Question From (1 To 50 )
- For intensive infusion therapy, patients with acute respiratory failure underwent subclavian vein catheterization using the Seldinger technique. After administration of 600 mL of the infusion solution, the patient’s condition sharply deteriorated, tachypnea increased from 26/min. to 40/min, tidal volume decreased from 400 mL to 250 mL. Auscultation detects sharply weakened respiration on the right. Percussion detects a dull sound. What complication developed in this patient
A. Pulmonary edema
B. Pulmonary embolism
C. Hydrothorax
D. Acute heart failure
E. Cerebral edem
Answer: Hydrothorax
Explanation
Based on the provided information, the most likely complication that developed in this patient is C. Hydrothorax.
Hydrothorax refers to the accumulation of fluid in the pleural cavity, which can occur as a complication of subclavian vein catheterization using the Seldinger technique. The Seldinger technique involves the insertion of a catheter into a blood vessel using a guidewire and dilators.
In this case, the patient’s condition sharply deteriorated after the administration of the infusion solution, with an increase in tachypnea (respiratory rate) from 26/min. to 40/min. and a decrease in tidal volume from 400 mL to 250 mL. These changes suggest a significant impairment in respiratory function.
Auscultation detecting sharply weakened respiration on the right side, along with the dull sound detected upon percussion, indicates that there is a problem specifically on the right side of the chest. The presence of these findings, along with the sudden deterioration in respiratory function, suggests the development of hydrothorax.
- Pulmonary edema (option A) typically presents with symptoms such as breathlessness, coughing, and frothy sputum. Although respiratory distress is present in this case, the specific findings of weakened respiration on the right side and dull sound on percussion point more towards hydrothorax than pulmonary edema.
- Pulmonary embolism (option B) usually presents with sudden-onset dyspnea, pleuritic chest pain, and sometimes hemoptysis. The absence of these features and the presence of specific localizing signs (weakened respiration on the right side) make pulmonary embolism less likely.
- Acute heart failure (option D) may cause respiratory symptoms, but the specific findings of weakened respiration on the right side and dull sound on percussion suggest a local pleural problem (hydrothorax) rather than a primary cardiac issue.
- Cerebral edema (option E) is not directly related to the presented symptoms and findings, and there is no indication in the question to suggest cerebral edema as a complication.
Therefore, based on the clinical presentation, the most likely complication developed in this patient is hydrothorax, which can occur as a result of subclavian vein catheterization using the Seldinger technique.
2.A 46-year-old man came to a doctor with complaints of a rash on his hands that appeared one week ago and is accompanied by severe itching. The patient has a history of bronchial asthma and has seasonal allergies. Physical examination detects dry skin of the hands and multiple erythematous papules and vesicles with serous contents, as well as areas of lichenification and excoriation, on the back of both hands. What is the most likely diagnosis in this case?
A. Psoriasis
B. Seborrheic dermatitis
C. Contact dermatitis
D. Eczema
E. Scabies
Answer: Eczema
Explanation
Based on the provided information, the most likely diagnosis in this case is D. Eczema.
Eczema, also known as dermatitis, is a common inflammatory skin condition characterized by itching, redness, and the formation of papules, vesicles, and fluid-filled blisters. It can be acute or chronic and is often associated with a personal or family history of allergies, asthma, or atopic dermatitis.
In this case, the patient’s complaints of a rash on the hands accompanied by severe itching, along with the presence of dry skin, erythematous papules, vesicles with serous contents, and areas of lichenification and excoriation, are typical features of eczema. The involvement of both hands further supports this diagnosis.
Psoriasis is a chronic autoimmune condition characterized by the development of thick, scaly plaques on the skin. Seborrheic dermatitis typically affects oily areas of the body, such as the scalp, face, and chest.
Contact dermatitis is an inflammatory reaction caused by exposure to irritants or allergens. Scabies is a parasitic infestation caused by mites. While the other conditions mentioned may also present with skin manifestations, the combination of symptoms described in this case is most consistent with eczema.
3.A 30-year-old woman came to a doctor with complaints of menstruations that have been missing for two years after her second childbirth. The childbirth was complicated by a massive bleeding. After giving birth, the woman started noticing hair loss and weight loss. Objectively, the woman’s body type is asthenic, her external genitalia are hypoplastic, the cervix is cylindrical, the body of the uterus is small and painless, the uterine appendages cannot be detected. What is the most likely diagnosis in this case?
A. Primary amenorrhea
B. Pituitary tumor (Cushing disease)
C. Pituitary amenorrhea (Sheehan syndrome)
D. Uterine pregnancy
E. Stein-Leventhal syndrome
Answer: Pituitary amenorrhea (Sheehan syndrome)
Explanation
Based on the given information, the most likely diagnosis in this case is Sheehan syndrome (pituitary amenorrhea).
Sheehan syndrome is a condition characterized by pituitary gland dysfunction resulting from severe postpartum hemorrhage during childbirth.
In this condition, the loss of blood during childbirth leads to insufficient blood supply to the pituitary gland, causing damage and subsequent hormone deficiency.
The symptoms described in the case, including the absence of menstruation for two years after childbirth, hair loss, and weight loss, are consistent with the hormonal imbalances that occur in Sheehan syndrome.
The asthenic body type, hypoplastic external genitalia, small and painless uterus, and inability to detect uterine appendages further support this diagnosis.
Primary amenorrhea refers to the absence of menstruation by the age of 16, which is not applicable in this case since the patient has had menstruation before.
Pituitary tumors, such as Cushing disease, can cause hormonal imbalances but are less likely in this scenario.
Uterine pregnancy would involve ongoing pregnancy rather than the absence of menstruation.
Stein-Leventhal syndrome, also known as polycystic ovary syndrome (PCOS), typically presents with different symptoms, such as irregular periods, ovarian cysts, and hormonal imbalances.
4.A 34-year-old man fell ill 3 days ago after an overexposure to cold. He complains of a fever of 39.2°C, marked general weakness, sweating, and cough. The cough was initially dry, but within the last 24 hours a small amount of “rusty”sputum was produced. Objective examination detects herpes on the lips. Percussion reveals a dull sound in the lower pulmonary lobes. Auscultation detects bronchial breathing and tachycardia. No changes were detected in the organs of the abdominal cavity. What is the most likely diagnosis in this case?
A. Croupous pneumonia
B. Lung abscess
C. Community-acquired focal pneumonia
D. Nosocomial pneumonia
E. Exudative pleurisy
Answer: Croupous pneumonia
Explanation
Based on the provided information, the most likely diagnosis in this case is croupous pneumonia, also known as lobar pneumonia or typical pneumonia.
Croupous pneumonia is typically caused by the bacterium Streptococcus pneumoniae. It is characterized by the inflammation and consolidation of an entire lobe or a large portion of a lobe of the lung.
The patient’s symptoms, such as fever, marked general weakness, sweating, and cough, are consistent with an acute respiratory infection. The production of “rusty” sputum, which is sputum containing blood, is a characteristic feature of croupous pneumonia.
The presence of herpes on the lips is unrelated to the diagnosis of pneumonia but may indicate a concomitant viral infection.
The findings on examination support the diagnosis of croupous pneumonia. Percussion revealing a dull sound in the lower pulmonary lobes suggests consolidation of lung tissue in that area.
Auscultation detecting bronchial breathing, which is a harsh breath sound heard over consolidated lung tissue, further supports the diagnosis. Tachycardia (increased heart rate) is a common response to infection.
5.A 65-year-old patient was prescribed pharmacotherapy (ramipril, atorvastatin, amlodipine, acetylsalicylic acid, bisoprolol) for essential hypertension with concomitant ischemic heart disease. Two weeks later, he consulted a doctor about a dry cough. Examination detects no signs of acute respiratory viral infection or damage to the bronchopulmonary apparatus. A side effect of ramipril is suspected. What drug can be used to replace ramipril in the treatment plan?
A. Torasemide
B. Enalapril
C. Nifedipine
D. Nebivolol
E. Valsartan
Answer: Valsartan
Explanation
If a dry cough is suspected to be a side effect of ramipril, an
angiotensin-converting enzyme (ACE) inhibitor, an alternative drug from a different class can be considered as a replacement.
Among the options provided, enalapril, which is also an ACE inhibitor, would not be the best choice as it belongs to the same class of medications as ramipril and can potentially cause a similar side effect of cough.
The most suitable alternative drug to replace ramipril in this case would be
valsartan, an angiotensin receptor blocker (ARB). Valsartan works by blocking the effects of angiotensin II, a hormone that constricts blood vessels, thereby lowering blood pressure.
ARBs are generally well-tolerated and are less likely to cause a dry cough compared to ACE inhibitors.
Therefore, replacing ramipril with valsartan can help alleviate the cough while still effectively managing essential hypertension and concomitant ischemic heart disease.
6.Two weeks after a case of tonsillitis, a 29-year-old patient noticed facial edema, weakness, and decreased work capacity. Gradually, he developed shortness of breath, leg edema, and lumbar edema. Objectively, his skin is pale, his heart sounds are weakened, he has hydrothorax, anasarca, and blood pressure of 150/100 mm Hg. Clinical urinalysis shows the following: specific gravity -1021, protein-9 g/L, erythrocytes 40-50 in the vision field, hyaline casts 4-6 in the vision field. What is the provisional diagnosis in this case?
A. Exacerbation of chronic glomerulonephritis
B. Acute pyelonephritis
C. Myxedema
D. Acute glomerulonephritis
E. Heart failure
Answer: Acute glomerulonephritis
Explanation
Based on the provided information, the provisional diagnosis in this case is “Acute glomerulonephritis.”
Acute glomerulonephritis is an inflammatory condition that affects the glomeruli, which are the filtering units of the kidneys.
The symptoms and clinical findings described in the case, such as facial edema, weakness, decreased work capacity, shortness of breath, leg edema, lumbar edema, pale skin, weakened heart sounds, and elevated blood pressure, are consistent with the manifestations of acute glomerulonephritis.
The presence of proteinuria (elevated protein levels in urine), erythrocyturia (red blood cells in urine), and hyaline casts in the urine analysis further supports the diagnosis of acute glomerulonephritis. The specific gravity of 1.021 suggests reduced concentrating ability of the kidneys.
