Clopidogrel
D. Torasemide
E. Ramipril
Answer: Digoxin
Explanation
| Digoxin is a medication commonly used in the treatment of heart failure and atrial fibrillation. However, it can increase the risk of arrhythmias, particularly if it is used in patients with underlying heart disease and electrolyte imbalances. The presence of frequent polymorphic ventricular extrasystoles in this patient suggests that she may be at risk for developing potentially life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation. Of the medications listed in the patient’s therapy scheme, Digoxin is the most likely culprit for causing these ventricular extrasystoles and should be discontinued. Bisoprolol, torasemide, and ramipril are all medications used in the treatment of heart failure, while clopidogrel is an antiplatelet medication used to prevent blood clots. While these medications may have side effects, they are not typically associated with an increased risk of arrhythmias. |
37. A 78-year-old man with a prostate adenoma underwent a herniotomy for a direct inguinal hernia. After the surgery he presents with absent urination. Enlarged urinary bladder is detectable above the patient’s pubis. What measures should be taken in this case?
A. Apply cold to the urinary bladder area
B. Prescribe antispasmodics subcutaneously
C. Prescribe proserin (neostigmine) intramuscularly
D. Prescribe processing of the postoperative wound with UHF field
E. Bladder catheterization
Answer: Bladder catheterization
Explanation
| The patient’s symptoms suggest acute urinary retention, which is a common complication following hernia surgery, particularly in older men with prostate enlargement. The presence of an enlarged urinary bladder above the pubis indicates that the bladder is distended with urine and unable to empty on its own. Bladder catheterization is the most effective and immediate treatment for acute urinary retention. This involves inserting a catheter through the urethra and into the bladder to drain the urine. The procedure is quick and relatively simple, and it can relieve the patient’s symptoms and prevent complications such as bladder damage or infection. Applying cold to the urinary bladder area (Option A) or prescribing antispasmodics subcutaneously (Option B) may provide some temporary relief of symptoms, but they do not address the underlying cause of the urinary retention. Proserin (neostigmine) intramuscularly (Option C) is a medication that can stimulate bladder contraction and increase the urinary flow rate, but it is typically reserved for cases of chronic urinary retention and is not recommended in acute cases. Processing of the postoperative wound with UHF field (Option D) is not a recognized treatment for urinary retention and is unlikely to be effective in this case. |
38. A 23-year-old woman with type 1 diabetes mellitus during the 2nd week of community-acquired pneumonia developed nausea and vomiting. In the evening she has lost her consciousness and was hospitalized. Objectively, the patient’s skin is pale and dry. Her respiration is loud, the tongue is dry, with brown deposit. Her heart rate is 129/min., blood pressure is 85/50 mm Hg. Palpation of the patient’s abdomen provokes no response. The liver is +3 cm. Acetone test is markedly positive, blood glucose is 26 mmol/L. Make the provisional diagnosis:
A. Hepatic coma
B. Hyperosmolar coma
C. Infectious toxic shock
D. Ketoacidotic coma
E. Lactacidemic coma
Answer: Ketoacidotic coma
Explanation
| The patient has type 1 diabetes mellitus, which predisposes her to diabetic ketoacidosis (DKA), a potentially life-threatening complication of diabetes. The presence of nausea, vomiting, and loss of consciousness, along with the markedly positive acetone test and high blood glucose level, suggest that the patient has developed DKA. In DKA, the body produces high levels of ketones, which can cause metabolic acidosis and a range of symptoms, including dehydration, tachycardia, hypotension, dry skin and mouth, and altered mental status. The brown deposit on the patient’s tongue is likely due to dehydration and poor oral hygiene. Hepatic coma (Option A) is a rare complication of liver disease, and the patient’s liver enlargement is unlikely to be the cause of her symptoms. Hyperosmolar coma (Option B) is a complication of hyperosmolar hyperglycemic state, which typically occurs in older patients with type 2 diabetes and is characterized by severe hyperglycemia and dehydration. Infectious toxic shock (Option C) is a rare but serious complication of bacterial infections, which can cause sepsis and organ dysfunction. Lactacidemic coma (Option E) is a rare complication of lactic acidosis, which can occur in patients with severe metabolic disturbances or underlying medical conditions, but it is not likely in this case. |
39. A 35-year-old woman came to the family doctor with complaints of profuse menstruations that last up to 10 days. Gynecological examination shows that the uterine cervix is without changes, the uterus is in anterflexio, has normal size, is mobile and painless. The uterine appendages on the both sides are without peculiarities. The family doctor made the provisional diagnosis of abnormal uterine bleeding. What instrumental method of examination needs to be performed first to diagnose this pathology?
