Question From ( 101 To 150 )

All Previous Years Krok 2 Papers with Explanations

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Question From ( 100 To 150 )

100. A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?

A. Syndrome of fermentative dyspepsia

B. Syndrome of decayed dyspepsia

C. Syndrome of fatty dyspepsia

D. Dyskinesia syndrome

E. Malabsorption syndrome

Answer: Syndrome of fermentative dyspepsia

Explanation

The correct name for the described syndrome is: A. Syndrome of fermentative dyspepsia

The syndrome of fermentative dyspepsia refers to a condition characterized by abdominal distension, increased flatulence, and the presence of liquid, foamy stools with a sour smell. It occurs after the consumption of dairy products and is often associated with lactose intolerance.

Lactose intolerance is the inability to digest lactose, a sugar found in milk and dairy products, due to the deficiency of the enzyme lactase. This leads to the fermentation of lactose by bacteria in the gut, resulting in the production of gas and the symptoms described.

Other options listed, such as the syndrome of decayed dyspepsia, syndrome of fatty dyspepsia, dyskinesia syndrome, and malabsorption syndrome, do not specifically match the symptoms and association with dairy product consumption as described in the case.

101. In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

A. Immunization of the population

B. Hospitalization of patients

C. Detection of carriers

D. Early diagnostics

E. Disinfection in disease focus

Answer: Immunization of the population

Explanation

The most effective measure to influence the epidemic process of diphtheria and reduce the morbidity rate to single cases in this situation would be: A. Immunization of the population Immunization, specifically through vaccination against diphtheria, is the primary preventive measure for controlling and reducing the spread of the disease.

By immunizing the population, individuals develop immunity to diphtheria, making them less susceptible to the infection and reducing the likelihood of transmission.

Immunization programs aim to achieve high vaccine coverage in the population, including both children and adults. This helps create herd immunity, where a significant portion of the population is immunized and provides indirect protection to those who are not vaccinated or have a weakened immune system.

While hospitalization of patients, detection of carriers, early diagnostics, and disinfection in disease focus are important measures in managing and controlling the disease, they may not be sufficient to achieve a significant reduction in morbidity rates or effectively influence the epidemic process. Immunization plays a crucial role in preventing diphtheria and breaking the chain of transmission within the community.

102. A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

A. Anovular menstrual cycle

B. Chronic adnexitis

C. Abnormalities in genital development

D. Immunologic infertility

E. Genital endometriosis

Answer: Anovular menstrual cycle

Explanation

Anovulation refers to a condition where a woman does not ovulate regularly or does not release mature eggs from the ovaries. In this case, the basal (rectal) temperature remains one-phase during the last three menstrual cycles, which indicates a lack of hormonal fluctuations associated with ovulation.

Ovulation is essential for fertility, as it is the process by which an egg is released from the ovary and can be fertilized by sperm. Without ovulation, pregnancy cannot occur. Anovulation can have various underlying causes, such as hormonal imbalances, polycystic ovary syndrome (PCOS), thyroid disorders, stress, or other factors affecting the normal functioning of the ovaries.

It is important to further evaluate and investigate the specific cause of anovulation in order to determine the appropriate treatment for infertility. This may involve hormonal tests, ultrasound examinations, and other diagnostic procedures to identify and address the underlying factors contributing to anovulation.

103. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A. Cancer of cervix of the uterus

B. Polypus of the cervis of the uterus

C. Cervical pregnancy

D. Nascent fibroid

E. Leukoplakia

Answer: Cancer of cervix of the uterus

Explanation

The symptoms and findings described are indicative of cervical cancer. The contact hemorrhages, enlarged and immobile cervix, and cauliflower-like appearance of the cervix seen on examination are consistent with advanced cervical cancer. Positive Chrobak and Schiller tests further support the suspicion of cervical cancer.

The Chrobak test involves the application of acetic acid to the cervix, which can reveal abnormal changes in the cervical tissue. The Schiller test involves the application of iodine solution to the cervix, and if the area remains unstained (acetowhite), it suggests abnormal cells present, such as in cervical dysplasia or cancer.

However, it is important to confirm the diagnosis through further diagnostic tests, such as a cervical biopsy, colposcopy, or imaging studies. These tests will help determine the stage and extent of the cervical cancer and guide appropriate treatment options, which may include surgery, radiation therapy, chemotherapy, or a combination of these approaches. Early detection and treatment of cervical cancer can greatly improve the prognosis and outcome for the patient.

104. A local doctor has to prepare a report about the health condition of the population of his region. What medical indexes of population health condition should he use?

A. Morbidity, disabilities, demographic, physical development

B. Social welfare, satisfaction of life quality

C. Way of life, genetic, pollution

D. Average treatment duration, complications

E. Average longevity

Answer: Morbidity, disabilities, demographic, physical development

Explanation

These indexes provide important insights into the overall health status of the population. Let’s break down each index: Morbidity: This refers to the incidence and prevalence of diseases and health conditions in the population.

Tracking morbidity allows the doctor to identify the most common diseases, their patterns, and trends in the population. It helps in planning and implementing appropriate healthcare measures and interventions. Disabilities: This index focuses on the presence and impact of disabilities in the population. It includes physical, sensory, cognitive, and mental disabilities. Assessing disabilities helps in understanding the burden of disability, identifying the need for rehabilitation services, and implementing measures to improve the quality of life for individuals with disabilities. Demographic: This index examines the demographic characteristics of the population, such as age, sex, ethnicity, and socioeconomic factors.

Demographic data is essential for understanding the distribution of health conditions across different population groups and identifying disparities in healthcare access and outcomes. Physical development: This index assesses the physical growth and development of individuals, particularly in children. It includes parameters such as height, weight, body mass index (BMI), and other developmental milestones.

Monitoring physical development helps in identifying nutritional deficiencies, growth disorders, and other health issues in the population, especially among children. By analyzing these medical indexes, the local doctor can gain a comprehensive understanding of the health condition of the population in his region and use this information to develop strategies for healthcare planning, prevention, and intervention.

105. A boy, aged 9, is examined: height127 cm (-0,36), weight – 28,2 kg (+0,96), chest circumference- 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the integrated assessment of the child’s physical development?

A. Harmonious

B. Disharmonious

C. Markedly disharmonious

D. Excessive

E. Below the average

Answer: Harmonious

Explanation

In a harmonious development pattern, all the measured parameters (height, weight, chest circumference, and lung vital capacity) are within a relatively balanced range compared to the average values for a child of that age.

While there may be slight variations from the average, these differences are considered to be within the normal range and do not indicate any significant deviations or disharmonies in physical development.

Therefore, based on the provided measurements, the child’s physical development is assessed as harmonious.

106. A 14 y.o. child suffers from of vegetovascular dystonia of pubertal period. He has developed sympathoadrenal crisis. What medicine should be used for crisis reduction?

A. Obsidan

B. No-shpa

C. Amisyl

D. Euphyline

E. Corglicone

Answer: Obsidan

Explanation

Obsidan (also known as Propranolol) is a beta-blocker medication that can help alleviate the symptoms of sympathoadrenal crisis. It works by blocking the effects of adrenaline (epinephrine) on the sympathetic nervous system, which can help reduce heart rate, blood pressure, and other symptoms associated with the crisis.

Therefore, Obsidan would be the most suitable choice for crisis reduction in this scenario. However, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan for the individual.

107. A woman complains of high temperature to 380C, mild pain in the throat during 3 days. On examinati-on: angle lymphatic nodes of the jaw are 3 cm enlarged, palatinel tonsils are enlarged and coated with grey plaque which spreads to the uvula and frontal palatinel arches. What is the most probable diagnosis?

A. Larynx dyphtheria

B. Infectious mononucleosis

C. Vincent’s angina

D. Agranulocytosis

E. Oropharyngeal candidosis

Answer: Larynx dyphtheria

Explanation

Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae. It commonly affects the throat and respiratory tract. The characteristic grey plaque on the tonsils, spreading to the uvula and frontal palatine arches, is a classic feature of diphtheria.