The onset of symptoms two weeks after a case of tonsillitis is consistent with post-streptococcal glomerulonephritis, which is a common cause of acute glomerulonephritis.
Group A Streptococcus infection in the tonsils can trigger an immune response that leads to inflammation and damage to the glomeruli.
7.During coke production, the concentration of dust in the air of the working area has been for many years exceeding the maximum permissible concentration by 4-8 times. What disease is most likely to develop among the workers in this industry as a result?
1.Anthracosis
2.Byssinosis
3.Asbestosis
4.Silicosis
5.Siderosis
Answer: Anthracosis
Explanation
Based on the provided information, the provisional diagnosis in this case is “Acute glomerulonephritis.”
Acute glomerulonephritis is an inflammatory condition that affects the glomeruli, which are the filtering units of the kidneys.
The symptoms and clinical findings described in the case, such as facial edema, weakness, decreased work capacity, shortness of breath, leg edema, lumbar edema, pale skin, weakened heart sounds, and elevated blood pressure, are consistent with the manifestations of acute glomerulonephritis.
The presence of proteinuria (elevated protein levels in urine), erythrocyturia (red blood cells in urine), and hyaline casts in the urine analysis further supports the diagnosis of acute glomerulonephritis. The specific gravity of 1.021 suggests reduced concentrating ability of the kidneys.
The onset of symptoms two weeks after a case of tonsillitis is consistent with post-streptococcal glomerulonephritis, which is a common cause of acute glomerulonephritis.
Group A Streptococcus infection in the tonsils can trigger an immune response that leads to inflammation and damage to the glomeruli.
8.A 14-year-old girl is being examined by a pediatrician. Objectively, she has a tall stature, asthenic body type, striae on the skin of the abdomen, blue sclera. She was diagnosed with a scoliotic posture and chest deformity. She has hypermobile joints, her fingers and arms are long. Cardiac ultrasound visualizes a mitral valve prolapse. What is the most likely cause of her tall stature?
A.Noonan syndrome
B.Marfan syndrome
C.Klinefelter syndrome
D.Williams syndrome Ehlers-Danlos syndrome
Answer: Marfan syndrome
Explanation
Based on the given information, the most likely cause of the girl’s tall stature, asthenic body type, striae on the skin, blue sclera, scoliotic posture, chest deformity, hypermobile joints, long fingers, and mitral valve prolapse is “Marfan syndrome.”
Marfan syndrome is a genetic disorder that affects the connective tissue, leading to abnormalities in various parts of the body, including the skeletal, cardiovascular, and ocular systems.
Individuals with Marfan syndrome often exhibit tall stature, long limbs, joint hypermobility, and various skeletal abnormalities such as scoliosis and chest deformities.
The condition also affects the eyes, leading to features like blue sclera and, in some cases, a mitral valve prolapse.
The presence of these characteristic clinical features, including tall stature, hypermobility, joint and skeletal abnormalities, along with the presence of a mitral valve prolapse, strongly suggests Marfan syndrome as the most likely cause in this case.
9.A 42-year-old man, a miner, was freed after 12 hours spent under the rubble. Objectively, both his lower legs and feet are pale; there is no pulsation on the peripheral vessels, no sensitivity, and no passive movements in the joints. He was hospitalized with tourniquets applied to both limbs. What urgent first aid must be provided in this case to prevent myoglobinuria and acute kidney failure?
A. Do not remove the tourniquets, provide hyperbaric oxygenation
B. Remove the tourniquets, provide detoxification therapy
C. Do not remove the tourniquets, provide detoxification therapy
D. Remove the tourniquets, provide hyperbaric oxygenation
E. Do not remove the tourniquets, amputate the limbs above the tourniquets
Answer: Remove the tourniquets, provide hyperbaric oxygenation
Explanation
In this case, the urgent first aid that must be provided to prevent myoglobinuria and acute kidney failure is option D: Remove the tourniquets and provide hyperbaric oxygenation.
The patient’s presentation suggests a condition known as crush syndrome, which occurs when a prolonged compression or crush injury to the muscles leads to tissue damage and the release of myoglobin, a muscle protein, into the bloodstream. The released myoglobin can cause kidney damage and potentially lead to acute kidney failure.
To prevent the complications associated with crush syndrome, it is crucial to relieve the pressure on the affected limbs by removing the tourniquets. This allows for the restoration of blood flow to the damaged muscles and minimizes further tissue damage.
Removing the tourniquets helps in preventing the buildup of toxins and metabolic byproducts, including myoglobin, in the affected tissues.
Hyperbaric oxygenation is another important intervention in this scenario. Hyperbaric oxygen therapy involves administering 100% oxygen in a pressurized chamber, which helps increase the oxygen supply to the damaged tissues. This promotes tissue healing, reduces the risk of infection, and helps prevent further complications.
Together, removing the tourniquets and providing hyperbaric oxygenation are vital steps to prevent myoglobinuria (the presence of myoglobin in the urine) and acute kidney failure in this patient with crush syndrome.
10.A 26-year-old woman, who has been suffering from rheumatoid arthritis for 8 months, has edemas of her elbow, radiocarpal, knee, and ankle joints, and rheumatoid nodules in the area of her elbow joints. Complete blood count shows ESR of 57 mm/hour and C-reactive protein (+++). X- ray of the joints reveals marked osteoporosis. What medicine would be used as the basic therapy in this case?
A. Diclofenac sodium
B. Methylprednisolone
C. Infliximab
D. Meloxicam
E. Methotrexate
Answer: Methotrexate
Explanation
In this case, the most appropriate medication for the basic therapy of rheumatoid arthritis would be option E: Methotrexate.
Methotrexate is considered a disease-modifying antirheumatic drug (DMARD) and is commonly used as a first-line treatment for rheumatoid arthritis. It helps reduce inflammation, relieve symptoms, and slow down the progression of joint damage in rheumatoid arthritis.
Methotrexate works by inhibiting certain enzymes involved in the immune system’s response, which helps suppress the inflammatory process in the joints. It is effective in reducing joint swelling, pain, and stiffness associated with rheumatoid arthritis.
Methotrexate is usually taken orally, and the dosage is adjusted based on the patient’s response and tolerance. Regular monitoring of blood tests, including liver function tests and complete blood count, is necessary to ensure its safe and effective use.
While other medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac sodium and Meloxicam, or corticosteroids like Methylprednisolone, may be used for symptomatic relief or short-term management of rheumatoid arthritis, Methotrexate is considered a cornerstone in the long-term treatment of the disease.
Infliximab, on the other hand, is a biologic DMARD and may be used as an alternative or in combination with Methotrexate for patients with more severe or refractory rheumatoid arthritis.
However, in this case, Methotrexate would be the preferred choice as the basic therapy for the patient’s rheumatoid arthritis, considering the duration of the disease, presence of joint edema, rheumatoid nodules, and the laboratory findings indicating active inflammation
11.A 6-year-old child became acutely ill and developed fever, headache, and pain during swallowing. Three hours later, a bright red fine punctate rash appeared on hyperemic skin. The rash is more numerous on the lateral surfaces of the body and in the natural folds. The oropharyngeal mucosa has a clearly demarcated hyperemia and there is a purulent plaque on the tonsils. What disease can be suspected in the child?
A. Diphtheria
B. Measles
C. Infectious mononucleosis
D. Rubella
E. Scarlet fever
Answer: Scarlet fever
Explanation
Based on the symptoms described, the most likely disease suspected in the child is
Scarlet fever.
Scarlet fever is caused by an infection with group A Streptococcus bacteria (Streptococcus pyogenes). It commonly affects children and presents with symptoms such as fever, headache, sore throat, difficulty swallowing (pain during swallowing), and a characteristic rash.
The key features that support the suspicion of Scarlet fever in this case are: Fine punctate rash: The appearance of a bright-red fine punctate rash is a characteristic feature of Scarlet fever. The rash typically starts on the chest and spreads to the rest of the body, including the lateral surfaces and natural folds, such as the armpits and groin.
Hyperemic skin: The presence of hyperemic (reddened) skin suggests increased blood flow to the affected areas, which is commonly seen in Scarlet fever.
Clearly demarcated hyperemia in oropharyngeal mucosa: Scarlet fever often involves inflammation of the throat and tonsils, leading to a clearly demarcated hyperemia (redness) of the oropharyngeal mucosa.
Purulent plaque on the tonsils: The presence of a purulent plaque (yellowish-white coating) on the tonsils is a characteristic finding in Scarlet fever. It indicates the involvement of the tonsils in the infection.
12.A person has been hospitalized with the diagnosis of trichinellosis. What food product. is the likely cause of this helminthiasis?
A. Rabbit
B. Poultry
C. Beef
D. Mution
E. Pork
Answer: Pork
Explanation
The likely cause of trichinellosis in this case is consuming undercooked or raw pork.
Trichinellosis is a parasitic infection caused by the roundworm Trichinella spiralis. This parasite can be found in the muscle tissue of various animals, but pork is the most common source of infection in humans.
Pigs become infected with Trichinella spiralis by consuming feed or meat containing the larvae of the parasite. The larvae then develop into adult worms in the pig’s intestines, and the female worms release larvae that migrate to the muscle tissue.
If a person consumes raw or undercooked pork containing these larvae, they can become infected with trichinellosis.It is important to note that proper cooking of pork kills the Trichinella larvae, making the meat safe to eat.
Freezing the pork at appropriate temperatures can also eliminate the parasites. Therefore, thorough cooking of pork and other meat products is crucial in preventing trichinellosis and other foodborne infections.
13.A 65-year-old woman came to a doctor with complaints of weakness in her left limbs. The weakness appeared in the morning and was gradually increasing throughout the day. Objectively, her consciousness is clear, her blood pressure is 190/100 mm Hg, her heart rate is 80/min rhythmic, a systolic murmur can be detected on the neck in the projection of the bifurcation of the right common carotid artery. Examination of the neurological status detects a smoothed out nasolabial fold on the left, deviation of the tongue to the left, a decrease in the muscle strength of the left limbs to 3 points, tendon reflexes are S>D, the Babinski sign is positive on the left, left-sided hemihypesthesia is observed. What is the most likely diagnosis in this case?