A. Colposcopy
B. Transabdominal ultrasound
C. Trans vaginal ultrasound
D. Culdoscopy
E. Laparoscopy
Answer: Trans vaginal ultrasound
Explanation
| Transvaginal ultrasound is a non-invasive imaging technique that uses high-frequency sound waves to create images of the uterus and ovaries. It can help to identify structural abnormalities, such as uterine fibroids or polyps, which can cause abnormal uterine bleeding. It can also detect other conditions, such as endometrial hyperplasia or cancer, that may require further investigation or treatment. Colposcopy (Option A) is a gynecological examination that uses a special microscope to examine the cervix, vagina, and vulva for signs of abnormal cells or lesions. It is not typically used to diagnose abnormal uterine bleeding, although it may be performed if abnormal cells or lesions are detected. Transabdominal ultrasound (Option B) is another type of ultrasound that uses a transducer placed on the abdomen to create images of the pelvic organs. However, transvaginal ultrasound is preferred over transabdominal ultrasound for evaluating the uterus and ovaries because it provides better resolution and more detailed images. Culdoscopy (Option D) and laparoscopy (Option E) are invasive procedures that involve inserting a scope into the pelvic cavity to visualize the uterus and ovaries. They are typically reserved for cases where other diagnostic methods, such as ultrasound or biopsy, have been inconclusive or where a surgical procedure is planned. |
40. A 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37.8°C, general weakness, weight loss. The patient’s condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, and various numerous moist crackles in the lower pulmonary segments on the left can be observed in this patient. Complete blood count: erythrocytes — 3.2 • 1012/L, leukocytes — 8.4 • 109/L, ESR — 56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?
A. Chronic abscess of the left lung
B. Chronic left-sided pneumonia
C. Left-sided pulmonary cystic dysplasia
D. Multiple bronchiectasis of the left lung
E. Suppuration of the cyst in the left lung
Answer: Multiple bronchiectasis of the left lung
Explanation
| Bronchiectasis is a chronic condition characterized by irreversible dilation and thickening of the bronchial walls, which can lead to recurrent infections and chronic inflammation. The symptoms described in this patient, including cough with purulent sputum, hemoptysis, dyspnea, and weight loss, are typical of bronchiectasis. The presence of clubbing of the fingers, cyanosis, and emphysematous changes on X-ray are also consistent with this diagnosis. Multiple bronchiectasis of the left lung (Option D) is the most likely diagnosis based on the patient’s symptoms and imaging findings. Chronic abscess of the left lung (Option A) is a possible differential diagnosis, but it is less likely given the absence of a focal lesion on imaging and the chronicity of the symptoms. Chronic left-sided pneumonia (Option B) is another possible differential diagnosis, but it is less likely given the absence of a response to antibiotics and the presence of emphysematous changes on X-ray. Left-sided pulmonary cystic dysplasia (Option C) and suppuration of a cyst in the left lung (Option E) are rare conditions that are less likely to be the cause of the patient’s symptoms. |
41. A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp; later the nodes suppurated. Temperature increased up to 37.7°C, intoxication symptoms appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, ncutrocytosis, raised ESR. What diagnosis will you make?
