101. A 3 y.o. child with weight defficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 mmol/L. What is the most probable diagnosis?
A. Mucoviscidosis (cystic fibrosis)
B. Bronchial asthma
C. Recurrent bronchitis
D. Bronchiectasis
E. Pulmonary hypoplasia
Answer: Mucoviscidosis (cystic fibrosis)
Explanation
| Cystic fibrosis is a genetic disorder that affects many organs, including the lungs. It is characterized by the production of thick, sticky mucus that can obstruct the airways and lead to recurrent infections and inflammation. The patient’s history of permanent moist cough and recurrent pneumonias with obstruction, along with distended chest and dullness on percussion over the lower parts of lungs, are all consistent with cystic fibrosis. The presence of different types of rales on auscultation also suggests a pulmonary condition that affects multiple areas of the lungs. The level of sweat chloride is also elevated, which is a diagnostic hallmark of cystic fibrosis. A sweat chloride level over 60 mmol/L is considered diagnostic for cystic fibrosis. Bronchial asthma (B) is a chronic inflammatory disorder of the airways that is characterized by episodes of wheezing, coughing, and shortness of breath, but usually not associated with moist cough or dullness on percussion. Recurrent bronchitis (C) is a condition in which the bronchial tubes become inflamed and narrowed, leading to cough and production of mucus, but it is not typically associated with distended chest or elevated sweat chloride level. Bronchiectasis (D) is a condition in which the bronchial tubes become permanently damaged and widened, leading to chronic cough and production of large amounts of mucus, but it is not typically associated with elevated sweat chloride level. Pulmonary hypoplasia (E) is a condition in which the lungs do not develop fully before birth, and typically presents with respiratory distress in the neonatal period. Therefore, based on the clinical presentation, examination findings, and elevated sweat chloride level, the most probable diagnosis is mucoviscidosis (cystic fibrosis). |
102. A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb- 70 g/L, RBC- 2, 3 ∗ 1012/L, Ht20. What is the most probable diagnosis?
A. Juvenile bleeding, posthemorrhagic anemia
B. Werlholf’s disease
C. Polycyst ovarian syndrome
D. Hormonoproductive ovary tumor
E. Noncomplete spontaneous abortion
Answer: Juvenile bleeding, posthemorrhagic anemia
Explanation
| Juvenile bleeding is a condition characterized by abnormal uterine bleeding in adolescent girls, often associated with anovulation or hormonal imbalances. The patient’s history of recurrent similar bleedings since the age of 12 on the background of disordered menstrual cycle, along with profuse bloody discharges from the genital tract after suppression of menses for 1.5 months, is consistent with juvenile bleeding. The presence of posthemorrhagic anemia, with low hemoglobin, low red blood cell count, and low hematocrit, is also a common finding in patients with this condition. On rectal examination, there is no pathology of the internal genitalia, suggesting that the bleeding is not caused by a structural abnormality. Werlholf’s disease (B) is a rare disorder in which blood clots form in small blood vessels throughout the body, leading to organ damage, but is not typically associated with abnormal uterine bleeding. Polycystic ovarian syndrome (C) is a condition in which the ovaries produce high levels of androgens, leading to irregular menstrual cycles and other symptoms, but is not typically associated with profuse bloody discharges or anemia. Hormonoproductive ovary tumor (D) is a rare type of ovarian tumor that produces hormones and can cause abnormal uterine bleeding, but is not common in adolescents. Noncomplete spontaneous abortion (E) is a condition in which the products of conception are not completely expelled from the uterus, leading to abnormal bleeding, but is not likely in a patient with a history of recurrent similar bleedings for several years. Therefore, based on the clinical presentation and examination findings described, the most probable diagnosis is juvenile bleeding, posthemorrhagic anemia. |
103. A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insulinotherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes?