A. Dyscirculatory encephalopathy
B. Acute hypertensive encephalopathy
C. Hemorrhagic stroke
D. Ischemic stroke
E. Multiple sclerosis
Answer:Ischemic stroke
Explanation
The most likely diagnosis in this case is an ischemic stroke.
An ischemic stroke occurs when there is a blockage or obstruction in the blood vessels supplying blood to the brain, leading to a lack of blood flow and oxygen to specific areas of the brain.
This can result in neurological symptoms and deficits, such as weakness, sensory changes, and speech difficulties, depending on the affected region.
In this case, the patient presents with weakness in the left limbs, which is consistent with a hemiparesis.
Other findings, such as the smoothed-out nasolabial fold, deviation of the tongue to the left, positive Babinski sign on the left, and left-sided hemihypesthesia, further support the diagnosis of an ischemic stroke affecting the right side of the brain.
The elevated blood pressure (190/100 mm Hg) and the presence of a systolic murmur in the neck suggest underlying vascular pathology that may have contributed to the development of the stroke.
14.A 45-year-old man came to a doctor complaining of a sore throat and fever that lasted for ten days. The patient has a history of ulcerative colitis, is a smoker, and has been smoking one pack of cigarettes per day for ten years. The patient’s father died of cancer of the large intestine at the age of 50. Physical examination shows the following: body temperature -38.6°C, blood pressure – 130/80 mm Hg, pulse – 72/min., respiratory rate 18/min. Examination of the oral cavity reveals erythematous pharynx and exudate in the tonsillar crypts. Antigen test for group A streptococcus was positive. What procedure that a doctor can recommend for secondary prevention of cancer would be optimal for this patient?
A. Flexible sigmoidoscopy
B. PSA test and digital rectal examination
C. Colonoscopy
D. Low-dose CT scan of the lungs
E. Fecal occult blood test
Answer: Colonoscopy
Explanation
For secondary prevention of cancer in this patient, the optimal procedure that a doctor can recommend is a colonoscopy.
The patient has a history of ulcerative colitis, which is a risk factor for the development of colorectal cancer.
Additionally, the patient’s father died of cancer of the large intestine at a relatively young age, further increasing the concern for potential colorectal cancer risk.
A colonoscopy is a procedure that allows a doctor to examine the entire colon and rectum using a flexible tube with a camera.
It is considered the gold standard for detecting colorectal cancer and precancerous polyps. During the procedure, if any abnormalities such as polyps or suspicious lesions are found, they can be biopsied or removed for further evaluation.
It’s important to note that the other options mentioned (flexible sigmoidoscopy, PSA test and digital rectal examination, low-dose CT scan of the lungs, fecal occult blood test) may be relevant for other types of cancer screenings or surveillance but are not the optimal choice for secondary prevention of colorectal cancer in this particular patient.
15.A patient with epilepsy suddenly developed status epilepticus with generalized seizures after self-discontinuation of antiepileptic drugs. What are the first-line drugs for the treatment of this condition?
A. Doxepin, amitriptyline, mianserin
B. Diazepam, lorazepam, midazolam
C. Levomepromazine, clozapine, quetiapine
D. Topiramate, oxcarbazepine, carbamazepine
E. Gabapentin, pregabalin, ethosuximide
Answer: Diazepam, lorazepam, midazolam
The first-line drugs for the treatment of status epilepticus with generalized seizures are: B. Diazepam, lorazepam, midazolam
Diazepam, lorazepam, and midazolam are benzodiazepines commonly used for the acute management of status epilepticus.
These medications have rapid onset of action and potent antiepileptic effects. They work by enhancing the inhibitory actions of gamma-aminobutyric acid (GABA), an important neurotransmitter that helps regulate brain activity.
16.A 38-year-old pregnant woman, gravida 2, gestation term of 23-24 weeks, has type 2 diabetes mellitus, for which she receives metformin in the dose of 2500 mg per 24 hours. Laboratory analysis detects glycated hemoglobin (HbA1c) levels of 72%. What further treatment strategy should be chosen for this patient?
A. Increase the dose of metformin to 3000 mg per 24 hours
B. Discontinue metformin and switch to sulfonylureas
C. Add GLP-1 analogues to metformin
D. Prescribe insulin therapy and discontinue metformin
E. Continue the treat
Answer: Prescribe insulin therapy and discontinue metformin
Explanation
In this case, the most appropriate treatment strategy for the pregnant woman with type 2 diabetes mellitus and high glycated hemoglobin (HbA1c) levels is:D.
Prescribe insulin therapy and discontinue metformin.
During pregnancy, maintaining tight glycemic control is crucial to reduce the risk of complications for both the mother and the fetus.
Insulin is the preferred treatment for diabetes in pregnancy because it does not cross the placenta and is considered safe for the developing baby.
While metformin is generally safe during pregnancy, it is usually recommended to switch to insulin therapy to optimize glycemic control. Insulin allows for more precise adjustments in dosage to meet the changing insulin requirements during pregnancy. It also provides better control of postprandial blood glucose levels, which is important for the developing fetus.
17.It was found that for every 100 births, women with risk factors had 30 preterm births, while women without risk factors had 5 preterm births. What statistical method of data processing would be optimal for a doctor to use to estimate the validity of differences between the groups that are being compared?
A. Standardization method
B. Calculation of relative values
C. Calculation of the Student’s criterion
D. Calculation of average values
E. Correlation analysis
Answer: Calculation of the Student’s criterion
Explanation
The optimal statistical method for a doctor to use to estimate the validity of differences between the groups being compared in this scenario would be the calculation of the Student’s criterion, commonly known as the t-test.
The t-test is a statistical test used to determine if there is a significant difference between the means of two groups. It is appropriate when comparing two independent groups, such as in this case where the two groups are women with risk factors and women without risk factors.
By calculating the t-value and comparing it to the critical value from the
t-distribution, the doctor can determine if the difference in preterm birth rates between the two groups is statistically significant. This analysis helps to assess whether the observed difference is likely due to chance or if there is a real difference between the groups.
Other statistical methods, such as standardization, calculation of relative values, calculation of average values, and correlation analysis, may provide additional insights but may not be the most suitable methods for directly assessing the validity of differences between the groups being compared
18.A 36-year-old patient complains of suffocation attacks with predominantly problematic exhalation. The attacks occur up to 2-3 times a day and can be relieved by inhalation of 62-adrenomimetics. This condition lasts for 10 years already. Objectively, the chest is expanded, percussion detects a bandbox resonance over the lungs, auscultation detects harsh respiration with prolonged exhalation. Laboratory analysis of sputum detects numerous eosinophils, Charcot-Leyden crystals, and Curschmann spirals. What is the provisional diagnosis in this case?
A. Spontaneous pneumothorax
B. Chronic obstructive bronchitis
C. Bronchial asthma
D. Cardiac asthma
E.Carcinoid syndrome
Answer: Bronchial asthma
Explanation
The optimal statistical method for a doctor to use to estimate the validity of differences between the groups being compared in this scenario would be the calculation of the Student’s criterion, commonly known as the t-test.
The t-test is a statistical test used to determine if there is a significant difference between the means of two groups. It is appropriate when comparing two independent groups, such as in this case where the two groups are women with risk factors and women without risk factors.
By calculating the t-value and comparing it to the critical value from the
t-distribution, the doctor can determine if the difference in preterm birth rates between the two groups is statistically significant. This analysis helps to assess whether the observed difference is likely due to chance or if there is a real difference between the groups.
Other statistical methods, such as standardization, calculation of relative values, calculation of average values, and correlation analysis, may provide additional insights but may not be the most suitable methods for directly assessing the validity of differences between the groups being compared
19.A 62-year-old man complains of constant pain in the epigastrium and weight loss of 12 kg. Physical and instrumental examinations (fibrogastroscopy with biopsy, abdominal ultrasound, and chest X-ray) detected cancer of the body of the stomach without signs of distant metastasis. Histology reveals moderately differentiated adenocarcinoma. What scope of surgical intervention is advised in this case?
A. Ivor Lewis procedure
B. Proximal subtotal gastric resection
C. Gastroenteroanastomosis (gastroenteric bypass)
D. Distal subtotal gastric resection
E. Gastrectomy
Answer: Gastrectomy
Explanation
In this case, the advised scope of surgical intervention would be gastrectomy. The patient has been diagnosed with cancer of the body of the stomach, which indicates a localized tumor within the stomach.
As there are no signs of distant metastasis, surgical intervention is an appropriate treatment option. Gastrectomy, which involves the removal of all or part of the stomach, is commonly performed for the treatment of gastric cancer.
The choice of the specific type of gastrectomy (total or subtotal) would depend on the location and extent of the tumor.
However, based on the information provided, it is not specified whether the tumor is located in the proximal or distal part of the stomach.
Therefore, a general recommendation for gastrectomy is appropriate.
20.The patient’s son has filed a lawsuit after his mother died of breast cancer. Due to the fact that in the past she survived a stroke and had diabetes, aggressive cancer therapy was contraindicated for her. She was suffering from severe pain, but doctors at the outpatient clinic were unable to obtain even 1 Mg of morphine for her treatment. What kind of care should have been provided in this case by the primary care doctors to relieve the patient’s condition?
A. Secondary medical care
B. Primary medical care
C. Palliative medical care
D. Tertiary medical care
E. Emergency medical care
Answer: Palliative medical care
Explanation
In this case, the primary care doctors should have provided palliative medical care to relieve the patient’s condition.
Palliative care focuses on providing relief from pain, symptoms, and suffering for patients who have a life-threatening illness, such as cancer.
It aims to improve the quality of life for patients and their families through the prevention and relief of suffering. Palliative care can be provided alongside curative or disease-modifying treatments, and it is appropriate for patients at any stage of their illness.
In this situation, the patient had contraindications for aggressive cancer therapy due to previous medical conditions.
As a result, the primary care doctors should have recognized the need for palliative care to address the patient’s severe pain and provide appropriate pain management. Palliative care would involve a comprehensive approach to symptom control, including the use of analgesics like morphine to alleviate pain.