A. –
B. Pemphigus
C. Scalp phlegmon
D. Pseudofurunculosis
E. Vesiculopustulosis
Answer: Pseudofurunculosis
Explanation
| Pseudofurunculosis, also known as impetigo, is a bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes. It is characterized by the development of red, pus-filled blisters or sores that are often surrounded by a red, inflamed halo. In this case, the infant developed subcutaneous red nodes on the scalp that later suppurated, which is consistent with the development of impetigo. The presence of anemia, leukocytosis, neutrocytosis, raised ESR, and the appearance of intoxication symptoms suggest a systemic infection. Additionally, the enlargement of regional lymph nodes is a common symptom of impetigo. Pemphigus is an autoimmune disease characterized by the development of blisters on the skin and mucous membranes. Scalp phlegmon is a bacterial infection of the scalp that can cause fever, pain, and swelling. Vesiculopustulosis is a general term used to describe the formation of blisters or pustules on the skin, which may be caused by a variety of conditions. None of these diagnoses are consistent with the symptoms described in this case. |
42. A 7-year-old boy suddenly developed pain and edema in his right knee. The day before, at school, he took part in cross-country skiing. There is no family history of hemophilia or susceptibility to bleeding. Objectively, his body temperature is 37.5°C. The knee is painful on palpation, hot to the touch, and has edema with local tissue tension above it. Incomplete blood count: Hb — 123 g/L, leukocytes — 5.6 • 109/L, platelets — 354 •109/L, prothrombin time — 12 seconds (normal range is 10-15 seconds), activated partial thromboplastin time — 72 seconds (normal range is 35^15 seconds). Bleeding time is normal, the factor VIII levels constitute 5% of normal value. Make the diagnosis:
A. Hemophilia B
B. Hemophilia A
C. Thrombocytopenia
D. Vitamin K deficiency
E. Henoch-Schoenlein purpura
Answer: Hemophilia A
Explanation
| Hemophilia A is a genetic disorder caused by a deficiency of clotting factor VIII. It primarily affects males and is characterized by bleeding into the joints, muscles, and other internal organs. In this case, the 7-year-old boy suddenly developed pain and edema in his right knee after cross-country skiing, which suggests bleeding into the joint. The knee is also hot to the touch, which is consistent with inflammation. The incomplete blood count and platelet count are within normal limits, ruling out thrombocytopenia as a diagnosis. Vitamin K deficiency is unlikely given the normal prothrombin time. Henoch-Schoenlein purpura typically presents with a rash, joint pain, and gastrointestinal symptoms, which are not present in this case. The prolonged activated partial thromboplastin time (aPTT) suggests a clotting factor deficiency. In this case, the factor VIII level is only 5% of normal, confirming the diagnosis of Hemophilia A. Hemophilia B is another type of hemophilia caused by a deficiency of clotting factor IX. However, the symptoms described in this case are more consistent with Hemophilia A. |
43. A 62-year-old woman was brought into the admission room with complaints of severe burning retrosternal pain and asphyxia. She has a 10-year-long history of essential hypertension. Objectively her condition is moderately severe. She presents with skin pallor, cyanotic lips, and vesicular respiration over her lungs. The II heart sound is accentuated over the aorta. Blood pressure — 210/120 mm Hg, heart rate (pulse) — 76/min. ECG shows elevation of ST segment in the leads I, aVL, and V5-V6. What is the most likely diagnosis?
A. Uncomplicated hypertensive urgency
B. Pulmonary embolism
C. Hypertensive emergency complicated with acute myocardial infarction
D. Hypertensive emergency complicated with acute left ventricular failure
E. Hypertensive emergency complicated with unstable angina pectoris
Answer: Hypertensive emergency complicated with acute myocardial infarction
Explanation
| Hypertensive emergency is a severe and potentially life-threatening condition characterized by a rapid increase in blood pressure, typically above 180/120 mm Hg, which can cause damage to the organs. In this case, the 62-year-old woman is presenting with severe retrosternal pain and asphyxia, which suggests a possible cardiac event. The elevated ST segment on the ECG in leads I, aVL, and V5-V6 is indicative of an acute myocardial infarction (heart attack), which is a medical emergency requiring immediate intervention. The accentuated second heart sound over the aorta suggests an increase in blood pressure, which is consistent with hypertensive emergency. Skin pallor, cyanotic lips, and vesicular respiration over the lungs suggest decreased oxygenation and possible respiratory distress. Uncomplicated hypertensive urgency typically presents with a severe headache, nausea, and vomiting, but without evidence of acute organ damage. Pulmonary embolism typically presents with sudden onset dyspnea, chest pain, and tachycardia. Acute left ventricular failure would present with shortness of breath, coughing, wheezing, and fluid accumulation in the lungs. Unstable angina pectoris typically presents with chest pain or discomfort that occurs at rest or with minimal exertion, and may progress to a heart attack. None of these diagnoses are consistent with the symptoms described in this case. |
44. A multigravida, labor II, 36-37 weeks of gestation, has gone into labor. Her waters broke 8 hours ago, the labor activity continues for the last 4 hours, it is regular, with contractions that last 35 seconds and occur every 3- 4 minutes. The child is in the cephalic presentation, with the head pressed to the entrance into the lesser pelvis. The parturient woman complains of a sudden sharp abdominal pain. Her pulse is 100/min., blood pressure is 110/70 — 100/70 mm Hg. The uterus is tense and does not relax between the contractions. Fetal heartbeat is muffled — 100/min. The amniotic fluid is blood-colored and continues to leak. What is the most likely diagnosis?