Other symptoms may include fever, difficulty swallowing, and enlarged lymph nodes. It is important to note that diphtheria is a serious condition and requires immediate medical attention. Prompt diagnosis and appropriate treatment, such as administration of diphtheria antitoxin and antibiotics, are essential to prevent complications and control the spread of the disease.

108. A 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and localized between scapulas. In a day temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

A. Perforation of esophagus with mediastinitis

B. Esophageal hemorrhage

C. Obstruction of esophagus

D. Pulmonary atelectasis

E. Aspirative pneumonia

Answer: Perforation of esophagus with mediastinitis

Explanation

The patient’s symptoms of sharp substernal pain following swallowing of a fish bone, worsening pain between the scapulas, elevated temperature, worsening dysphagia, and deteriorating condition are indicative of esophageal perforation.

When a foreign body lodges in the esophagus and causes trauma, it can lead to a perforation or tear in the esophageal wall. Perforation of the esophagus can result in the leakage of gastric contents and saliva into the mediastinal space, leading to mediastinitis, which is inflammation of the tissues in the mediastinum.

Mediastinitis is a severe and potentially life-threatening condition that requires immediate medical attention.

Other complications such as esophageal hemorrhage, obstruction of the esophagus, pulmonary atelectasis, or aspirative pneumonia may also occur in certain cases, but in this scenario, the development of mediastinitis due to esophageal perforation is the most likely complication.

109. A child from the first noncomplicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3th day appeared changes of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces- golden-yellow. Mother’s blood group is (II)Rh−, child- (II)Rh+. On the third day child’s Hb is 200 g/L, RBC- 6, 1 ∗ 1012/L, bilirubin in blood – 58 mk mol/L due to unconjugated bilirubin, Ht- 0,57. What is the child’s jaundice explanation?

A. Brain delivery trauma

B. Physiologic jaundice

C. Hemolytic disease of newborn

D. Bile ducts atresia

E. Fetal hepatitis

Answer: Brain delivery trauma

Explanation

The child’s history of cephalhematoma (a collection of blood between the skull bone and its covering) following a noncomplicated pregnancy but complicated labor suggests the possibility of trauma during delivery. Jaundice appearing on the second day, along with changes in neurological status such as nystagmus and Graefe’s sign, further support the hypothesis of brain delivery trauma.

In cases of birth trauma, such as head injury during delivery, there can be an increased breakdown of red blood cells, leading to elevated levels of unconjugated bilirubin.

Unconjugated bilirubin is a breakdown product of red blood cells that can accumulate in the blood and cause jaundice. Other options such as physiologic jaundice (which is a normal, transient condition in newborns), hemolytic disease of the newborn (caused by Rh or other blood group incompatibilities between mother and baby), bile duct atresia, or fetal hepatitis are less likely based on the given information and the presence of brain delivery trauma as the most probable cause of jaundice in this case.

110. A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?

A. Probing of uterus cavity

B. Bimanual examination

C. Ultrasound examination

D. Laparoscopy

E. Metrosalpingography

Answer: Probing of uterus cavity

Explanation

The immediate doctor’s tactic to confirm the diagnosis of uterine perforation during the artificial abortion would be: A. Probing of uterus cavity When there is a suspicion of uterine perforation during a procedure like dilating the cervical canal, the doctor may use a probe to carefully assess the uterine cavity.

The probe is inserted into the uterus to evaluate the depth and extent of the perforation.

This allows the doctor to directly confirm if a perforation has occurred and determine the severity of the injury. While other diagnostic options like bimanual examination, ultrasound examination, laparoscopy, or metrosalpingography may also be used in certain situations, the immediate and initial step to confirm the diagnosis would typically involve probing the uterus cavity.

111. A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39, 50C. He had a respiratory disease 1,5 week ago. On examination: temperature- 38, 50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?

A. Antistreptolysine-0

B. 1-antitrypsine

C. Creatinkinase

D. Rheumatic factor

E. Seromucoid

Answer: Antistreptolysine-0

Explanation

The symptoms of joint pain, elevated temperature, and a history of respiratory disease 1.5 weeks ago suggest a possible infectious etiology. Antistreptolysin-O (ASO) is an antibody produced by the body in response to a streptococcal infection, particularly Group A streptococcus.

Elevated levels of ASO in the blood indicate recent or ongoing streptococcal infection. Rheumatic fever, which is a possible concern in this case, is a complication of untreated streptococcal infection.

Therefore, measuring the level of Antistreptolysin-O (ASO) can help in determining if a streptococcal infection is the underlying cause of the joint symptoms and systemic manifestations in this patient.

112. A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He sufferes from hemophilia B-type. What antihemophilic medicine should be inclended in pre-and post-operative treatment plan?

A. Fresh frosen plasma

B. Cryoprecipitate

C. Fresh frosen blood

D. Native plasma

E. Dried plasma

Answer: Fresh frosen plasma

Explanation

Fresh frozen plasma (FFP) contains clotting factors, including factor IX, that are deficient in patients with hemophilia B. Administration of FFP can help replace the missing clotting factors and aid in clot formation, reducing the risk of bleeding and promoting hemostasis.

It is important to note that specific treatment plans for hemophilia should be determined by a healthcare professional experienced in managing patients with bleeding disorders. The dosage and frequency of FFP administration will depend on the severity of the hemophilia and the surgical procedure being performed.

113. A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

A. Punction and drainage of pleural cavity

B. Decortication of pleura

C. Pneumoectomy

D. Thoracoplasty

E. Lobectomy

Answer: Punction and drainage of pleural cavity

Explanation

Empyema refers to the collection of pus in the pleural cavity, which can occur as a complication of various conditions, including trauma. The initial treatment for empyema involves the drainage of the infected fluid from the pleural cavity.

This can be achieved through a procedure called thoracentesis or pleural drainage, where a needle or catheter is inserted into the pleural space to remove the pus. Punction and drainage of the pleural cavity help relieve symptoms, remove infected material, and promote the resolution of the empyema.

Depending on the severity of the empyema and the response to initial drainage, further interventions such as antibiotics or surgical procedures may be necessary. It’s important to note that the specific treatment approach may vary depending on the individual patient’s condition and the assessment of the healthcare team involved in the patient’s care.

114. A 28 y.o. homeless male was admitted to the hospital because of initial diagnosis “influenza”. Roseolo-petechiae rash has appeared on the trunk and internal surfaces of the limbs on the fifth day. Temperature is 410C, euphoria, face and sclera’s hyperemia, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Typhus

B. Alcogolic delirium

C. Leptospirosis

D. Measles

E. Abdominal typhoid

Answer: Typhus

Explanation

Typhus is an infectious disease caused by bacteria transmitted by fleas, lice, or ticks. It typically presents with symptoms such as high fever, rash, headache, muscle aches, and general malaise. The presence of roseolo-petechiae rash, high fever (41°C), hyperemia of the face and sclera, splenomegaly, and excitement in this case are consistent with the clinical presentation of typhus. Other options can be ruled out based on the specific symptoms described.

Alcoholic delirium typically occurs due to alcohol withdrawal and is characterized by confusion, tremors, and hallucinations but does not typically present with rash or high fever. Leptospirosis is a bacterial infection that can cause fever, muscle pain, and rash, but it is less likely to present with the specific symptoms described in this case.

Measles typically presents with a characteristic rash and fever, but the other symptoms mentioned are not commonly associated with measles. Abdominal typhoid, caused by Salmonella typhi, typically presents with fever, abdominal pain, and gastrointestinal symptoms, but the rash and other specific symptoms described are not typical. It is important to note that a definitive diagnosis can only be made by a healthcare professional after a thorough evaluation, including appropriate laboratory tests.

115. A patient complains of intense pressing pain in the pharynx, mainly to the Krok 2 Medicine 2005 15 right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient’s condition is grave. Body temperature – 38, 90C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

A. Peritonsillar abscess

B. Diphtheria

C. Pharyngeal tumour

D. Vincent’s disease

E. Phlegmonous tonsillitis

Answer: Peritonsillar abscess

Explanation

A peritonsillar abscess is a localized collection of pus that forms near the tonsils. It typically occurs as a complication of tonsillitis or a severe bacterial infection in the throat. The symptoms described in the case, such as intense pressing pain in the pharynx, difficulty swallowing, constrained voice, enlarged and painful submandibular glands, and fever, are consistent with a peritonsillar abscess.