21.On the fourth day of life, a healthy newborn child developed melena and started vomiting blood. Coagulogram reveals prolonged prothrombin time, decreased prothrombin index, and deficiency of plasma factors II, VII, IX, and X. What is the most likely disease in this case?
A.Hemorrhagic disease of the newborn
B.Hemolytic disease of the newborn
C.Disseminated intravascular coagulation syndrome
D.Hemophilia A
E. Neonatal sepsis
Answer: Hemorrhagic disease of the newborn
Explanation
In this case, the most likely disease is hemorrhagic disease of the newborn (HDN). HDN is a bleeding disorder that occurs in newborn infants, typically within the first few days of life.
It is characterized by abnormal bleeding due to vitamin K deficiency or impaired vitamin K function.
The presentation of melena (black, tarry stools) and vomiting blood, along with laboratory findings of prolonged prothrombin time, decreased prothrombin index, and deficiency of plasma factors II, VII, IX, and X, are indicative of a coagulation disorder.
Vitamin K is essential for the synthesis of these clotting factors, and its deficiency can result in abnormal bleeding.
Newborn infants are particularly susceptible to vitamin K deficiency due to several factors, including limited transfer of vitamin K across the placenta, low levels of vitamin K in breast milk, and an immature gut that does not produce enough vitamin K. This deficiency can lead to inadequate clotting factor production and subsequent bleeding manifestations.
The treatment for HDN involves the administration of vitamin K to correct the deficiency and restore normal coagulation function.
In many countries, routine prophylactic administration of vitamin K to newborns is recommended shortly after birth to prevent this condition.
22.A patient was hospitalized into the neurosurgery department with a closed craniocerebral injury, a fracture of the right temporal bone. Five hours later, the patient’s condition sharply deteriorated, he developed. respiratory disorders, periodical tonic seizures, and anisocoria (dilation of the right pupil). What complication can be suspected in this case?
A. Characteristics associated with the course of concussion
B. Subarachnoid hemorrhage
C. Brain abscess
D. Ischemic stroke in the area of the right cerebral peduncle
E. Epidural hematoma
Answer: Epidural hematoma
Explanation
In this case, the most likely complication that can be suspected is an epidural hematoma.
An epidural hematoma is a collection of blood between the skull and the dura mater (the outermost layer of the meninges) caused by arterial bleeding, often resulting from a skull fracture.
The patient’s deteriorating condition, respiratory disorders, periodical tonic seizures, and anisocoria (dilation of the right pupil) are indicative of increased intracranial pressure, which is a characteristic feature of an epidural hematoma. The initial trauma, in this case, the fracture of the right temporal bone, can cause damage to an artery, leading to bleeding and subsequent formation of a hematoma.
As the hematoma expands within the limited space between the skull and the dura mater, it can compress the brain and impede its normal functioning, resulting in neurological symptoms such as seizures and changes in the size of the pupils.
The development of respiratory disorders suggests increasing intracranial pressure affecting the brainstem.
Epidural hematomas require urgent medical intervention, typically in the form of surgical evacuation to remove the accumulated blood and relieve the pressure on the brain.
Timely diagnosis and prompt surgical management are crucial to prevent further neurological deterioration and potential life-threatening complications associated with increased intracranial pressure.
23.A 42-year-old man complains of weakness, palpitations, nosebleeds, and skin hemorrhages. His condition progressively deteriorated throughout the last month. Objectively, his condition is severe, he has petechial and spotted hemorrhages on the skin of his limbs and torso, lymph nodes and spleen are not palpable, the pulse is 116/min., the liver is +2 cm. Complete blood count reveals pancytopenia. What disease can be primarily suspected in this case?
A. Hemorrhagic vasculitis
B. Hypoplastic anemia
C. Acute leukemia
D. Acute agranulocytosis
E. Werlhof disease
Answer: Hypoplastic anemia
Explanation
Based on the symptoms and findings described, the most likely disease in this case is B. Hypoplastic anemia.
Hypoplastic anemia refers to a condition characterized by a deficiency of all three blood cell types (red blood cells, white blood cells, and platelets) due to decreased production of these cells in the bone marrow.
The symptoms reported by the patient, such as weakness, palpitations, nosebleeds, and skin hemorrhages, are consistent with the manifestations of anemia and thrombocytopenia (low platelet count) associated with hypoplastic anemia.
The presence of petechial and spotted hemorrhages on the skin, along with pancytopenia (low counts of red blood cells, white blood cells, and platelets), further support the suspicion of hypoplastic anemia.
The absence of palpable lymph nodes and spleen indicates that these organs are not enlarged, which is consistent with hypoplastic anemia.
The elevated pulse rate (116/min) may be a compensatory response to the anemia, as the body tries to increase cardiac output to meet the oxygen demands.
24.After falling and hitting the back of the head, a child lost hearing in the right ear and developed peripheral paralysis of the right facial nerve, discharge of a clear fluid from the right auditory canal, and diffuse neurological symptoms. Make the provisional diagnosis
A. Cerebral contusion, subarachnoid hemorrhage
B.Concussion
C. Meningoencephalitis
D. Post-traumatic meningoencephalitis
E. Cerebral contusion, basilar skull fracture
Answer: Cerebral contusion, basilar skull fracture
Explanation
Based on the symptoms described, the provisional diagnosis in this case would be
E. Cerebral contusion, basilar skull fracture.
The loss of hearing in the right ear, peripheral paralysis of the right facial nerve (which can present as drooping of the right side of the face), discharge of clear fluid from the right auditory canal, and diffuse neurological symptoms are indicative of a traumatic injury to the head.
A basilar skull fracture occurs when the base of the skull is fractured, and it can result in several characteristic signs and symptoms.
The clear fluid discharge from the auditory canal is known as “CSF otorrhea” and is often associated with basilar skull fractures.
The leakage of cerebrospinal fluid (CSF) can occur due to a tear in the dura mater (the protective covering of the brain and spinal cord) caused by the fracture.
The presence of neurological symptoms suggests involvement of the brain, and a cerebral contusion (bruising of the brain tissue) is a common accompanying injury in cases of severe head trauma.
25.A 48-year-old woman complains that within the last 8-9 months she had very heavy periods that impair her ability to work. For years, her health has been monitored by a gynecologist for uterine fibroids. Objectively, her cervix is cylindrical, clean, the cervical opening is closed; the body of the uterus is enlarged up to 9-10 weeks of pregnancy, firm, mobile, and painless; the appendages on both sides cannot be determined; the parametria are free; the fornices are deep; mucous discharge is being produced. What is the most likely diagnosis in this case?
A. Dysfunctional uterine bleeding
B. Juvenile uterine bleeding
C. Uterine fibroids and pregnancy
D. Endometriosis that predominantly affects the body of the uterus
E. Uterine fibroids
Answer: Uterine fibroids
Explanation
Based on the symptoms and findings described, the most likely diagnosis in this case is E. Uterine fibroids.
Uterine fibroids are noncancerous growths that develop in the uterus. They are a common cause of heavy menstrual bleeding, also known as menorrhagia.
The patient’s complaint of heavy periods that impair her ability to work, along with a history of monitoring for uterine fibroids, suggests that fibroids may be the underlying cause.
The objective findings of an enlarged uterus (up to 9-10 weeks of pregnancy), firm and mobile uterus, and absence of abnormalities in the cervix, parametria, and fornices are consistent with the presence of uterine fibroids. The absence of palpable appendages suggests that the fibroids are not arising from the ovaries.
It is important to note that the definitive diagnosis of uterine fibroids would require confirmation through imaging studies, such as ultrasound or MRI.
- Dysfunctional uterine bleeding (choice A) and juvenile uterine bleeding (choice B) are terms used to describe abnormal uterine bleeding patterns, but they do not specifically indicate the presence of uterine fibroids.
- The diagnosis of uterine fibroids and pregnancy (choice C) would typically require confirmation through imaging studies to assess the presence and potential impact of fibroids on the pregnancy.
- Endometriosis (choice D) is a condition characterized by the presence of endometrial tissue outside the uterus, and it does not typically cause an enlarged uterus or heavy menstrual bleeding.
Therefore, based on the information provided, the most likely diagnosis in this case is uterine fibroids (choice E).
26.A 64-year-old man fell to the floor, landing on his left side. Objectively, shortening of the left limb and external rotation of the hip are observed. The patient is unable to perform the straight leg raise test. During palpation and tapping on the heel, the patient feels pain in the hip joint. What is the likely diagnosis in this case?
A. Contusion of the hip joint
B. Femoral neck fracture
C. Hip dislocation
D. Greater trochanteric fracture
E. Fracture of the upper third of the femur
Answer: Hip dislocation
Explanation
Based on the provided information, the likely diagnosis in this case is C. Hip dislocation.
Hip dislocation occurs when the femoral head is forced out of the acetabulum. The characteristic findings of shortening of the left limb, external rotation of the hip, inability to perform the straight leg raise test, and pain in the hip joint upon palpation and tapping on the heel are consistent with a posterior hip dislocation.
In a posterior hip dislocation, the limb appears externally rotated and shortened due to the femoral head being displaced posteriorly.
The patient’s inability to perform the straight leg raise test is likely due to pain and disruption of the hip joint mechanics. Palpation and tapping on the heel elicit pain in the hip joint, which is a common finding in hip dislocations.
- Contusion of the hip joint (choice A) would not typically cause significant deformity, such as limb shortening and external rotation. It is usually associated with localized pain and tenderness but does not result in joint dislocation.
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- Femoral neck fracture (choice B) and fractures of the upper third of the femur (choice E) typically present with more localized pain and deformity but are not associated with the characteristic findings of hip dislocation.
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- Greater trochanteric fracture (choice D) would not cause significant limb shortening or external rotation of the hip. It is usually associated with pain localized to the greater trochanter region.
Therefore, based on the information provided, the likely diagnosis is C. Hip dislocation.
27.A man complains of red and sore skin on his right calf. Objectively, his body temperature is 38.5°C; his inguinal lymph nodes on the right are enlarged and painful; the skin is red, with clear boundaries. between the redness and healthy skin; edema is observed; there are vesicles filled with a dark liquid; palpation is painful. What is the provisional diagnosis in this case?