A. Premature detachment of the normally positioned placenta
B. Cervical rupture
C. Partial placenta previa
D. Rupture of the umbilical vessels
E. Uterine rupture
Answer: Premature detachment of the normally positioned placenta
Explanation
| Premature detachment of the normally positioned placenta, also known as placental abruption, is a medical emergency that occurs when the placenta detaches from the uterine wall before delivery. This can result in heavy bleeding and fetal distress. In this case, the multigravida woman has gone into labor, and her waters broke 8 hours ago. The sudden sharp abdominal pain, tense uterus that does not relax between contractions, and muffled fetal heartbeat suggest placental abruption. Cervical rupture is a rare complication of labor that can occur due to trauma or previous surgery on the cervix. Partial placenta previa is a condition in which the placenta partially covers the cervix, which can cause bleeding but is not typically associated with sudden abdominal pain. Rupture of the umbilical vessels is also a rare complication of labor that can cause fetal distress and heavy bleeding. Uterine rupture is a rare but serious complication that occurs when the uterus tears during labor, which can cause heavy bleeding and fetal distress. However, the symptoms described in this case are more consistent with placental abruption. |
45. A 45-year-old woman was hospitalized with complaints of periodical severe headaches against the background of elevated blood pressure up to 180/90 mm Hg, muscle weakness, and frequent urination (at night as well). Her anamnesis states that despite combining various antihypertensive drugs and adjusting their dosage her arterial hypertension cannot be corrected with drugs. The patient’s blood serum potassium levels are 2.0 mmol/L, blood serum sodium levels are 160.0 mmol/L. Ultrasound imaging detects three-dimensional formations approximately 1.0 cm in diameter in the both adrenal glands. Selective endovascular blood sampling from the suprarenal veins was performed, which revealed significant increase of cortisol and aldosterone levels. Make the diagnosis:
A. Pheochromocytoma
B. Aldosteroma
C. Cushing’s syndrome
D. Androsteroma
E. Cushing’s disease
Answer: Aldosteroma
Explanation
| The patient’s symptoms and laboratory findings suggest the presence of primary hyperaldosteronism, which is also known as Conn’s syndrome. This condition is characterized by the excessive production of aldosterone by the adrenal glands, which leads to hypertension, hypokalemia (low potassium levels), and metabolic alkalosis (high pH). The ultrasound imaging shows the presence of small, three-dimensional formations in both adrenal glands, which are consistent with adrenal adenomas. The endovascular blood sampling from the suprarenal veins showed a significant increase in cortisol and aldosterone levels, which is consistent with the diagnosis of aldosteroma. Pheochromocytoma (A) is another type of adrenal tumor that can cause hypertension, but it typically causes episodic hypertension, accompanied by headaches, palpitations, and sweating. Cushing’s syndrome (C and E) is a condition caused by excessive cortisol production, and it typically presents with weight gain, moon facies, and muscle weakness. Androsteroma (D) is a rare adrenal tumor that can cause virilization in women, but it does not typically cause hypertension or hypokalemia. |
46. A 28-year-old man was hospitalized on the 9th day of illness with complaints of fever of 39°C, headache, general weakness, constipation, and disturbed sleep. Objectively, on the skin of his abdomen there are isolated roseolas, his pulse is 78/min., the liver is enlarged by 2 cm. Make the diagnosis:
A. Epidemic typhus
B. Sepsis
C. Leptospirosis
D. Brucellosis
E. Typhoid fever
Answer: Typhoid fever
Explanation
| The patient’s symptoms of fever, headache, general weakness, and disturbed sleep are consistent with the diagnosis of typhoid fever. Typhoid fever is caused by the bacterium Salmonella typhi, which is transmitted through contaminated food or water. The disease typically presents with a gradual onset of fever, headache, malaise, and abdominal pain. Constipation is a common symptom of typhoid fever, and the presence of roseolas on the skin is also a characteristic finding. An enlarged liver (hepatomegaly) is a common finding in typhoid fever, as the bacteria can infect the liver and cause inflammation. The pulse rate of 78 beats per minute is not particularly suggestive of any specific diagnosis. Epidemic typhus (A) is caused by the bacterium Rickettsia prowazekii and is transmitted by lice. Sepsis (B) is a serious medical condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction. Leptospirosis (C) is caused by the bacterium Leptospira interrogans and is transmitted through contact with contaminated water or soil. Brucellosis (D) is caused by the bacteria of the genus Brucella and is transmitted through contact with infected animals or contaminated animal products. None of these conditions match the patient’s symptoms and findings as closely as typhoid fever. |