To confirm the diagnosis, a doctor may perform a physical examination, including an inspection of the throat and palpation of the affected area. Imaging studies such as ultrasound or CT scan may also be used to assess the extent of the abscess.

Prompt medical intervention is necessary for a peritonsillar abscess, as it can cause severe pain and difficulty in breathing and swallowing. Treatment usually involves draining the abscess, either by needle aspiration or incision and drainage. Antibiotics may also be prescribed to control the infection. It’s important for the patient to seek immediate medical attention for proper diagnosis and treatment of a peritonsillar abscess.

116. In a 65 y.o. female patient a tumor 13х8 сm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On ausculation: systolic murmur. What is the most probable diagnosis?

A. Abdominal aortic aneurism

B. Stomach tumor

C. Arterio-venous aneurism

D. Tricuspid valve insufficiency

E. Mitral insufficiency

Answer: Abdominal aortic aneurism

Explanation

An abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta, which is the main blood vessel that supplies blood to the abdomen, pelvis, and lower extremities. The typical presentation of an AAA includes a pulsatile mass in the abdominal area, above the umbilicus.

The mass may be tender to touch and is often accompanied by a systolic murmur due to turbulent blood flow. In this case, the palpated tumor in the umbilical area, its size, tenderness, and pulsation, along with the presence of a systolic murmur on auscultation, are highly suggestive of an abdominal aortic aneurysm.

Confirmation of the diagnosis is usually done through imaging studies, such as ultrasound or computed tomography (CT) scan. These imaging techniques can determine the size and characteristics of the aneurysm, which helps in planning appropriate management. Abdominal aortic aneurysms can be potentially life-threatening if they rupture, leading to severe internal bleeding. Therefore, prompt evaluation and management are crucial.

Treatment options depend on the size of the aneurysm and may include surveillance, medical management, or surgical intervention, such as endovascular repair or open surgical repair. It is important for the patient to seek immediate medical attention for proper diagnosis and appropriate management of an abdominal aortic aneurysm.

117. A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

A. Trichomonas colpitic

B. Gonorrhea

C. Chlamydiosis

D. Vagina candidomicosis

E. Bacterial vaginosis

Answer: Trichomonas colpitic

Explanation

Trichomoniasis is a sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis. It commonly presents with symptoms such as profuse, frothy, and foamy vaginal discharge, along with itching, burning, and inflammation of the genitalia. The discharge may have a foul odor.

On examination, findings may include hyperemia (redness) of the vaginal mucosa, bleeding on touch, and foamy discharge in the urethral area. These clinical features are highly suggestive of Trichomonas colpitis. Trichomoniasis is usually transmitted through sexual contact, including vaginal intercourse.

It can also be transmitted through contaminated objects, such as shared towels or bathing suits. Extramarital sexual activity increases the risk of acquiring Trichomonas infection. Diagnosis is typically made by examining the vaginal discharge under a microscope to identify the presence of Trichomonas organisms. In some cases, a DNA-based test or culture may be performed for confirmation.

Treatment for Trichomonas colpitis usually involves the use of oral antibiotics, such as metronidazole or tinidazole, to eliminate the infection. It is important to treat both sexual partners to prevent reinfection. It is recommended that the patient seeks medical attention for proper diagnosis and treatment of Trichomonas colpitis, and also to address any potential risk factors and discuss safe sexual practices.

118. A 18 y.o. woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37, 50C, considerable mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina examination the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

A. Recent acute ascending gonorrhea

B. Trichomoniasis

C. Candydomycosis

D. Chronic gonorrhea

E. Chlamydiosis

Answer: Recent acute ascending gonorrhea

Explanation

Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It commonly affects the urogenital tract, including the urethra, cervix, uterus, and ovaries. The patient’s symptoms of lower abdominal pain, fever, mucopurulent discharges from the genital tract, and colic during urination are consistent with acute gonorrhea. The findings on examination, such as urethral infiltration, hyperemic and erosive cervix, and painful and thickened uterus and ovaries, further support the diagnosis.

The presence of diplococci on bacterioscopy is highly suggestive of Neisseria gonorrhoeae, the causative agent of gonorrhea. Acute ascending gonorrhea refers to the infection spreading from the lower urogenital tract to the upper reproductive organs, including the uterus and ovaries.

This can lead to more severe symptoms and complications if not treated promptly. It is important for the patient to seek medical attention for diagnosis and treatment of gonorrhea. The recommended treatment involves a course of antibiotics effective against Neisseria gonorrhoeae, such as ceftriaxone combined with azithromycin or doxycycline to cover for possible co-infection with Chlamydia trachomatis, another common sexually transmitted bacterium.

Additionally, it is crucial to notify and treat sexual partners to prevent further transmission of the infection. Safe sexual practices, including consistent and correct use of barrier methods such as condoms, are important in preventing the spread of gonorrhea and other sexually transmitted infections.

119. A 30 y.o. male patient complains of itching of the skin which intensifies in the evening. He has been ill for 1,5 months. On examination: there is rash with paired papules covered with bloody crusts on the abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand. There are traces of line scratches. What additional investigations are necessary to make diagnosis?

A. Examination of rash elements scrape

B. Determination of dermographism

C. Serologic blood examination

D. Blood glucose

E. Examination for helmints

Answer: Examination of rash elements scrape

Explanation

The patient’s symptoms, such as itching of the skin that intensifies in the evening, the presence of rash with paired papules covered with bloody crusts, and the distribution of the rash on specific areas of the body (abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand), are suggestive of scabies.

Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei. To confirm the diagnosis, a skin scraping or skin biopsy can be performed. In this procedure, a small sample of the skin is taken from the affected area and examined under a microscope to detect the presence of the scabies mites, their eggs, or fecal matter.

Examination of the rash elements scrape allows for the direct visualization of the scabies mites or their products, providing a definitive diagnosis. It is an important step in differentiating scabies from other skin conditions with similar symptoms.

Other investigations mentioned in the options, such as determination of dermographism (a skin reaction to scratching or pressure), serologic blood examination, blood glucose test, and examination for helminths, may be relevant in certain cases but are not specific for diagnosing scabies. The examination of rash elements scrape is the most appropriate and specific investigation in this scenario.

120. A child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0,45. What is the most probable diagnosis?

A. Edematous-hemorrhagic syndrome

B. Disseminated intravascular clotting syndrome

C. Pulmonary edema

D. Hyaline membrane disease

E. Congenital pneumonia

Answer: Edematous-hemorrhagic syndrome

Explanation

The symptoms described, including respiratory distress, anasarca (generalized swelling), fine bubbling moist rales over the lower lobe of the right lung, skin extravasations, and bloody foam from the mouth, suggest a condition characterized by fluid accumulation and bleeding. Edematous-hemorrhagic syndrome is a condition that occurs in severely premature infants and is associated with multiple organ involvement.

The presence of atelectasis of the lower lobe of the right lung on the chest X-ray is consistent with lung involvement. The low hemoglobin (Hb) level and high hematocrit (Ht) value in the blood indicate hemoconcentration, which can be seen in this syndrome.

Disseminated intravascular coagulation (DIC) syndrome is a condition characterized by abnormal blood clotting and bleeding, but it typically presents with more severe bleeding manifestations and abnormal coagulation parameters. Pulmonary edema and hyaline membrane disease are also possible in premature infants, but the symptoms described in the case are more suggestive of edematous-hemorrhagic syndrome.

Congenital pneumonia is less likely in this case, as the symptoms and findings described are more consistent with a generalized syndrome rather than an isolated lung infection. It is important to note that a definitive diagnosis can only be made by a healthcare professional based on a thorough evaluation of the patient’s clinical presentation, medical history, and appropriate diagnostic tests.