A.Herpetic infection
B. Phlegmon of the leg
C. Varicella
D. Erysipelas
E. Cutaneous anthrax
Answer: Erysipelas
Explanation
Based on the provided information, the provisional diagnosis in this case is D. Erysipelas.
Erysipelas is a bacterial skin infection, typically caused by Streptococcus pyogenes, that affects the superficial layers of the skin.
It commonly presents with symptoms such as red and sore skin, elevated body temperature, localized pain, and clear boundaries between the affected area and healthy skin. Enlarged and painful lymph nodes in the groin area are also characteristic of erysipelas.
The presence of vesicles filled with a dark liquid and edema further support the diagnosis of erysipelas.
- Herpetic infection (choice A) typically presents with grouped vesicles on an erythematous base and is often associated with a tingling or burning sensation. It may be recurrent in nature and is caused by the herpes simplex virus.
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- Phlegmon of the leg (choice B) refers to a deep tissue infection, often involving the subcutaneous fat and muscle, and is characterized by diffuse inflammation and swelling.
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- Varicella (choice C), commonly known as chickenpox, presents with a vesicular rash that starts on the trunk and spreads to the extremities. It is caused by the varicella-zoster virus.
- Cutaneous anthrax (choice E) is a rare bacterial infection caused by Bacillus anthracis. It typically presents with a painless ulcer or eschar with surrounding edema and can progress to systemic symptoms.
28.A 72-year-old patient came to a doctor with complaints of hand tremors, stiffness, slowness of walking and speech, and difficulties in performing routine household chores. Physical examination detects general bradykinesia, hypomimia, emprosthotonos “shuffling” gait, hand tremors at rest, D>S, plastic type of increased muscle tone. the “cogwheel rigidity” phenomenon, and marked postural instability. What medicines must be a primary part of the treatment regimen for this patient?
A. Antidepressants
B. Medicines containing levodopa
C. Medicines that improve microcirculation
D. Anticholinergic agents.
E. Anticholinesterase drugs
Answer: Medicines containing levodopa
Explanation
The primary medicines that should be part of the treatment regimen for this patient with the described symptoms are B. Medicines containing levodopa.
The patient’s symptoms, such as hand tremors, stiffness, slowness of movement, and difficulties in performing routine tasks, are consistent with the clinical features of Parkinson’s disease.
Parkinson’s disease is a neurodegenerative disorder characterized by the loss of dopamine-producing cells in the brain. Levodopa is the most effective medication for managing the motor symptoms of Parkinson’s disease.
Levodopa is a precursor of dopamine and is converted into dopamine in the brain, replenishing the depleted dopamine levels.
It helps alleviate the symptoms of bradykinesia, rigidity, and tremors, improving motor function and overall quality of life for patients with Parkinson’s disease.
Levodopa is typically combined with a peripheral decarboxylase inhibitor (e.g., carbidopa) to enhance its availability in the brain and reduce potential side effects.
While other medications may be used as adjunctive therapies or for managing specific symptoms in Parkinson’s disease, such as antidepressants for associated mood disorders or anticholinergic agents for tremor control, the primary and most effective treatment for motor symptoms is levodopa.
29.A 27-year-old man came to a doctor with complaints of pain and swelling in his toes II and III on the left foot, redness of the eyes and purulent discharge from them, and painful urination. Patient history taking revealed that the patient has several sexual partners and rarely uses condoms. Physical examination revealed bilateral conjunctivitis and dactylitis of the toes. Blood test shows ESR of 40 mm/hour. X-ray of the toes detects an increase in the volume of soft tissues and joint space narrowing. What is the most likely diagnosis in this case?
A.Gout
B.Rheumatoid arthritis
C.Syphilis
D.Reactive arthritis
E.Gonorrhea
Answer: Reactive arthritis
Explanation
The most likely diagnosis in this case is D. Reactive arthritis.
Reactive arthritis is an inflammatory condition that typically occurs as a reaction to an infection in another part of the body, most commonly involving the gastrointestinal or genitourinary system.
The clinical presentation of this patient, including pain and swelling in the toes (dactylitis), red eyes (conjunctivitis), purulent discharge from the eyes, and painful urination, is consistent with the characteristic features of reactive arthritis.
Risk factors for reactive arthritis include a history of sexually transmitted infections, multiple sexual partners, and inconsistent condom use, which are mentioned in the patient’s history.
The presence of conjunctivitis, urethritis (painful urination), and dactylitis (swelling and pain in the toes) further support the diagnosis.
The elevated erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation seen in reactive arthritis. X-ray findings of increased soft tissue volume and joint space narrowing in the toes are also consistent with the inflammatory nature of the condition. It’s important to note that other conditions, such as gout or rheumatoid arthritis, may present with similar symptoms, but given the patient’s history of sexual risk factors and the characteristic clinical findings, reactive arthritis is the most likely diagnosis.
30.An 18-year-old adolescent was diagnosed with a duodenal ulcer for the first time. The test for Helicobacter pylori is positive, the pH of gastric juice is 1.0. What would be the optimal treatment plan in this case?
A. De-nol (bismuth subcitrate) + trichopol (metronidazole)
B. De-nol (bismuth subcitrate) + cimetidine
C. Clarithromycin + omeprazole
D. Quamatel (famotidine) + amoxicillin
E. Omeprazole + oxacillin
Answer: De-nol (bismuth subcitrate) + trichopol (metronidazole)
Explanation
The correct answer is A. De-nol (bismuth subcitrate) + trichopol (metronidazole).
The optimal treatment plan for an 18-year-old adolescent with a positive test for Helicobacter pylori and a duodenal ulcer involves the use of a triple therapy regimen, which typically includes a proton pump inhibitor (PPI) and two antibiotics. De-nol (bismuth subcitrate) and trichopol (metronidazole) are commonly used antibiotics in the treatment of H. pylori infection.
Here’s an explanation of why this treatment plan is optimal:
- De-nol (bismuth subcitrate): Bismuth compounds have antimicrobial activity against H. pylori and also exert a protective effect on the gastric mucosa.
De-nol is a bismuth-containing medication that helps eradicate the bacteria and promote healing of the ulcer.
- Trichopol (metronidazole): Metronidazole is another antibiotic effective against H. pylori. It works by inhibiting the growth of the bacteria and aiding in its eradication.
- Combining De-nol and trichopol enhances the effectiveness of the treatment, as it targets H. pylori with dual antibiotics.
- Trichopol (metronidazole): Metronidazole is another antibiotic effective against H. pylori. It works by inhibiting the growth of the bacteria and aiding in its eradication.
Other options mentioned in the question, such as cimetidine (option B), omeprazole (option E), famotidine (option D), and oxacillin (option E), are not recommended as standalone treatments for H. pylori infection.
31.One week ago, a 68-year-old woman suddenly developed pain in the left half of her chest and shortness of breath. Objectively, the following is observed: cyanosis, distended neck veins, pulse- 100/min., blood pressure -110/70 mm Hg, respiratory rate-28/min., liver +4 cm, the left lower leg is edematous and sharply painful to palpation. Auscultation detects a dull lung sound on the left, below the scapula; sonorous moist fine vesicular crackles are present; the borders of the heart are expanded on the right; the II heart sound is accentuated over the pulmonary artery. ECG shows deep S waves in leads I and aVL, as well as deep Q waves in leads III and aVF, and a negative T wave in leads III and aVE. What is the most likely diagnosis in this case?
A. Pleurisy
B. Myocardial infarction
C. Croupous pneumonia
D. Pericarditis
E. Thromboembolism of pulmonary artery branches
Answer: Thromboembolism of pulmonary artery branches
Explanation
The most likely diagnosis in this case is E. Thromboembolism of pulmonary artery branches.
Clinical presentation: The 68-year-old woman developed sudden chest pain and shortness of breath one week ago. On examination, cyanosis, distended neck veins, tachycardia (pulse rate of 100/min), and low blood pressure (110/70 mm Hg) are observed. The left lower leg is edematous and painful to palpation. Auscultation reveals abnormal lung sounds, expanded borders of the heart, and an accentuated second heart sound over the pulmonary artery.
Dull lung sound, crackles, and edema: The dull lung sound below the scapula suggests decreased air entry in that region. The sonorous moist fine vesicular crackles indicate fluid accumulation in the lung. The edema and sharp pain in the left lower leg are consistent with deep vein thrombosis (DVT).
Cardiac findings: The expanded borders of the heart on the right suggest
right-sided cardiac involvement. The accentuated second heart sound over the pulmonary artery indicates increased pressure in the pulmonary circulation.
ECG findings: The ECG shows specific changes associated with acute pulmonary embolism, including deep S waves in leads I and aVL, deep Q waves in leads III and aVF, and negative T waves in leads III and aVF. These changes are known as S1Q3T3 pattern and are suggestive of right ventricular strain.
Diagnosis: Considering the acute onset of symptoms, presence of DVT symptoms, lung and cardiac findings, and the ECG changes, the most likely diagnosis in this case is thromboembolism of the pulmonary artery branches. A blood clot (embolus) has traveled to the pulmonary arteries, causing obstruction and leading to acute symptoms.
- Options 1 (Pleurisy), 3 (Croupous pneumonia), and 4 (Pericarditis) do not explain the combination of symptoms and findings described in the scenario, and they lack specific features suggestive of these conditions.
- Option 2 (Myocardial infarction) is less likely because the ECG changes and clinical findings are more consistent with acute pulmonary embolism rather than myocardial infarction.
In summary, based on the clinical presentation, examination findings, and ECG changes, the most likely diagnosis in this case is thromboembolism of pulmonary artery branches.
32.A 45-year-old man with a history of myocardial infarction developed a brief attack of palpitations, accompanied by the sensations of lack of air, fear, and vertigo. His blood pressure is 90/60 mm Hg. ECG during the attack shows extended QRS complex (0.13 seconds) with the heart rate of 160/min., discordant shift of ST segment and T wave, dissociation of atrial and ventricular rhythm. What disturbance of cardiac rhythm is it?
A. Atrial fibrillation
B. Paroxysmal supraventricular tachycardia
C. Paroxysmal ventricular tachycardia
D. Frequent ventricular extrasystoles
E. Ventricular fibrillation
Answer: Paroxysmal ventricular tachycardia
The disturbance of cardiac rhythm described in this case is C. Paroxysmal ventricular tachycardia.