47. An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5 years. The first instance of this disease occurred after a car accident. Objectively: the patient presents with a papular rash covered in silvery scales, “thimble” sign (small pits on the nails), affected joints. What is the most likely diagnosis?
A. Onychomycosis
B. Panaritium
C. Rheumatism
D. Lupus erythematosus
E. Psoriasis
Answer: Psoriasis
Explanation
| Psoriasis is a chronic skin condition that is characterized by red, scaly patches on the skin. The patches are typically covered in silvery scales and can be itchy or painful. The “thimble” sign (small pits on the nails) is a characteristic feature of psoriasis, as are affected joints. Psoriatic arthritis is a type of arthritis that can develop in people with psoriasis, and it can cause joint pain, stiffness, and swelling. The fact that the patient has been suffering from this condition for 5 years suggests that it is a chronic condition, which is consistent with the diagnosis of psoriasis. The fact that the first instance of the disease occurred after a car accident is not particularly relevant to the diagnosis. Onychomycosis (A) is a fungal infection of the nails, and it typically causes thickening, discoloration, and separation of the nail from the nail bed. Panaritium (B) is a type of skin infection that affects the fingers and toes. Rheumatism (C) is a general term that refers to any disorder that affects the joints, muscles, or bones. Lupus erythematosus (D) is an autoimmune disorder that can affect the skin, joints, and internal organs. While some of these conditions may present with skin rash and joint involvement, none of them match the patient’s symptoms and findings as closely as psoriasis. |
48. A 19-year-old young man was diving and hit his head on the bottom of the pool. He complains of pain in the neck, his head movements are limited and painful. During examination his head is bowed forward and to the right and the patient supports it with his hands. Palpation detects tense neck muscles and protruding spinous process of the IV cervical vertebra (C4). When pressure is applied to this process and to the head (axial load), the pain intensifies. Make the provisional diagnosis:
A. Neck muscle injury
B. Cervical spine contusion
C. Complicated spine cervical fracture
D. Spinal root injury
E. Uncomplicated cervical spine fracture
Answer: Uncomplicated cervical spine fracture
Explanation
| The patient’s history of hitting his head on the bottom of the pool, coupled with his symptoms of neck pain and limited and painful head movements, suggest a possible cervical spine injury. The fact that the patient is supporting his head with his hands and that palpation detects tense neck muscles and a protruding spinous process of the IV cervical vertebra (C4) further supports this diagnosis. The fact that the pain intensifies when pressure is applied to the spinous process and to the head (axial load) suggests that the patient may have an uncomplicated cervical spine fracture. An uncomplicated fracture is one that does not involve any damage to the spinal cord or nerve roots. However, it is important to note that this is a provisional diagnosis and further imaging studies, such as X-rays or MRI, may be needed to confirm the diagnosis. Neck muscle injury (A) is a possible diagnosis, but it is less likely given the patient’s history of trauma and the fact that the pain intensifies with axial loading. Cervical spine contusion (B) is another possible diagnosis, but it typically presents with more diffuse pain and tenderness in the neck, rather than localized pain at a specific vertebral level. Complicated cervical spine fracture (C) involves damage to the spinal cord or nerve roots, and would typically present with more severe neurological symptoms such as weakness, numbness, or paralysis. Spinal root injury (D) may also present with neurological symptoms such as weakness or numbness. |
49. A 48-year-old woman complains of disturbed menstrual cycle: her periods last for 7-9 days and arc excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure — 150/90 mm Hg, pulse — 90/min., rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornices are free. What is the most likely diagnosis?