121. A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil- 2%; eosinophil5%. There is a urate crystales in urine, erythrocyte- 2-3 in the field of vision. What is the preliminary diagnosis?

A. Chronic myeloleucosis

B. Leukemoid reaction

C. Lymphogranulomatosis

D. Hepar cirrhosis

E. Urolithiasis

Answer: Chronic myeloleucosis

Explanation

The patient’s symptoms, including general weakness, fatigue, left subcostal pain, and frequent painful urination, along with the findings of moderate splenomegaly, neutrophilic leukocytosis progressing to myelocyte, and presence of urate crystals and erythrocytes in the urine, are indicative of a myeloproliferative disorder.

Chronic myeloleukemia is a type of leukemia characterized by the excessive production of myeloid cells in the bone marrow. It typically presents with symptoms related to an increased number of white blood cells, such as fatigue, weakness, and abdominal discomfort due to splenomegaly.

The blood test findings of neutrophilic leukocytosis with a shift to myelocytes, along with the presence of basophils and eosinophils, are consistent with the characteristic blood cell changes seen in CML.

While other conditions, such as leukemoid reaction (reactive leukocytosis), lymphogranulomatosis (Hodgkin lymphoma), and hepar cirrhosis (liver cirrhosis), can present with similar symptoms, the combination of symptoms and laboratory findings described in the case is most suggestive of chronic myeloleukemia.

It is important to note that a definitive diagnosis can only be made by a healthcare professional through further evaluation, including bone marrow examination and genetic testing for the presence of the Philadelphia chromosome, which is a characteristic genetic abnormality associated with CML.

122. A 2 m.o. child was delivered at term with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of child.

A. Corresponding to the age

B. 150 g less than necessary

C. Hypotrophy of I grade

D. Hypotrophy of II grade

E. Paratrophy of I grade

Answer: Corresponding to the age

Explanation

Based on the information provided, the current weight of the 2-month-old child, which is 4900 g, is considered to be corresponding to the age. In the first few months of life, it is expected that infants will experience steady weight gain.

In this case, the child has gained 1400 g (4900 g – 3500 g) since birth, which indicates appropriate growth and is within the expected range for a 2-month-old. Therefore, the answer is A. Corresponding to the age.

123. A 2 m.o. breast-fed child suffers from cheek skin hyperemia, sporadic papulous elements on the skin of the chest and back following the apple juice introduction. The child is restless. What is the initial pediatritian’s tactics?

A. Clarify mother’s diet and exlude obligate allergens

B. Refer to prescribe dermathologist

C. Administer general ultraviolet irradiation

D. Treat with claritine

E. Apply ointment with corticosteroids to affected skin areas

Answer: Clarify mother’s diet and exlude obligate allergens

Explanation

The initial pediatrician’s tactics in this case would be to clarify the mother’s diet and exclude obligate allergens. Since the child is breast-fed and experiencing symptoms after the introduction of apple juice, it suggests a possible allergic reaction.

Clarifying the mother’s diet and identifying any potential allergens that may be passed through breast milk is an important step in managing the child’s symptoms. By eliminating the allergens from the mother’s diet, it can help alleviate the symptoms in the child. Therefore, the correct answer is A. Clarify mother’s diet and exclude obligate allergens.

124. A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

A. Perforative ulcer

B. Acute cholecystitis

C. Acute bowel obstruction

D. Acute appendicitis

E. Right-sided renal colic

Answer: Perforative ulcer

Explanation

The patient’s symptoms and physical examination findings suggest a diagnosis of perforative ulcer. A perforative ulcer is a complication of peptic ulcer disease in which a hole develops in the stomach or duodenal lining, allowing the contents of the digestive tract to leak into the abdominal cavity. This can lead to severe abdominal pain, fever, and signs of peritonitis (inflammation of the lining of the abdominal cavity).

The patient’s complaint of severe pain in the right abdominal side that radiates to the right supraclavicular area, in addition to the presence of dryness and bitterness in the mouth, suggests that the ulcer may be located in the duodenum, which is in close proximity to the liver and gallbladder.

The onset of pain after eating fat and fried food is also consistent with peptic ulcer disease. The physical examination findings of right-sided abdominal pain, tenderness, and tension in the right hypochondrium are also suggestive of a perforative ulcer, as these symptoms may be related to inflammation and irritation of the peritoneum.

The other answer choices are less likely based on the information provided in the question. Acute cholecystitis, acute bowel obstruction, and acute appendicitis may present with abdominal pain and tenderness, but they are unlikely to cause pain that radiates to the right supraclavicular area or dryness and bitterness in the mouth. Right-sided renal colic may cause flank pain that radiates to the abdomen, but it would not explain the other symptoms described in the question.

Therefore, based on the information provided in the question, the most likely diagnosis for the 43-year-old woman is a perforative ulcer.

125. On the 5-th day of the respiratory disease a 24 y.o. man has developed progressive headaches systemic dizziness, feeling of seeing double, paresis of mimic muscles on the right, choking while swallowing. Acute viral encephalitis has been diagnosed. What is the main direction of urgent therapy?

A. Zovirax

B. Glucocorticoids

C. Ceftriaxon

D. Lasix

E. Hemodesis

Answer: Zovirax

Explanation

Zovirax (acyclovir) is an antiviral medication commonly used to treat viral infections, including herpes simplex encephalitis, which is the most common cause of acute viral encephalitis in adults. It works by inhibiting the replication of the virus and reducing the severity and duration of symptoms.

Glucocorticoids (choice B), such as prednisone, are often used in the treatment of inflammatory conditions but are not the mainstay of treatment for viral encephalitis.

Ceftriaxone (choice C) is a broad-spectrum antibiotic and is not effective against viral infections like encephalitis. Lasix (choice D) is a diuretic medication used to treat conditions such as fluid retention and high blood pressure. It is not the appropriate treatment for viral encephalitis.

Hemodesis (choice E) is a colloid solution used for volume replacement in certain medical conditions and is not specific for the treatment of viral encephalitis. Therefore, the most appropriate choice for the main direction of urgent therapy in this case is Zovirax (acyclovir, choice A).

126. A 65 y.o. woman complains of complicated mouth opening following foot trauma 10 days ago. Next day she ate with difficulties, there were muscles tension of back, the back of the head and abdomen. On the third day there was tension of all muscle groups, generalized convulsions every 10-15 min. What is the most probable diagnosis?

A. Tetanus

B. Tetania

C. Meningoencephalitis

D. Hemorrhagic stroke

E. Epilepsy

Answer: Tetanus

Explanation

Tetanus is a bacterial infection caused by the bacterium Clostridium tetani, which enters the body through a wound or injury. The bacterium produces a toxin that affects the nervous system, leading to muscle stiffness and spasms. In this case, the patient’s complaint of complicated mouth opening following foot trauma, along with the subsequent development of muscle tension and generalized convulsions, is highly suggestive of tetanus.

The progression of symptoms, starting with difficulty eating and muscle tension, followed by generalized convulsions, is characteristic of tetanus. Tetania (choice B) refers to a condition characterized by increased muscle tone and hyperexcitability of the nerves, but it is not the most likely diagnosis in this case. Meningoencephalitis (choice C) refers to inflammation of the brain and meninges, which can be caused by various infectious agents.

While it is possible to have muscle stiffness and spasms in cases of severe meningoencephalitis, the history of foot trauma and the progression of symptoms make tetanus a more likely diagnosis. Hemorrhagic stroke (choice D) refers to bleeding within the brain, which typically presents with sudden onset neurological deficits such as weakness, speech difficulties, or loss of consciousness. This does not match the symptoms described in the case.

Epilepsy (choice E) is a chronic neurological disorder characterized by recurrent seizures. While generalized convulsions can occur in epilepsy, the history of foot trauma and the progression of symptoms make tetanus a more likely diagnosis in this case. Therefore, the most probable diagnosis based on the given information is Tetanus (choice A).

127. A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP- 180/20 mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, S2 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic Xray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctor’s tactics should be?