Clinical presentation: The 45-year-old man with a history of myocardial infarction experienced a brief attack of palpitations, accompanied by sensations of lack of air, fear, and vertigo. His blood pressure is 90/60 mm Hg.
ECG findings during the attack:
Extended QRS complex: The QRS complex duration of 0.13 seconds indicates a widened QRS complex, suggesting an abnormal ventricular activation.
Heart rate of 160/min: The rapid heart rate of 160 beats per minute suggests tachycardia.
Discordant shift of ST segment and T wave: The ST segment and T wave have opposite deflections in relation to the QRS complex. This is a characteristic finding in ventricular tachycardia.
Dissociation of atrial and ventricular rhythm: The atria and ventricles beat independently, indicating dissociation between the two.
3. Diagnosis: The combination of symptoms, ECG findings (wide QRS complex, rapid heart rate, discordant ST segment and T wave, dissociation of atrial and ventricular rhythm), and the patient’s history of myocardial infarction suggest paroxysmal ventricular tachycardia.
- Options A (Atrial fibrillation) and B (Paroxysmal supraventricular tachycardia) involve abnormal atrial rhythms but do not explain the widened QRS complex or the discordant shift of the ST segment and T wave observed in the ECG.
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- Option D (Frequent ventricular extrasystoles) refers to premature ventricular contractions (PVCs) but does not explain the sustained tachycardia observed in the ECG.
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- Option E (Ventricular fibrillation) is a life-threatening arrhythmia characterized by chaotic, uncoordinated ventricular activity. The described ECG findings suggest a regular and organized rhythm, making ventricular fibrillation less likely.
In summary, based on the symptoms, ECG findings, and history of myocardial infarction, the most likely disturbance of cardiac rhythm in this case is paroxysmal ventricular tachycardia.
33.A 34-year-old woman came to a doctor with complaints of muscle weakness, thirst, increased urination at night, paresthesias, and seizure attacks. Objectively, her general condition is satisfactory, her face and legs are doughy, her pulse is 80/min., her blood pressure is 200/110 mm Hg, the II heart sound is accentuated over the aorta. Complete blood count shows K+ levels of 3.1 mmol/L and Na+ levels of 165 mmol/L. ECG shows inversion of T waves and depression of S-T segments. Ultrasound detects hyperplasia of the right adrenal gland. What is the provisional diagnosis in this case?
A. Hypoparathyroidism
B. Essential hypertension
C. Glucosteroma
D. Primary hyperaldosteronism
E. Pheochromocytoma
Answer: Primary hyperaldosteronism
Explanation
The provisional diagnosis in this case is D. Primary hyperaldosteronism.
Clinical presentation: The 34-year-old woman presents with symptoms of muscle weakness, thirst, increased urination at night, paresthesias, and seizure attacks. On examination, her face and legs are doughy, and her blood pressure is elevated.
Elevated blood pressure: The blood pressure reading of 200/110 mm Hg indicates hypertension.
Accentuated second heart sound over the aorta: The accentuated second heart sound suggests increased blood flow through the aorta.
Electrolyte abnormalities:
- Hypokalemia (low potassium): The potassium (K+) level of 3.1 mmol/L is below the normal range.
- Hypernatremia (high sodium): The sodium (Na+) level of 165 mmol/L is above the normal range.
ECG findings: Inversion of T waves and depression of S-T segments are nonspecific but can be seen in patients with hypokalemia.
Ultrasound findings: Hyperplasia of the right adrenal gland suggests adrenal pathology.
Putting the clinical findings together, the most likely provisional diagnosis is primary hyperaldosteronism, also known as Conn’s syndrome. This condition is characterized by the excessive production of aldosterone by the adrenal glands, leading to increased sodium reabsorption and potassium excretion, resulting in hypertension and electrolyte abnormalities.
- Option A (Hypoparathyroidism) is unlikely because the symptoms and electrolyte abnormalities observed are not consistent with hypoparathyroidism.
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- Option B (Essential hypertension) is less likely given the specific electrolyte abnormalities and the finding of adrenal gland hyperplasia on ultrasound.
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- Option C (Glucosteroma) is not supported by the clinical presentation or the laboratory and imaging findings described.
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- Option E (Pheochromocytoma) typically presents with paroxysmal episodes of hypertension associated with palpitations, headache, and diaphoresis. The electrolyte abnormalities described are not typical for pheochromocytoma.
In summary, based on the symptoms, electrolyte abnormalities, and adrenal gland hyperplasia, the provisional diagnosis in this case is primary hyperaldosteronism (Conn’s syndrome).
34.A 64-year-old man is undergoing outpatient treatment for ischemic heart disease, diffuse cardiosclerosis, persistent atrial fibrillation, and functional class III heart failure. The pharmacotherapy consists of cordarone (amiodarone) twice a day, torasemide every other day, and trimetazidine twice a day. The family physician recommended taking warfarin (3 mg per day) to prevent thrombus formation. What parameter should be measured in this case for optimal control of the effectiveness and safety of anticoagulant therapy?
A. Erythrocyte sedimentation rate
B. Lee-White clotting time
C. International normalized ratio
D. Fibrinogen levels
E. Platelet count
Answer: International normalized ratio
Explanation
The parameter that should be measured in this case for optimal control of the effectiveness and safety of anticoagulant therapy is C. International normalized ratio (INR).
The patient is receiving warfarin, an oral anticoagulant, to prevent thrombus formation due to his persistent atrial fibrillation. Warfarin works by inhibiting the synthesis of certain clotting factors in the liver, thereby reducing the ability of the blood to clot. To ensure the effectiveness and safety of warfarin therapy, regular monitoring of anticoagulation levels is necessary.
The international normalized ratio (INR) is a standardized measurement used to monitor and adjust the dose of warfarin. It measures the time it takes for the blood to clot compared to a reference value, taking into account variations in different laboratory testing systems.
An INR value within the therapeutic range indicates that the anticoagulant effect of warfarin is appropriate for preventing thrombus formation.
Monitoring the INR helps in assessing the effectiveness of warfarin therapy and adjusting the dosage if needed. The target INR range for patients with atrial fibrillation and a history of ischemic heart disease is generally between 2.0 and
3.0. Values below the therapeutic range may indicate a higher risk of clot formation, while values above the therapeutic range may increase the risk of bleeding.
- Option A (Erythrocyte sedimentation rate) is a nonspecific marker of inflammation and is not directly related to the monitoring of anticoagulant therapy.
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- Option B (Lee-White clotting time) is an outdated test that is not commonly used for monitoring anticoagulant therapy. It is less accurate and reliable compared to the INR.
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- Option D (Fibrinogen levels) and Option E (Platelet count) are not specific parameters for monitoring anticoagulant therapy with warfarin.
In summary, the optimal parameter to measure for the control of the effectiveness and safety of anticoagulant therapy with warfarin is the international normalized ratio (INR). Regular monitoring of INR values helps ensure appropriate anticoagulation levels and reduce the risk of thrombosis or bleeding complications.
35.A baby with the gestation term of 30 weeks was born with a body weight of 1100.0 g. Three hours after birth, frequent apneas appeared, “gasping” type of breathing is observed, the heart rate is 98/min. The Silverman score is 9 points. Additional oxygenation did not improve the child’s condition. What must the doctor do next?
A. Tracheal intubation
B. Tactile stimulation
C. Positive pressure ventilation of the lungs
D. External cardiac massage
E. Artificial pulmonary ventilation
Answer: Artificial pulmonary ventilation
Explanation
The given clinical scenario describes a premature baby born at 30 weeks gestation with a low birth weight of 1100.0 g who developed apneas, gasping type of breathing, and a low heart rate of 98/min, which indicates respiratory distress syndrome (RDS).
Additionally, the Silverman score, which assesses the respiratory effort of neonates, is high, indicating severe respiratory distress.
In this situation, the first step to manage respiratory distress is to administer supplemental oxygen. However, in this case, additional oxygenation did not improve the child’s condition.
Therefore, the next step should be to provide artificial pulmonary ventilation, which is the most effective way to improve oxygenation and ventilation in neonates with respiratory distress.
- Option A (tracheal intubation) may be necessary if the baby does not respond to artificial pulmonary ventilation.
- Option B (tactile stimulation) is not appropriate as the baby is already showing signs of respiratory distress, indicating that stimulation alone is unlikely to improve the condition.
- Option D (external cardiac massage) is not indicated in this case as the baby’s heart rate is within the normal range.
- Option C (positive pressure ventilation of the lungs) is similar to artificial pulmonary ventilation and could be considered, but artificial pulmonary ventilation is generally preferred as it provides more control over the amount of oxygen delivered and the pressure used to inflate the lungs.
Therefore, the correct answer is option E (artificial pulmonary ventilation).
36.A 27-year-old patient developed a fever of 38.7°C, lumbar pain, weakness, and headache after an overexposure to cold. Examination detects a positive Pasternacki sign (costovertebral angle tenderness) on the left. General urinalysis detects pyuria and bacteriuria. What is the most likely diagnosis in this case?
A. Acute cystitis
B. Renal colic
C. Acute glomerulonephritis
D. Acute pyelonephritis
E. Paranephric abscess
Answer: Acute pyelonephritis
Explanation
The most likely diagnosis in this case is D. Acute pyelonephritis.
The patient’s symptoms of fever, lumbar pain, weakness, and headache following an overexposure to cold, along with a positive Pasternacki sign (costovertebral angle tenderness) on the left, suggest an infection involving the kidney.
General urinalysis showing pyuria (presence of white blood cells in the urine) and bacteriuria (presence of bacteria in the urine) further support the diagnosis of acute pyelonephritis, which is an infection of the renal parenchyma.
- Acute cystitis (option A) refers to a bladder infection and typically presents with lower urinary tract symptoms such as dysuria and urinary frequency.
- Renal colic (option B) is associated with kidney stones and presents with severe flank pain.
- Acute glomerulonephritis (option C) is characterized by hematuria, proteinuria, and signs of renal dysfunction.
- Paranephric abscess (option E) presents with localized pain and signs of infection, but without the characteristic urinary symptoms seen in this case.