A. Determination of insular cells antibodies
B. Glucose-tolerant test
C. Glycemia examination on an empty stomach
D. Estimation of glucolized blood hemoglobin
E. Fructosamine estimation
Answer: Determination of insular cells antibodies
Explanation
| Insulin-dependent diabetes mellitus, also known as type 1 diabetes, is an autoimmune disorder in which the body’s immune system attacks and destroys the insulin-producing beta cells in the pancreas. This leads to an absolute deficiency of insulin and requires insulin therapy to manage the disease. The presence of antibodies against insular cells is a characteristic feature of type 1 diabetes. On the other hand, insulin-independent diabetes mellitus, also known as type 2 diabetes, is a condition in which the body becomes resistant to insulin or does not produce enough insulin to maintain normal blood glucose levels. It is typically managed with diet, exercise, oral medications, and sometimes insulin therapy. The presence of insular cell antibodies is not typically associated with type 2 diabetes. Glucose-tolerant test (B), glycemia examination on an empty stomach (C), estimation of glucolized blood hemoglobin (D), and fructosamine estimation (E) are all tests used to monitor blood glucose levels and assess glycemic control in patients with diabetes, but they are not specific to differentiating between type 1 and type 2 diabetes. Therefore, the most important examination for differentiation of the 1st (insulin-dependent) and the 2nd (insulin-independent) types of diabetes is determination of insular cells antibodies. |
104. A 43 y.o. patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenoutic papillitis 0,5 cm long has been revealed. What is the best way of treatment?
A. To perform endocsopic papillosphincterotomy
B. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs
C. To perform external choledoch drainage
D. To perform transduodenal papillosphincterotomy
E. To perform choledochoduodenostomy
Answer: To perform endocsopic papillosphincterotomy
Explanation
| The patient’s history of cholecystectomy 6 years ago and recurrent pain in the right subcostal area and jaundice suggests the presence of common bile duct stones. The stenotic papillitis with a length of 0.5 cm found on examination is also consistent with this diagnosis. Endoscopic papillosphincterotomy is a minimally invasive procedure in which the endoscope is used to cut the papilla of Vater and remove the stones from the common bile duct. This procedure has been shown to be safe and effective in the treatment of choledocholithiasis. Conservative treatment with antibiotics, spasmolytics, and anti-inflammatory drugs (B) may be helpful in managing symptoms and preventing complications, but it does not address the underlying problem of common bile duct stones. External choledoch drainage (C) is a surgical procedure in which a drainage tube is placed directly into the common bile duct to allow drainage of bile. This procedure is typically reserved for cases in which endoscopic treatment is not possible or has failed. Transduodenal papillosphincterotomy (D) is a surgical procedure in which the papilla of Vater is cut from the duodenum side, but it is more invasive than endoscopic papillosphincterotomy and is typically reserved for cases in which endoscopic treatment is not possible or has failed. Choledochoduodenostomy (E) is a surgical procedure in which the common bile duct is connected directly to the duodenum, but it is also more invasive than endoscopic papillosphincterotomy and is typically reserved for cases in which endoscopic treatment is not possible or has failed. Therefore, based on the clinical presentation and examination findings described, the best way of treatment is to perform endoscopic papillosphincterotomy. |
105. A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria – 7,1 g/L, protein content in the daily urine – 4,2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9,2 mmol/L). What variant of glomerulonephritis is the most probable?
A. Nephrotic
B. Nephritic
C. Isolated urinary
D. Hematuric
E. Mixed
Answer: Nephrotic
Explanation
| Nephrotic syndrome is a kidney disorder characterized by a group of symptoms, including proteinuria (excessive protein in the urine), hypoalbuminemia (low levels of albumin in the blood), edema, and hyperlipidemia. The patient’s history of evident edema, proteinuria of 7.1 g/L, and protein content in the daily urine of 4.2 g, along with permanent hypoproteinemia of 43.2 g/L and hypercholesterolemia of 9.2 mmol/L, are all consistent with nephrotic syndrome. Nephritic syndrome (B) is another type of glomerulonephritis that is characterized by hematuria (blood in the urine), proteinuria, hypertension, and decreased glomerular filtration rate, but typically not associated with edema or hypoalbuminemia. Isolated urinary (C) is not a recognized classification of glomerulonephritis. Hematuric (D) is a type of glomerulonephritis that is characterized by hematuria, proteinuria, and variable degrees of renal impairment, but typically not associated with edema or hypoalbuminemia. Mixed (E) is not a recognized classification of glomerulonephritis. Therefore, based on the clinical presentation and laboratory findings described, the most probable variant of glomerulonephritis is nephrotic. |
106. A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- 35 ∗ 109/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?