A. Adrenogenital syndrome
B. Climacteric syndrome
C. Stein-Leventhal syndrome (polycystic ovary syndrome)
D. Uterine myoma
E. Premenstrual syndrome
Answer: Climacteric syndrome
Explanation
| Climacteric syndrome, also known as menopause or perimenopause, is a natural biological process that occurs in women as they age. It is characterized by a gradual decline in ovarian function, which leads to a decrease in estrogen production and the eventual cessation of menstrual periods. The symptoms of climacteric syndrome can include disturbed menstrual cycles, excessive bleeding, hot flashes, insomnia, irritability, and headaches. The fact that the patient is 48 years old and has been experiencing these symptoms for the last half-year further supports the diagnosis of climacteric syndrome. The fact that the patient’s blood pressure is elevated (150/90 mm Hg) and her pulse rate is increased (90/min) may be related to climacteric syndrome, as hormonal changes during menopause can affect cardiovascular function. However, it is important to monitor these values and consider additional evaluation if they remain elevated. Uterine myoma (D) is a benign tumor of the uterus that can cause heavy menstrual bleeding, but it typically presents with uterine enlargement and/or palpable masses. Adrenogenital syndrome (A) is a rare genetic disorder that affects the adrenal glands and can cause hormonal imbalances, but it typically presents with virilization in women. Stein-Leventhal syndrome (polycystic ovary syndrome) (C) is a hormonal disorder that can cause irregular menstrual cycles, but it typically presents with other symptoms such as hirsutism (excessive hair growth), acne, and obesity. Premenstrual syndrome (E) is a collection of physical and emotional symptoms that occur in the days leading up to a woman’s menstrual period, but it typically does not cause excessive bleeding. |
50. A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart dullness: right — the parasternal line, upper — the III rib, left — 1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
A. Infectious myocarditis
B. Hypertrophic cardiomyopathy
C. Exudative pericarditis
D. Somatoform autonomic dysfunction
E. Functional cardiopathy
Answer: Infectious myocarditis
Explanation
| The patient’s history of respiratory infection followed by dyspnea at rest, paleness of skin, and muffled heart sounds suggest a possible cardiac condition. The fact that the patient has tachycardia (heart rate of 110 beats per minute) and hypotension (blood pressure of 90/55 mm Hg) further supports this diagnosis. The borders of relative heart dullness are also suggestive of a cardiac condition. The fact that the dullness extends to the left (1.0 cm outwards from the midclavicular line) suggests that the patient may have an enlarged heart, which is a characteristic finding in myocarditis. Hypertrophic cardiomyopathy (B) is a genetic condition that causes the heart muscle to become abnormally thick, but it typically presents with symptoms such as chest pain, shortness of breath, and palpitations. Exudative pericarditis (C) is a condition in which there is an accumulation of fluid in the pericardial sac around the heart, but it typically presents with chest pain and a characteristic “pericardial rub” on auscultation. Somatoform autonomic dysfunction (D) is a psychiatric condition that can cause symptoms such as chest pain and palpitations, but it typically does not cause muffled heart sounds or cardiac dullness. Functional cardiopathy (E) is a non-specific term that is not a specific diagnosis. |