Given the patient’s symptoms, physical examination findings, and urinalysis results, acute pyelonephritis is the most likely diagnosis.
37.Approximately 40% of patients with bacterial pneumonia develop concomitant pleural effusion. This diagnosis can be confirmed by chest X-ray in the direct vertical projection, if there is at least:
A.500 mL of liquid
B.300 mL of liquid
C.100 mL of liquid
D.200 mL of liquid
Answer: 300 mL of liquid
Explanation
The correct answer is B) 300 mL of liquid.
To confirm the diagnosis of pleural effusion using a chest X-ray in the direct vertical projection, a minimum of approximately 300 mL of fluid is required to be present in the pleural space.
At this volume, the fluid accumulation becomes visible on the X-ray image as blunting of the costophrenic angles, which are the sharp angles formed by the diaphragm and the chest wall.
Therefore, the presence of at least 300 mL of liquid in the pleural space is necessary for the diagnosis of pleural effusion to be confirmed using a chest X-ray in the direct vertical projection.
38.A pediatrician needs to analyze the infant mortality rates. What must be taken as the unit of observation for this purpose?
A. A case of death of a child within the first month of life
B. A case of death of a child after 28 days of life
C. A case of death of a child under one year of age
D. A case of death of a child within the first 7 days of life
E. A case of the death of a child during childbirth
Answer: A case of death of a child under one year of age
Explanation
The unit of observation for analyzing infant mortality rates is C) A case of death of a child under one year of age.
Infant mortality rate refers to the number of deaths of infants under one year of age per 1,000 live births in a given population. It is a commonly used indicator of the overall health and well-being of a population.
By considering deaths within the first year of life, including both neonatal deaths (within the first 28 days) and post-neonatal deaths (from 28 days to one year), the infant mortality rate provides valuable information about the survival and health outcomes of infants in a specific population.
Therefore, when analyzing infant mortality rates, the unit of observation is a case of death of a child under one year of age.
39.A 64-year-old man came to a doctor with complaints of edemas of the legs, lower back, and anterior abdominal wall. He has a history of chronic bronchitis with bronchiectasis. Physical examination shows the following: body temperature – 37.2°C, blood pressure 110/75 mm Hg, pulse 82/min., respiratory rate – 19/min. General urinalysis – results are as follows: specific gravity – 1025, protein – 9.9 g/L, leukocytes 2-3 in the vision field, erythrocytes 1-2 in the vision field, no casts. Daily proteinuria is 11.4 g per 24 hours. Blood biochemistry test shows the following: total protein 52 g/L, albumins – 30 g/L, cholesterol 9.6 mmol/L. What type of kidney disorder is most likely in this patient?
A. Tubulointerstitial nephritis, nephrotic syndrome
B. Diabetic nephropathy, nephritic syndrome
C. Pyelonephritis, urinary syndrome
D. Glomerulonephritis, nephritic syndrome
E. Amyloidosis, nephrotic syndrome
Answer: Amyloidosis, nephrotic syndrome
Explanation
The correct answer is E) Amyloidosis, nephrotic syndrome.
The patient’s clinical presentation, laboratory findings, and history of chronic bronchitis with bronchiectasis suggest the possibility of secondary amyloidosis. Amyloidosis is a condition characterized by the abnormal deposition of insoluble amyloid protein in various organs, including the kidneys.
In this case, the presence of edema in the legs, lower back, and anterior abdominal wall, along with significant proteinuria (9.9 g/L) and daily protein excretion (11.4 g per 24 hours), is indicative of nephrotic syndrome. Nephrotic syndrome is a kidney disorder characterized by increased permeability of the glomerular filtration barrier, leading to excessive loss of protein in the urine.
The low levels of total protein (52 g/L) and albumin (30 g/L) in the blood are consistent with the loss of protein through the kidneys. Additionally, the elevated cholesterol level (9.6 mmol/L) is commonly seen in nephrotic syndrome due to alterations in lipid metabolism.
The absence of significant leukocytes and erythrocytes in the urine, along with the absence of casts, suggests a primarily glomerular origin rather than tubulointerstitial or infectious causes (options A, B, and C).
Given the clinical picture and the association with chronic inflammatory conditions like bronchiectasis, the most likely diagnosis in this patient is amyloidosis, leading to nephrotic syndrome (option E). In amyloidosis, the deposition of amyloid proteins in the glomeruli impairs their function, resulting in proteinuria and other related manifestations.
40.A 40-year-old man complains of impaired vision, rapid heartbeat, and an aching pain in the muscles of his back, lumbar region, and legs and in his shoulder and hip joints. Objectively, the signs of uveitis can be observed. X-ray detects blurring of the contours of the sacroiliac joints and single- syndesmophytes between the vertebral bodies. Laboratory testing detects antibodies against HLA-B27 antigens, anemia, and ESR of 28 mm/hour. What disease causes such a clinical presentation?
A. Ankylosing spondylitis
B. Deforming spondyloarthrosis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Reiter’s syndrome
Answer: Ankylosing spondylitis
Explanation
The disease that most likely causes the described clinical presentation is: A. Ankylosing spondylitis.
The patient’s symptoms, including impaired vision, musculoskeletal pain in the back, lumbar region, legs, shoulder, and hip joints, along with signs of uveitis, are characteristic of ankylosing spondylitis.
The presence of HLA-B27 antibodies, blurring of the sacroiliac joint contours on X-ray, and syndesmophytes between the vertebral bodies further support this diagnosis.
Anemia and elevated ESR (erythrocyte sedimentation rate) are common laboratory findings associated with ankylosing spondylitis.
41.A worker at a workshop that produces car batteries came to a doctor with complaints of nausea, loss of appetite, sharp pain in the abdominal cavity, and constipations. Examination reveals elevated blood pressure, bradycardia, an enlarged liver, pain in the right subcostal region, a grayish blue stripe on the gums, and gray skin. Complete blood count indicates the presence of erythrocytes with basophilic stippling and reduced hemoglobin levels. Aminolevulinic acid and coproporphyrin can be detected in the patient’s urine. What is the most likely provisional diagnosis in this case?
A. Aluminum poisoning
B. Cadmium poisoning
C. Lead poisoning
D. Mercury poisoning
E. Food poisoning
Answer: Lead poisoning
Explanation
The most likely provisional diagnosis in this case is: C. Lead poisoning.
The patient’s symptoms, including nausea, loss of appetite, abdominal pain, constipation, elevated blood pressure, bradycardia, an enlarged liver, pain in the right subcostal region, grayish blue stripe on the gums (known as Burton’s line), and gray skin, are indicative of lead poisoning.
The presence of erythrocytes with basophilic stippling and reduced hemoglobin levels in the complete blood count, along with the detection of aminolevulinic acid and coproporphyrin in the urine, further support this diagnosis.
Lead poisoning is commonly associated with occupational exposure, such as in this case of working in a car battery workshop.
It is important for the patient to receive appropriate medical treatment and for the source of lead exposure to be identified and controlled to prevent further harm.
42.A 40-year-old woman has been suffering from epilepsy since she was 15, Generalized epileptic seizures occur 2-3 times a month at night and are accompanied by involuntary urination and defecation. After a psychotrauma (her father’s death), the attacks became more frequent and now occur every 2-3 minutes. The woman does not return to consciousness between the attacks, her pupils are unresponsive to light. What is the most likely diagnosis in this case?
A. Absence seizure
B. Hysterical attack
C. Epileptic psychosis
D. Status epilepticus
E. An increase in the number of grand seizures
Answer: Status epilepticus
Explanation
The most likely diagnosis in this case is: D. Status epilepticus.
Status epilepticus is a medical emergency characterized by prolonged or repeated seizures without recovery of consciousness between the seizures.
In this scenario, the woman is experiencing frequent seizures every 2-3 minutes, which is highly indicative of status epilepticus.
The presence of involuntary urination and defecation during the seizures is consistent with the loss of control seen in generalized seizures.
The psychotrauma she experienced following her father’s death may have triggered the increased frequency of the seizures. The unresponsiveness of her pupils to light suggests a more severe and prolonged form of seizure activity.
Status epilepticus requires immediate medical attention and intervention to prevent further complications and potential harm to the patient.
Treatment typically involves administering antiepileptic medications and ensuring adequate airway, breathing, and circulation support.
43.A 36-year-old woman complains of pain in her joints and muscles, loss of appetite, constipations, rapid fatigability, and subfebrile body temperature. Objectively, she has dysphagia, symmetrical arthritis, skin thickening on her hands and feet, atrophy and small ulcers on the fingertips, Raynaud’s syndrome, and telangiectasia. What disease is the cause of such a clinical presentation?
A. Systemic scleroderma
B. Rheumatoid arthritis
C. Dermatomyositis
D. Raynaud’s disease
E. Systemic lupus erythematosus
Answer: Systemic scleroderma
Explanation
The most likely disease causing the clinical presentation described is: A. Systemic scleroderma.
Systemic scleroderma, also known as systemic sclerosis, is a chronic autoimmune connective tissue disease characterized by fibrosis (thickening) and hardening of the skin and various internal organs.
The symptoms and findings described in the case, such as joint and muscle pain, loss of appetite, constipation, dysphagia (difficulty swallowing), arthritis, skin thickening, fingertip ulcers, Raynaud’s syndrome (color changes in response to cold or stress), and telangiectasia (dilated blood vessels), are typical manifestations of systemic scleroderma.
In systemic scleroderma, the immune system mistakenly attacks the body’s own tissues, leading to inflammation and fibrosis. It can affect multiple organs, including the skin, joints, muscles, gastrointestinal tract, and blood vessels. Treatment typically involves a multidisciplinary approach and may include medications to manage symptoms, immunosuppressive therapy, physical therapy, and lifestyle modifications
44.A 14-year-old girl developed morning fever, cheilitis, stomatitis, photosensitivity, leukocytosis of 24- 109/L, and thrombocytopenia. Laboratory studies detect antinuclear antibodies in a high titer. Make the provisional diagnosis.
A. Juvenile idiopathic arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Systemic scleroderma
E. Sepsis
Answer: Systemic lupus erythematosus
Explanation
The provisional diagnosis for the 14-year-old girl based on the given information is: B. Systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs and systems in the body.