A. Chronic lympholeucosis
B. Chronic myeloleucosis
C. Lymphogranulomatosis
D. Acute leucosis
E. Tuberculous lymphadenitis
Answer: Chronic lympholeucosis
Explanation
| CLL is a type of leukemia that affects the lymphocytes, which are a type of white blood cell that plays a role in the immune system. The patient’s symptoms of tiredness, sweating, and enlargement of lymph nodes in the cervical, submaxillary, and axillary regions, along with a high white blood cell count of 35 × 10^9/L and a high percentage of lymphocytes on myelogram, are all consistent with CLL. Botkin and Gumprecht bodies are characteristic morphological features of CLL and are composed of apoptotic lymphocytes. The normal levels of hemoglobin and thrombocytes suggest that the patient’s bone marrow is functioning normally and not being replaced by the leukemia cells. Lymphogranulomatosis (C), also known as Hodgkin’s lymphoma, is a type of lymphoma that affects the lymphatic system, but it typically presents with specific patterns of lymph node involvement and the presence of Reed-Sternberg cells on biopsy. Acute leukemia (D) typically presents with more acute symptoms and a more rapid onset than CLL. Tuberculous lymphadenitis (E) is a type of granulomatous inflammation caused by tuberculosis and is not associated with a high white blood cell count or lymphocytosis. Therefore, based on the clinical presentation and laboratory findings described, the most probable diagnosis is chronic lymphocytic leukemia. |
107. Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?
A. Through the rectum
B. Through the postoperative wound
C. By means of the sacral approach
D. Through the anterior abdominal wall
E. Through the obturator foramen
Answer: Through the rectum
Explanation
| Pelvic abscesses are collections of pus that can occur in the pelvis as a complication of various conditions, including pelvic inflammatory disease, diverticulitis, and postoperative infections. In this case, the patient has a pelvic abscess as a complication of gangrenous appendicitis. Transrectal drainage is a minimally invasive and effective method for draining pelvic abscesses. The procedure involves inserting a needle or catheter through the rectal wall and into the abscess cavity under image guidance, such as ultrasound or computed tomography (CT) scan. This allows for direct visualization of the abscess and drainage of the pus. Other surgical approaches, such as through the postoperative wound (B), the sacral approach (C), the anterior abdominal wall (D), or the obturator foramen (E), may be used in some cases, but they are typically more invasive and associated with higher risk of complications. Therefore, based on the clinical presentation described, the best way to expose the pelvic abscess in this patient is through the rectum. |
108. Examination of a just born placenta reveals defect 2×3 cm large. Hemorrhage is absent. What tactic is the most reasonable?
A. Manual uretus cavity revision
B. Prescription of uterotonic medicines
C. External uterus massage
D. Parturient supervision
E. Instrumental uterus cavity revision
Answer: Manual uretus cavity revision
Explanation
| A defect in the placenta is a sign of possible retained placental tissue, which can lead to postpartum hemorrhage and other complications. Manual uterine cavity revision involves manually exploring the uterine cavity to ensure that all placental tissue has been expelled. This is important to prevent postpartum hemorrhage and other complications. Prescription of uterotonic medicines (B), external uterus massage (C), and parturient supervision (D) are all important aspects of postpartum care, but they are not sufficient to address the potential complication of retained placental tissue. Instrumental uterine cavity revision (E) may be necessary in some cases, but it is a more invasive procedure and should be reserved for cases in which manual exploration is not successful or feasible. Therefore, based on the description provided, the most reasonable tactic in this case is manual uterine cavity revision to ensure that all placental tissue has been expelled and to prevent postpartum hemorrhage and other complications. |
109. A 3 y.o. girl has had a temperature rise up to 380, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn’t reveal any changes over her lungs. Percussion sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?