A. Cardiosurgeon consultation

B. Dispensary observation

C. Administration of therapeutic treatment

D. Continuation of investigation

E. Exemption from physical exercises

Answer: Cardiosurgeon consultation

Explanation

The patient, an 18-year-old female student, presents with symptoms of dyspnea during intensive exertion, which has worsened over the past six months. Physical examination findings include an accelerated pulse rate of 88 bpm, high blood pressure (180/120 mm Hg), pale skin, and dilated heart borders to the left and up. There is also a systolic-diastolic murmur in the 2nd intercostal space and accentuated second heart sound (S2) at the pulmonary artery.

The ECG shows hypertrophy of both ventricles, and the chest X-ray reveals pulsation and protrusion of the left ventricle and pulmonary trunk. Given these findings, it is indicative of a cardiovascular condition that requires further evaluation and management by a cardiosurgeon. The symptoms, physical examination findings, and diagnostic tests suggest the presence of significant cardiac pathology, such as structural heart disease or cardiomyopathy.

A cardiosurgeon is a specialist who can provide expertise in diagnosing and treating complex cardiovascular conditions. Dispensary observation (choice B) may be necessary after a cardiosurgeon consultation, depending on the final diagnosis and treatment plan.

Administration of therapeutic treatment (choice C) would require a definitive diagnosis, which is best determined by a cardiosurgeon. Continuation of investigation (choice D) is important, but it should be done in collaboration with a cardiosurgeon.

Exemption from physical exercises (choice E) may be necessary depending on the severity of the condition and recommendations from the cardiosurgeon. Therefore, the most appropriate initial step would be to seek a cardiosurgeon consultation (choice A) for further evaluation, diagnosis, and management of the patient’s cardiovascular condition.

128. A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

A. Replacement of marrow elements with adipose tissue

B. Replacement of marrow elements with fibrous tissue

C. Prevalence of megaloblasts

D. Presence of blast cells

E. Absolute lymphocytosis

Answer: Replacement of marrow elements with adipose tissue

Explanation

Aplastic anemia is a condition characterized by the failure of the bone marrow to produce an adequate number of blood cells, including red blood cells, white blood cells, and platelets. In this condition, the bone marrow becomes hypocellular, meaning there is a decrease in the number of hematopoietic cells and an increase in fat cells (adipose tissue) within the bone marrow.

The bone marrow punction, or bone marrow aspiration, is a diagnostic procedure used to evaluate the cellular composition of the bone marrow. In aplastic anemia, the bone marrow aspirate would show a decrease in hematopoietic cells and an increase in fat cells, indicating the replacement of marrow elements with adipose tissue.

This finding is consistent with the hypocellular nature of aplastic anemia. Therefore, the most likely change in the marrow punctatum for a suspected case of aplastic anemia is the replacement of marrow elements with adipose tissue (choice A).

129. A girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

A. Menarche

B. Juvenile haemorrhage

C. Haemophilia

D. Endometrium cancer

E. Werlhof’s disease

Answer: Menarche

Explanation

Menarche refers to the onset of menstruation in girls, which typically occurs during puberty. It marks the beginning of the menstrual cycle and is characterized by the periodic shedding of the endometrium (lining of the uterus) accompanied by vaginal bleeding.

In this scenario, the girl’s age of 13 and the presence of moderate bloody discharge from the genital tract, along with the development of secondary sexual characteristics, are consistent with the normal physiological process of menarche.

Menarche usually occurs between the ages of 9 and 16, and the initial menstrual periods can sometimes be irregular or accompanied by light to moderate bleeding. Therefore, considering the age, clinical presentation, and normal development of secondary sexual characteristics, the most probable cause of the bloody discharge is menarche (choice A).

130. A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of the thorax, cough, bloodstreaked sputum. On X-ray: intensive triangle shadow in the area of lower lobe that is connected to mediastinum. What is the most likely disorder in the lungs?

A. Central cancer of lungs

B. Tuberculosis of lungs

C. Bronchiectasia

D. Pulmonary infarction

E. Pleuropneumonia

Answer: Central cancer of lungs

Explanation

In a 55-year-old male patient with a history of weakness, pain in the right side of the thorax, cough, and bloodstreaked sputum, along with an intensive triangle shadow on the X-ray that is connected to the mediastinum, central cancer of the lungs is a plausible diagnosis.

Central lung cancers typically arise from the main bronchi or bronchial bifurcation and can cause symptoms such as cough, chest pain, hemoptysis (bloodstreaked sputum), and weakness.

The presence of an intensive triangle shadow on the X-ray, especially if it is connected to the mediastinum, suggests a tumor in the central area of the lungs. Other options such as tuberculosis of the lungs (choice B), bronchiectasis (choice C), pulmonary infarction (choice D), or pleuropneumonia (choice E) do not align with the given clinical presentation and radiographic findings.

Therefore, the most likely disorder in the lungs in this case is central cancer of the lungs (choice A). It is important for the patient to undergo further evaluation and appropriate management by a healthcare professional.

131. In a forest summer camp children have variable procedures to harden their organisms. What procedure has the most hardening power?

A. Contrast shower

B. Morning exercises on the fresh air

C. Hygienic shower

D. Walking on the fresh air

E. Bath with hydromassage

Answer: Contrast shower

Explanation

A contrast shower involves alternating between hot and cold water during the shower. This stimulates blood circulation, increases oxygen supply to the tissues, and enhances the body’s ability to adapt to temperature changes.

The contrast between hot and cold water helps to strengthen the immune system, improve overall circulation, and increase resilience to environmental stressors.

While other options such as morning exercises on fresh air (choice B), hygienic shower (choice C), walking on fresh air (choice D), and bath with hydromassage (choice E) can contribute to overall well-being and health, a contrast shower specifically targets the hardening and adaptation of the body to different temperatures, making it the procedure with the most hardening power.

It’s important to note that individual preferences and health conditions should be considered when choosing any procedure, and consulting with a healthcare professional is always advisable.

132. There is a dynamic growth of number of congenital abnormalities such as central paralysis, newborns blindness, idiocy among the population that lives near to pesticides production enterprise. Compounds of which pollutant can cause the development of this pathology?

A. Mercury

B. Strontium

C. Cadmium

D. Iron

E. Chrome

Answer: Mercury

Explanation

Mercury is a toxic heavy metal that can have severe health effects, particularly on the developing nervous system. Exposure to mercury during pregnancy can result in neurodevelopmental disorders in infants, including central paralysis, visual impairment, and intellectual disability (idiocy).

Prolonged exposure to mercury and its compounds, especially through inhalation or ingestion, can lead to a range of health problems.

Mercury can bioaccumulate in the food chain, and individuals living in close proximity to industrial facilities that release mercury-containing pollutants are at higher risk of exposure. It’s important for regulatory authorities and industries to implement proper pollution control measures to minimize the release of toxic substances like mercury and protect the health of nearby populations.

133. A 7 y.o. child had elevation of temperature tol 400C in anamnesis. For the last 3 months he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal column. What is the most probable diagnosis?

A. Juvenile rheumatic arthritis

B. Rheumatism

C. Toxic synovitis

D. Septic arthritis

E. Osteoarthrits

Answer: Juvenile rheumatic arthritis

Explanation

Juvenile Rheumatoid Arthritis is a chronic autoimmune inflammatory condition that primarily affects children and adolescents. It is characterized by joint inflammation, swelling, and pain. The symptoms can vary in severity and may involve multiple joints.

Systemic symptoms like fever and elevated temperature can also be present. The fusiform swelling of the fingers and joints, along with the pain in the sternum and cervical spine, are consistent with the joint involvement seen in Juvenile Rheumatoid Arthritis.

It is important to consult a healthcare professional for a proper evaluation and diagnosis. Treatment options for Juvenile Rheumatoid Arthritis include medications, physical therapy, and other interventions aimed at reducing inflammation and managing symptoms.