The symptoms described in the case, including morning fever, cheilitis (inflammation of the lips), stomatitis (inflammation of the mouth), photosensitivity (sensitivity to sunlight), leukocytosis (increased white blood cell count), thrombocytopenia (low platelet count), and the presence of antinuclear antibodies in a high titer, are indicative of SLE.
SLE is characterized by an overactive immune system that mistakenly attacks healthy tissues, resulting in inflammation and damage.
It predominantly affects women, and symptoms can vary widely among individuals. Common manifestations of SLE include joint pain and swelling, skin rashes (such as the classic butterfly rash on the face), fatigue, and involvement of various organs such as the kidneys, heart, lungs, and central nervous system.
Treatment aims to control symptoms, prevent flare-ups, and minimize organ damage. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressive agents may be prescribed based on the severity and specific manifestations of the disease.
45.A 32-year-old patient looks at the pattern on the wallpaper and sees the lines begin to move and form silhouettes of fantastic animals. Instead of a lighting fixture hangi- ng from the ceiling, he sees a giant octopus. What psychopathological symptom is it?
A.Derealization
B. Pseudohallucinations
C. Visual hallucinations
D. Functional hallucinations
E. Pareidolic illusions
Answer: Derealization
Explanation
The correct psychopathological symptom in this case would be: A. Derealization.
Derealization is a symptom characterized by a distorted perception of the external world, where the surroundings may feel unreal, dreamlike, or distorted.
It involves a sense of detachment or estrangement from the environment, often described as if the person is observing their surroundings from a distance or through a foggy lens.
In derealization, there is a subjective experience of the external world appearing altered or different, rather than specific visual perceptions like hallucinations.
In the given scenario, the patient perceiving the lines on the wallpaper as moving and forming silhouettes of animals, and seeing a giant octopus instead of a lighting fixture, suggests a distortion in their perception of the environment.
This experience aligns more with derealization, where there is a sense of unreality or distortion in the external world, rather than hallucinations or pseudohallucinations.
46.For 12 hours, a woodcutter has been working outdoors in windy weather at the air temperature of +4-5°C. His shoes were compressing the distal parts of his feet. Now he complains of a pricking and burning pain in his toes 1-3 on both feet, pain in the interphalangeal joints, and decreased skin sensitivity in toes 1-3. Examination detects slightly edematous toes, bluish skin, painful and reduced movements in the interphalangeal joints, slightly reduced skin sensitivity, and retained pulsation of the arteries on the dorsum of the feet. What is the provisional diagnosis in this case?
A. First degree frostbite
B. Acute interphalangeal joint arthritis
C. Critical ischemia of the feet
D. Crush syndrome
E. Obliterating endarteritis
Answer: First degree frostbite
Explanation
The most likely provisional diagnosis in this case would be: A. First-degree frostbite.
Frostbite occurs when body tissues freeze due to prolonged exposure to cold temperatures.
In first-degree frostbite, the outer layer of the skin is affected. The symptoms described, including pricking and burning pain in the toes, bluish skin, decreased skin sensitivity, and retained arterial pulsation, are consistent with the initial stage of frostbite.
The compressing shoes in combination with the cold and windy weather may have contributed to the development of frostbite in the distal parts of the feet, particularly toes 1-3.
47.A man was undergoing treatment for a myocardial infarction. On day 13, his chest pain increased and he developed shortness of breath. Objectively, the following is observed: temperature 38.2°C, pulse – 112/min. respiration rate 26/min. fine bubbling crackles can be heard under the right shoulder blade. On day 15, he was diagnosed with right-sided exudative pleurisy. Complete blood count shows the following: leukocytes – 8.9109/L, eosinophils – 8%. ESR-24 mm/hour. What complication of myocardial infarction occurred in this patient?
A. Recurrent myocardial infarction
B. Dressler syndrome
C. Pneumonia
D. Pulmonary embolism
E. Cardiac asthma
Answer: Dressler syndrome
Explanation
Based on the provided information, the most likely complication of myocardial infarction (MI) in this patient is B. Dressler syndrome.
Dressler syndrome, also known as post-myocardial infarction syndrome, typically occurs 2-6 weeks after a myocardial infarction. It is characterized by fever, pleuritic chest pain, pericarditis, and sometimes pleurisy. The symptoms may be accompanied by an elevated white blood cell count, increased erythrocyte sedimentation rate (ESR), and sometimes eosinophilia.
In this case, the patient experienced increased chest pain and developed shortness of breath, along with a low-grade fever (temperature 38.2°C) and elevated heart rate (pulse – 112/min). The presence of fine bubbling crackles under the right shoulder blade suggests pleural involvement. The subsequent diagnosis of
right-sided exudative pleurisy aligns with Dressler syndrome, which involves inflammation of the pericardium and sometimes the pleura.
- Recurrent myocardial infarction (option A) typically presents with similar symptoms as an initial MI, but the provided information does not indicate a new episode of myocardial ischemia.
- Pneumonia (option C) would present with different symptoms, such as productive cough, fever, and focal findings on chest examination. The absence of these findings and the specific pleural involvement in this case make pneumonia less likely.
- Pulmonary embolism (option D) usually presents with sudden-onset dyspnea, pleuritic chest pain, and sometimes hemoptysis. The absence of these features and the presence of pleural inflammation make pulmonary embolism less likely.
- Cardiac asthma (option E) is a condition characterized by wheezing and shortness of breath due to heart failure. While the patient in this case does have shortness of breath, the presence of pleuritic chest pain and the specific pleural findings suggest Dressler syndrome rather than cardiac asthma.
Therefore, based on the clinical presentation and laboratory findings, Dressler syndrome (post-myocardial infarction syndrome) is the most likely complication in this patient.
48.A 19-year-old patient complains of a dry cough, muscle pain, and a fever of 390C. A sore throat and subfebrile body temperature were observed for the last week. Objectively, the respiration is harsh. Complete blood count shows the following: leukocytes 10.0 109/L, leukocyte left shift, ESR – 26 mm/hour. Chest X-ray shows an intensified pulmonary pattern, low-intensity focal shadows in the lower segments of the right lung. What medicines should be prescribed in this case?
A. Aminoglycosides
B. Penicillin antibiotics
C. Sulfanilamides
D. Second or third generation cephalosporins
E. Macrolides
Answer: Macrolides
Explanation
Based on the symptoms and findings described, the most appropriate choice of medication in this case would be: E. Macrolides.
The symptoms of a dry cough, muscle pain, sore throat, and fever, along with the findings of harsh respiration, leukocytosis with a left shift, and an intensified pulmonary pattern on chest X-ray, suggest a respiratory infection.
Macrolide antibiotics, such as azithromycin, clarithromycin, or erythromycin, are commonly used to treat respiratory tract infections, including
community-acquired pneumonia, which could be a possible diagnosis in this case. Macrolides have broad-spectrum activity against many common respiratory pathogens, including atypical bacteria such as Mycoplasma pneumoniae and Chlamydia pneumoniae.
Aminoglycosides, sulfanilamides, and second or third-generation cephalosporins are not the optimal choices for this scenario, as they may not cover the likely causative agents of community-acquired pneumonia.
Penicillin antibiotics, while effective against certain bacterial infections, may not provide adequate coverage against atypical bacteria that are commonly associated with respiratory tract infections.
49.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 blood testing detected 1.44 ° ethanol in the blood and carboxyhemoglobin levels of 55 %. What is the cause of death in this case?
A.Alcohol poisoning
B. Aniline poisoning
C. Carbon monoxide poisoning
D. Arsenic poisoning
E. Potassium cyanide poisoning
Answer: Carbon monoxide poisoning
Explanation
Based on the findings described, the most likely cause of death in this case is: C. Carbon monoxide poisoning.
The presence of carboxyhemoglobin levels of 55% in the blood indicates significant carbon monoxide (CO) exposure. Carbon monoxide is a colorless and odorless gas that can be produced by incomplete combustion of fuels such as gas, oil, or coal.
Inhaled carbon monoxide binds to hemoglobin in the blood, reducing its ability to carry oxygen, leading to tissue hypoxia.
The pink skin and mucosa, bright-red plethoric internal organs, and liquid bright-red blood are consistent with the effects of carbon monoxide poisoning, as it causes a cherry-red coloration in tissues due to the formation of carboxyhemoglobin.
The presence of ethanol (alcohol) in the blood at a concentration of 1.44% suggests that the individual had consumed alcohol, but it is not the primary cause of death in this case.
Aniline poisoning and arsenic poisoning would present with different clinical manifestations and findings, not consistent with the described scenario.
50.A 25-year-old woman had an abortion half a year ago. She complains of loss of appetite, weakness, and arthralgia. Two weeks later, she developed dark urine and jaundice. Against this background, her general condition continues to deteriorate. Viral hepatitis is suspected. What marker of viral hepatitis is likely to be positive in the patient?
A. Anti-HEV IgM
B. Anti-CMV IgM
C. Anti-HBs
D. Anti-HBc IgM
E. Anti-HAV IgM
Answer: Anti-HBc IgM
Explanation
Based on the clinical presentation and history provided, the most likely marker of viral hepatitis that would be positive in the patient is: D. Anti-HBc IgM (antibodies to hepatitis B core antigen IgM).
The patient’s symptoms, including loss of appetite, weakness, arthralgia, dark urine, and jaundice, are consistent with viral hepatitis. The fact that she had an abortion half a year ago suggests a possible recent exposure to the hepatitis B virus (HBV) during the procedure.
During the acute phase of HBV infection, IgM antibodies to hepatitis B core antigen (Anti-HBc IgM) are typically detected in the blood. Anti-HBc IgM is an indicator of recent HBV infection and is present during the early stages of acute hepatitis B.
Anti-HEV IgM (antibodies to hepatitis E virus IgM) is specific to hepatitis E and would not be relevant in this case.
Anti-CMV IgM (antibodies to cytomegalovirus IgM) is specific to cytomegalovirus infection and would not be relevant in the context of viral hepatitis.
Anti-HBs (antibodies to hepatitis B surface antigen) are typically positive in individuals who have recovered from HBV infection or have received the hepatitis B vaccine. It is not specific to acute hepatitis B.