A. Acute simple tracheitis
B. Acute obstructive bronchitis
C. Recurrent bronchitis, acute condition
D. Acute simple bronchitis
E. Bilateral microfocal pneumonia
Answer: Acute simple tracheitis
Explanation
| Acute simple tracheitis is a viral infection that affects the trachea, leading to inflammation and symptoms such as fever, rhinitis, dry cough, and flabbiness. The wooden resonance on percussion and puerile breathing on auscultation are also consistent with tracheitis. The absence of changes on lung palpation and the absence of rales on auscultation suggest that the lower airways are not involved. Leukopenia, lymphocytosis, and increased ESR are nonspecific laboratory findings that can be seen in viral infections such as tracheitis. Acute obstructive bronchitis (B), recurrent bronchitis, acute condition (C), and acute simple bronchitis (D) are all respiratory conditions that can present with cough, fever, and other respiratory symptoms, but they typically involve the lower airways and are associated with abnormal lung sounds on examination. Bilateral microfocal pneumonia (E) is a type of pneumonia that is characterized by small areas of inflammation in the lungs and typically presents with fever, cough, and abnormal lung sounds on examination. Therefore, based on the clinical presentation and laboratory findings described, the most probable diagnosis is acute simple tracheitis. |
110. A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39 − 400. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky’s symptom is positive. What is the most probable diagnosis?
A. Acute epidermal necrolisis
B. Pemphigus vulgaris
C. Polymorphous exudative erythema
D. Bullous dermatitis
E. Duhring’s disease
Answer: Acute epidermal necrolisis
Explanation
| AEN/TEN is a severe and potentially life-threatening skin condition that is usually caused by a reaction to medications, such as aspirin. The sudden onset of fever, general indisposition, and skin rash with red spots and blisters, which resemble second-degree burns with erosive surface or epidermis peeling, are all consistent with AEN/TEN. The positive Nikolsky’s sign, which is characterized by the separation of the skin layers with slight pressure, is also indicative of AEN/TEN. Pemphigus vulgaris (B) is a chronic autoimmune disorder that causes blistering of the skin and mucous membranes. Polymorphous exudative erythema (C) is a type of rash that is often caused by a reaction to medications, but it is not typically associated with skin blistering or peeling. Bullous dermatitis (D) is a general term for skin conditions that cause the formation of fluid-filled blisters, but it is not specific to AEN/TEN. Duhring’s disease (E) is another name for dermatitis herpetiformis, a chronic autoimmune disorder that causes an itchy rash and blisters. Therefore, based on the clinical presentation and laboratory findings described, the most probable diagnosis is acute epidermal necrolysis. |
111. A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, is positioned near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?
A. Right-sided direct inguinal hernia
B. Right-sided oblique inguinal hernia
C. Right-sided femoral hernia
D. Varicose veins of the right hip
E. Lipoma of the right inguinal area
Answer: Right-sided direct inguinal hernia
Explanation
| An inguinal hernia is a protrusion of abdominal contents through a weakness or defect in the abdominal wall in the inguinal region. In this case, the patient has a lump in the right inguinal region that appears on exercise and has a soft elastic consistency. The lump is round-shaped, 4 cm in diameter, and located near the medial part of Poupart’s ligament. The fact that the lump is situated inwards from the spermatic cord suggests that it is a direct hernia. Direct hernias occur when abdominal contents herniate through a weakness in the transversalis fascia, which is the innermost layer of the abdominal wall, and protrude directly through the inguinal canal. They typically present as round-shaped lumps near the medial part of Poupart’s ligament and are often associated with soft elastic consistency. Right-sided oblique inguinal hernia (B) and right-sided femoral hernia (C) are less likely based on the location of the lump and the fact that it is situated inwards from the spermatic cord. Varicose veins of the right hip (D) and lipoma of the right inguinal area (E) may present as lumps in the inguinal region, but they typically have a different consistency and location. Therefore, based on the clinical presentation described, the most probable preliminary diagnosis is right-sided direct inguinal hernia. |
112. A 54 y.o. patient has been suffering from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria – 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of α2- and γ-globulins, ESR- 50 mm/h. What is the most probable diagnosis?