134. A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left – 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?

A. Aortic stenosis

B. Defect of interventricular septum

C. Defect of interatrial septum

D. Coarctation of the aorta

E. Open aortic duct

Answer: Aortic stenosis

Explanation

The most probable defect in the 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus), systolic murmur in the second intercostal to the right of the sternum, murmur passing to the neck and along the sternum left edge, weakened pulse on the left brachial artery, BP of 110/60 mm Hg on the right arm and 100/60 mm Hg on the left arm, and ECG results showing hypertrophy of the right ventricle is Aortic Stenosis (Choice A). Aortic stenosis is a narrowing of the aortic valve, which obstructs the flow of blood from the left ventricle to the aorta.

The stigmata of dysembryogenesis in this case are suggestive of a genetic syndrome, such as William’s syndrome or Shprintzen-Goldberg syndrome, which are associated with cardiovascular abnormalities.

The presence of a systolic murmur in the second intercostal to the right of the sternum, with radiation to the neck and along the sternum left edge, is consistent with aortic stenosis. The weakened pulse on the left brachial artery and the presence of right ventricular hypertrophy on the ECG further support this diagnosis. It is important to consult a pediatric cardiologist for further evaluation and management of the condition.

Treatment options for aortic stenosis may include medication, balloon valvuloplasty, or surgical intervention, depending on the severity of the stenosis and the symptoms experienced by the child.

135. At’s planned to construct multifield a new hospital in one of the cental city districts. What building type is the most appropriate in this case?

A. Centralized and blocked

B. Centralized

C. Decentralized

D. Mixed

E. Blocked

Answer: Centralized and blocked

Explanation

A centralized and blocked hospital design refers to a single large building or complex that houses all the necessary departments and facilities within a centralized location. This design offers several advantages for a hospital in a central city district:

Efficient Use of Space: By having all departments and facilities in one centralized building or complex, space can be utilized more efficiently, maximizing the available land area in a densely populated city district.

Streamlined Operations: A centralized design allows for better coordination and communication among different departments, promoting efficient workflows and patient care. Ease of Access: A centralized location in the city district ensures easier access for patients, staff, and emergency services. It allows for better integration with transportation networks and reduces travel time for patients seeking medical care.

Shared Resources: A centralized and blocked design enables the sharing of resources such as equipment, laboratories, and support services, leading to cost savings and improved efficiency. Enhanced Collaboration: With all departments and facilities in close proximity, healthcare professionals can collaborate more effectively, leading to better coordinated and comprehensive care for patients.

While other building types, such as decentralized or mixed designs, may have their own advantages in certain contexts, a centralized and blocked design is often preferred for a new hospital in a central city district due to the unique challenges and considerations of urban settings.

136. A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occured?

A. Thromboembolia of pulmonary artery

B. Hemorrhagia

C. Hypostatic pneumonia

D. Myocardial infarction

E. Valvular pneumothorax

Answer: Thromboembolia of pulmonary artery

Explanation

Thromboembolism refers to the formation of a blood clot (thrombus) in one part of the body that breaks free and travels through the bloodstream until it becomes lodged in a blood vessel, obstructing blood flow. In this case, the patient’s symptoms, including acute air insufficiency, cyanotic skin with a grey shade, tachypnea (rapid breathing), and substernal pain, are suggestive of a pulmonary embolism.

The patient’s recent venectomy (surgical removal of a vein) due to subcutaneous vein thrombophlebitis increases the risk of developing a blood clot, which can potentially travel to the pulmonary artery.

The obstruction of blood flow to the lungs leads to reduced oxygenation of the blood, resulting in symptoms such as shortness of breath, cyanosis (bluish discoloration of the skin), and chest pain. Immediate medical intervention is necessary to treat the thromboembolism and restore adequate blood flow to the lungs.

This may involve anticoagulant therapy to prevent further clot formation and potentially the use of thrombolytic medications to dissolve the existing clot. Close monitoring and supportive care are also important in managing this serious condition.

137. A 1,5 y.o. child fell ill acutely with high temperature 380C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occured in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis?

A. Polyomyelitis

B. Viral encephilitis

C. Polyartropathy

D. Osteomyelitis

E. Hip joint arthritis

Answer: Polyomyelitis

Explanation

Poliomyelitis is a viral infection caused by the poliovirus. It primarily affects the nervous system, particularly the motor neurons in the spinal cord. The typical symptoms of poliomyelitis include fever, headache, fatigue, and muscle pain. As the illness progresses, it can lead to muscle weakness, paralysis, and loss of reflexes. In this case, the child initially presented with acute illness characterized by high fever, headache, and fatigue.

The subsequent development of muscle pain in the right leg, along with the absence of movement and tendon reflexes, suggests the involvement of the motor neurons. Additionally, the preservation of sensitivity indicates that the sensory neurons are still functioning.

Poliomyelitis is commonly associated with muscle weakness or paralysis, often asymmetrically affecting one or more limbs. The leg involvement described in the scenario is consistent with this pattern. Further diagnostic tests, such as laboratory analysis of cerebrospinal fluid or viral isolation, may be necessary to confirm the diagnosis of poliomyelitis.

Treatment mainly focuses on supportive care, including pain management, physical therapy, and monitoring for complications. It is important to note that poliomyelitis has become rare in many parts of the world due to the widespread use of polio vaccines.

138. On observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

A. Natural light coefficient

B. Light coefficient

C. Depth of study room

D. Time of the room insolation

E. Presence of mixed (upper-lateral) light

Answer: Natural light coefficient

Explanation

The Natural Light Coefficient is a measure of the amount of natural light present in a given space. It takes into account factors such as the size and placement of windows, the orientation of the building, and the presence of any obstructions that may block natural light.

Assessing the Natural Light Coefficient is important because it directly impacts the quality of lighting in the study environment. Sufficient natural light has been shown to have numerous benefits, including improved visual comfort, reduced eye strain, enhanced mood, and increased productivity and alertness.

By evaluating the Natural Light Coefficient, one can determine the extent to which natural light is available in the study rooms. This information can be used to optimize the lighting conditions and create a more visually comfortable and conducive learning environment for the students.

Other factors mentioned in the options, such as the Light Coefficient and the Presence of mixed (upper-lateral) light, are also relevant to evaluating the visual regimen, but the Natural Light Coefficient specifically focuses on the contribution of natural light, which is considered desirable for promoting a healthy and effective studying environment.

139. A 24 y.o. woman presents with prolonged fever, nocturnal sweating. She’s lost weight for 7 kg during the last 3 months. She had irregular intercourses. On examination: enlargement of all lymphaden groups, hepatolienal syndrom. In blood: WBC- 2, 2 ∗ 109/L. What is the most likely diagnosis?

A. HIV-infection

B. Lymphogranulomatosis

C. Tuberculosis

D. Infectious mononucleosis

E. Chroniosepsis

Answer: HIV-infection

Explanation

HIV (Human Immunodeficiency Virus) is a viral infection that affects the immune system, leading to a weakened immune response and increased susceptibility to infections and other complications. The symptoms described, such as prolonged fever, weight loss, and lymphadenopathy, are commonly seen in individuals with HIV.

It is important to note that these symptoms can also be seen in other conditions, including lymphogranulomatosis (Choice B), tuberculosis (Choice C), infectious mononucleosis (Choice D), and chronic sepsis (Choice E). However, considering the patient’s low white blood cell count and the association of weight loss with irregular intercourse,

HIV infection is the most likely diagnosis. Further diagnostic tests, such as HIV serology (including HIV antibody and viral load testing), would be needed to confirm the diagnosis of HIV infection. Early detection and appropriate management of HIV infection are crucial to ensure optimal outcomes for the patient.

140. A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S1 at apex, there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What rind of heart disorder is observed?

A. Mitral stenosis

B. Aortic valve insufficiency

C. Pulmonary artery stenosis

D. Mitral valve insufficiency

E. Opened arterial duct

Answer: Mitral stenosis

Explanation

Mitral stenosis refers to the narrowing of the mitral valve, which separates the left atrium and left ventricle of the heart. This narrowing restricts the blood flow from the left atrium to the left ventricle during diastole (ventricular relaxation and filling phase).

The diastolic thoracic wall tremor, also known as a diastolic thrill, is caused by the turbulent blood flow through the narrowed mitral valve. The accentuated S1 at the apex is due to the delay in closure of the mitral valve during diastole. The diastolic murmur with presystolic intensification, opening snap, and S2 accent at the pulmonary artery are additional characteristic auscultatory findings associated with mitral stenosis.

The other options, including aortic valve insufficiency (Choice B), pulmonary artery stenosis (Choice C), mitral valve insufficiency (Choice D), and opened arterial duct (Choice E), do not fit the clinical presentation described in the question.

Mitral stenosis is commonly seen in patients with a history of rheumatic fever, which is likely the underlying cause in this case. Management of mitral stenosis involves medical therapy to control symptoms and prevent complications, and in some cases, intervention such as balloon valvuloplasty or surgical repair may be required.

141. A 31 y.o. woman has suffered from systemic sclerodermia for 14 years. She was treated in hospitals many times. She complains of periodical dull pain in the cardiac area, palpitation, dyspnea, headache, eyelids swelling, weight loss, pain and limbs deformities. Which organ’s disorder worsens the prognosis?

A. Kidneys

B. Heart

C. Lungs

D. Gastro-intestinal tract

E. Skin and joints

Answer: Kidneys

Explanation

Kidney involvement in systemic scleroderma can lead to renal crisis, which is a potentially life-threatening condition characterized by sudden-onset high blood pressure, kidney failure, and increased levels of certain substances in the blood.

Systemic scleroderma is a chronic autoimmune connective tissue disease that affects multiple organs, including the skin, blood vessels, lungs, heart, gastrointestinal tract, and kidneys. The disease is characterized by fibrosis (thickening and hardening) of the affected tissues, which can lead to various complications and organ dysfunction.

While systemic scleroderma can affect multiple organs, renal involvement is considered one of the most serious manifestations of the disease. Renal crisis can occur in some patients and is associated with a poor prognosis if not promptly treated. Other organ complications, such as cardiac (Choice B), pulmonary (Choice C), gastrointestinal (Choice D), and musculoskeletal (Choice E) involvement, can also contribute to morbidity and affect the quality of life, but kidney involvement is often associated with a more severe prognosis.

142. A 70 y.o. male patient with mild headaches complains of speech disorder, weakness in right limbs. There was a history of miocardial infarction and arrhythmia. On nu eroligical examination there are elements of motor aphasia, central paresis of VII and XII cranial nerves pairs on the right side, cental type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

A. Ischemic stroke

B. Hemorrhagic stroke

C. Transitory ischemic attack

D. Epidural hematoma

E. Cerebral tumor

Answer: Ischemic stroke

Explanation

The most probable diagnosis for the 70-year-old male patient with mild headaches, speech disorder, weakness in right limbs, history of myocardial infarction, and arrhythmia is an ischemic stroke (Choice A). Ischemic stroke occurs when there is a blockage or reduction in blood flow to a specific part of the brain, leading to the death of brain cells in that area.

The symptoms described in the patient, such as speech disorder (motor aphasia), weakness in right limbs (hemiparesis), and cranial nerve involvement (VII and XII cranial nerves on the right side), are consistent with the clinical presentation of an ischemic stroke.

Risk factors for ischemic stroke include older age, history of cardiovascular diseases (such as myocardial infarction and arrhythmia), and the presence of comorbidities such as hypertension, diabetes, or high cholesterol.

The patient’s history of myocardial infarction and arrhythmia could contribute to the development of vascular disease and increase the risk of stroke. It is important to note that without further medical evaluation, including imaging studies such as a CT scan or MRI, it is not possible to definitively determine the cause of the symptoms. However, based on the provided information, an ischemic stroke is the most probable diagnosis.

143. A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exertion. He has had it for 1 year. On exami nation: heart boarders are dilated to the left side, sounds are muffled, pulse- 76 bmp, rhythmic, AP- 155/80 mm Hg, ECG: the left type, the rest of signs are normal. What additional examination is necessary to confirm the diagnosis?

A. Bicycle ergometry

B. Echocardiography

C. Blood lipoproteins

D. General blood count

E. Transaminases of blood

Answer: Bicycle ergometry

Explanation

The patient’s symptoms of squeezing pain in the substernal area that radiates to the left hand, occurring occasionally and on physical exertion, along with the findings of dilated heart borders to the left side and muffled sounds, are suggestive of a possible cardiovascular condition, particularly ischemic heart disease or coronary artery disease.

Bicycle Ergometry, also known as a stress test or exercise tolerance test, is a non-invasive diagnostic procedure used to evaluate the heart’s response to physical exertion.

During the test, the patient exercises on a bicycle or treadmill while their heart activity, blood pressure, and ECG are continuously monitored. This test helps to assess the presence of any abnormal changes in the heart’s function and blood flow during exercise, which can indicate underlying coronary artery disease.

Other additional examinations, such as echocardiography (Choice B), blood lipoproteins (Choice C), general blood count (Choice D), or transaminases of blood (Choice E), may provide useful information in the evaluation of cardiovascular health and risk factors but are not specifically designed to confirm the diagnosis of ischemic heart disease. The Bicycle Ergometry test is the most appropriate choice for further evaluation in this case.

144. A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?

A. Hyperkaliemia

B. Hyperhydratation

C. Hypokaliemia

D. Hypernatremia

E. Hypocalcemia

Answer: Hyperkaliemia

Explanation

Hyperkalemia refers to an elevated level of potassium in the blood. In patients with chronic glomerulonephritis who are on hemodialysis, the kidneys are unable to effectively regulate potassium levels, leading to a buildup of potassium in the blood.

Hyperkalemia can cause various cardiac manifestations, including irregularities in heart activity, bradycardia, and atrioventricular block. The ECG findings of high sharpened T-waves can also be seen in hyperkalemia. The patient’s symptoms of hypotension, progressive weakness, and dyspnea can also be attributed to hyperkalemia.

In severe cases, hyperkalemia can lead to life-threatening cardiac arrhythmias. It is worth noting that the patient’s history of severely disturbed drinking and diet regimen can contribute to the development of hyperkalemia.

Proper management of fluid and dietary intake is crucial in patients on hemodialysis to prevent electrolyte imbalances, including hyperkalemia. Therefore, hyperkalemia (Choice A) is the most likely cause of the patient’s changes in heart activity and other symptoms.

145. A 20 daily y.o. female patient is suffering from chronic bronchitis. Recently there has been production about 0,5 L of purulent sputum with maximum discharge in the morning. Fingers are like “drum sticks”, there are “watching glass”nails. What is the most probable diagnosis?

A. Bronchiectasia

B. Pneumonia

C. Chronic bronchitis

D. Gangrene of lungs

E. Tuberculosis

Answer: Bronchiectasia

Explanation

Bronchiectasis is a chronic condition characterized by permanent and irreversible dilation of the bronchi and bronchioles. It is often associated with chronic bronchitis and recurrent respiratory infections. The symptoms described in the case, including the production of purulent sputum, maximum discharge in the morning, and “drum stick” fingers, are indicative of bronchiectasis.

The excessive production of purulent sputum is a result of chronic inflammation and infection in the dilated bronchi. The presence of “watch glass” nails, which refers to the clubbing of the fingers, is commonly associated with chronic respiratory conditions, including bronchiectasis.

Pneumonia (Choice B) is an acute infection of the lung tissue and is less likely to be the cause of the chronic symptoms described in the case. Chronic bronchitis (Choice C) can be a contributing factor to the development of bronchiectasis, but it does not fully explain the dilation of the bronchi.

Gangrene of the lungs (Choice D) and tuberculosis (Choice E) are less likely based on the given information. Therefore, bronchiectasis (Choice A) is the most probable diagnosis considering the chronic nature of the symptoms and the characteristic signs associated with the condition.

146. A 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb– 105 g/L; RBC- 3, 2 ∗ 1012/L; coloured index– 0,95; thromb.– 20 ∗ 109/L. The sedimantation time according to Lee White is 5 ; hemorrhagia duration according to Duke is 8 , “pinch and tourniquet”test is positive. What is the most probable diagnosis?

A. Idiopathic thrombocytopenic purpura

B. Hemophilia

C. Hemorrhagic diathesis

D. Iron deficiency anemia

E. Marchiafava-Micheli’s disease

Answer: Idiopathic thrombocytopenic purpura

Explanation

ITP is an autoimmune disorder characterized by a low platelet count (thrombocytopenia), which leads to the development of petechiae and purpura on the skin. It commonly presents with symptoms such as weakness, dizziness, and easy bruising or bleeding.

The patient in the case has a low hemoglobin level (Hb) of 105 g/L, a low red blood cell count (RBC) of 3.2 x 10^12/L, and a thrombocyte count of 20 x 10^9/L, all of which indicate thrombocytopenia. The presence of petechiae on the skin further supports the diagnosis of ITP.

The positive “pinch and tourniquet” test suggests capillary fragility and bleeding tendency, which is characteristic of ITP. The prolonged hemorrhage duration according to Duke’s test and the positive Lee White sedimentation test also indicate abnormal bleeding. Hemophilia (Choice B) is a genetic disorder that primarily affects blood clotting factors and is not typically associated with thrombocytopenia.

Hemorrhagic diathesis (Choice C) is a general term for a bleeding tendency but does not specifically point to a diagnosis. Iron deficiency anemia (Choice D) may cause weakness and fatigue, but it does not explain the presence of petechiae and thrombocytopenia.

Marchiafava-Micheli’s disease (Choice E) is a rare condition characterized by damage to the corpus callosum and is unrelated to the symptoms described in the case. Therefore, based on the clinical presentation and laboratory findings, the most probable diagnosis is idiopathic thrombocytopenic purpura (Choice A).

147. A 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of 50 sec duration. There is a appearing of the fetus head. Perineum is of 4 cm height, has turned pale. What should be done in this case?

A. Episiotomy

B. Perineum protection

C. Perineotomy

D. Vacuum extraction of the fetus

E. Observation

Answer: Episiotomy

Explanation

Episiotomy is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth. It is done to enlarge the vaginal opening and facilitate the delivery of the baby’s head, especially if there is inadequate stretching of the perineum.

The given scenario describes a primipara (a woman giving birth for the first time) in active labor with intense pushing contractions and the appearance of the fetal head. The perineum is described as having a height of 4 cm and turning pale, which suggests that it may not be stretching adequately to accommodate the baby’s head.

To prevent perineal tears and reduce the risk of trauma to the mother, an episiotomy can be performed. The surgical incision allows controlled enlargement of the vaginal opening, reducing the likelihood of extensive tears and facilitating the delivery of the baby. Perineum protection (Choice B) may be employed to support the perineum and minimize trauma during the delivery process, but in this case, with the described circumstances, an episiotomy is more appropriate.

Perineotomy (Choice C) is not a recognized term in obstetrics. It may be a typographical error or confusion with episiotomy. Vacuum extraction of the fetus (Choice D) is a technique used in certain situations to assist with the delivery of the baby using a vacuum device. However, in this case, the description does not indicate a need for vacuum extraction.

Observation (Choice E) alone is not sufficient in this situation, as there is a risk of perineal trauma and inadequate stretching of the perineum. Therefore, an active intervention like episiotomy is necessary. Overall, based on the given information, the most appropriate action in this case is to perform an episiotomy (Choice A).

148. A 28 y.o. male patient was admitted to the hospital because of high temperature 390C, headache, generalized fatigue, constipation, sleep disorder for 9 days. There are sporadic roseolas on the abdomen, pulse- 78 bpm, liver is enlarged for 2 cm. What is the most probable diagnosis?

A. Abdominal typhoid

B. Typhus

C. Sepsis

D. Brucellosis

E. Leptospirosis

Answer: Abdominal typhoid

Explanation

Abdominal typhoid, also known as typhoid fever, is a bacterial infection caused by Salmonella typhi. It is characterized by fever, headache, fatigue, constipation, sleep disturbances, and roseola (pink spots) on the abdomen. Other common symptoms include enlarged liver and spleen. In this case, the patient presents with a high temperature of 39°C, headache, generalized fatigue, constipation, sleep disorder, and sporadic roseolas on the abdomen.

The presence of an enlarged liver further supports the diagnosis of abdominal typhoid. Typhus (Choice B) is a different infectious disease caused by Rickettsia bacteria. It typically presents with fever, headache, rash, and muscle pain, but it does not typically cause constipation or liver enlargement.

Sepsis (Choice C) is a life-threatening condition resulting from an infection that spreads throughout the body. It can cause fever, fatigue, and other symptoms, but it is not specific to abdominal typhoid.

Brucellosis (Choice D) is an infectious disease caused by Brucella bacteria. It can cause fever, fatigue, and other flu-like symptoms, but it does not typically cause constipation or roseolas on the abdomen. Leptospirosis (Choice E) is a bacterial infection caused by Leptospira bacteria. It can cause fever, headache, muscle pain, and other symptoms, but it does not typically cause constipation or roseolas on the abdomen.

Based on the symptoms described, the most likely diagnosis is abdominal typhoid (Choice A). It would be appropriate to confirm the diagnosis through further diagnostic tests and initiate appropriate treatment for Salmonella typhi infection.

149. A 40 h.o. child age has hyperosthesia, CNS depression, dyspepsia. Sepsis is suspected. What should the differential diagnosis be made with?

A. Hypoglycemia

B. Hypocalcemia

C. Hyperbilirubinemia

D. Hyperkaliemia

E. Hypomagnesemia

Answer: Hypoglycemia

Explanation

Hypoglycemia is a condition characterized by low blood glucose levels. In newborns, it can occur due to various reasons, including inadequate feeding, metabolic disorders, or hormonal imbalances. Symptoms of hypoglycemia in newborns can include hyperosthesia (increased sensitivity to stimuli), CNS depression (lethargy, decreased responsiveness), and dyspepsia (poor feeding, gastrointestinal disturbances).

Other conditions listed in the options can cause different symptoms and would have a different presentation: Hypocalcemia (Choice B) can cause symptoms such as jitteriness, tremors, seizures, and muscle spasms.

Hyperbilirubinemia (Choice C) refers to elevated levels of bilirubin in the blood and is typically associated with jaundice. Hyperkalemia (Choice D) is an elevated level of potassium in the blood and can cause cardiac arrhythmias, muscle weakness, and abnormal ECG findings. Hypomagnesemia (Choice E) is a low level of magnesium in the blood and can cause symptoms such as muscle twitches, tremors, and seizures.

Given the symptoms described in the question and the suspicion of sepsis, hypoglycemia is a critical consideration as it can occur in newborns and requires immediate attention and management. It is important to confirm the diagnosis through appropriate laboratory tests and initiate appropriate treatment to stabilize the child’s blood glucose levels.

150. A 20 y.o. patient with bronchial asthma experiences dyspnea attacks 3-4 times a week. Nocturnal attacks are 1 time a week. FEV1- 50% of necessary figures, during the day it’s variations is 25%. What is the severity of bronchial asthma condition?

A. Moderate severity condition

B. Mild condition

C. Serious condition

D. Asthmatic status

E. Intermittent flow

Answer: Moderate severity condition

Explanation

The severity of asthma is typically assessed based on symptoms, lung function tests, and the frequency of exacerbations. In this case, the patient experiences dyspnea attacks 3-4 times a week and nocturnal attacks once a week. This frequency indicates ongoing symptoms and some impairment of lung function. The Forced Expiratory Volume in 1 second (FEV1) is a measure of lung function, and in this case, it is reported to be 50% of the necessary figures.

A decrease in FEV1 indicates airway obstruction. The variation in FEV1 during the day is reported to be 25%, which suggests some variability in lung function throughout the day. Based on these findings, the patient’s asthma condition falls into the moderate severity category.

Moderate severity asthma is characterized by more frequent symptoms, decreased lung function, and increased risk of exacerbations compared to mild asthma. However, it is not as severe as a serious condition or asthmatic status.

It is important for the patient to receive appropriate management and treatment to control their asthma symptoms, prevent exacerbations, and improve lung function. Regular follow-up with a healthcare provider is recommended to adjust the treatment plan as needed.

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