A. Secondary renal amyloidosis
B. Acute glomerulonephritis
C. Myelomatosis
D. Chronic glomerulonephritis
E. Systemic lupus erythematosus
Answer: Secondary renal amyloidosis
Explanation
| Secondary renal amyloidosis is a complication of chronic inflammatory diseases, such as osteomyelitis, that leads to the deposition of amyloid protein in the kidneys, causing proteinuria and other signs of kidney dysfunction. In this case, the patient has a history of osteomyelitis and is presenting with proteinuria, hypoalbuminemia, and an increase in α2- and γ-globulins, which are all consistent with secondary renal amyloidosis. The elevated ESR is also a nonspecific marker of inflammation. Acute glomerulonephritis (B) is a type of kidney inflammation that typically presents with hematuria, proteinuria, and hypertension. Myeloma (C) is a type of cancer that can affect bone marrow, leading to the formation of abnormal proteins that can deposit in the kidneys and cause kidney dysfunction. Chronic glomerulonephritis (D) is a type of kidney inflammation that can lead to kidney damage and dysfunction over time. Systemic lupus erythematosus (E) is an autoimmune disease that can affect various organs, including the kidneys, but it typically presents with a different pattern of laboratory abnormalities and symptoms. Therefore, based on the clinical presentation and laboratory findings described, the most probable diagnosis is secondary renal amyloidosis. |
113. A mineshaft is situated on the territory of homestead land, it is 20 m away from the house, 10 m – from the toilet and 15 m – from the neighbour’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of probable water pollution?
A. 30 m
B. 25 m
C. 20 m
D. 15 m
E. 10 m
Answer: 30 m
Explanation
| According to the sanitary code, the minimum distance that should be established between a well and a potential source of water pollution is 30 meters. In this case, the mineshaft is 20 meters away from the house, 10 meters away from the toilet, and 15 meters away from the neighbor’s house. Since all of these structures could potentially contribute to water pollution, the minimum distance between the well and the mineshaft (or any other potential source of pollution) should be at least 30 meters. Therefore, the correct answer is A, 30 meters. |
114. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. 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
| Contact hemorrhages, an enlarged and immobile cervix, and a cauliflower-like appearance of the cervix on examination are all suggestive of cervical cancer. Positive Chrobak and Schiller tests, which are used to detect abnormal cells on the surface of the cervix, further support this diagnosis. Polypus of the cervix of the uterus (B) may present with abnormal bleeding, but it typically does not cause an enlarged and immobile cervix or a cauliflower-like appearance. Cervical pregnancy (C) is a rare condition in which the fertilized egg implants in the cervix rather than in the uterus, but it typically presents with vaginal bleeding and pain. Nascent fibroid (D) is a benign tumor that can occur in the uterus, but it typically does not cause contact bleeding or a cauliflower-like appearance of the cervix. Leukoplakia (E) is a condition that causes white patches on the cervix or other areas of the body, but it is not typically associated with an enlarged or immobile cervix or contact bleeding. Therefore, based on the clinical presentation and examination findings described, the most probable diagnosis is cancer of the cervix of the uterus. |
115. A boy, aged 9, was examined: height – 127 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 complex assessment of the child’s physical development?
A. Harmonious
B. Disharmonious
C. Apparently disharmonious
D. Excessive
E. Below the average
Answer: Harmonious
Explanation
| Harmonious physical development refers to a proportional growth of different parts of the body. In this case, the child’s height-for-age is slightly below the average (-0.36), but his weight-for-age is above average (+0.96), and his chest circumference-for-age is also above average (+0.66). The lung vital capacity-for-age is within the normal range (-0.16). Overall, these measurements suggest that the child’s physical development is harmonious, with slightly lower height-for-age but higher weight-for-age and chest circumference-for-age. The lung vital capacity is also within the normal range, indicating no respiratory compromise. Disharmonious physical development (B) refers to disproportional growth of different parts of the body, while apparently disharmonious physical development (C) refers to a temporary disproportional growth pattern that may resolve with time. Excessive physical development (D) refers to growth parameters that are above the normal range, while below the average (E) refers to growth parameters that are consistently below the normal range. Therefore, based on the data provided, the complex assessment of the child’s physical development is harmonious. |
116. A 14 y.o. child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for atack reduction?
A. Obsidan
B. No-shpa
C. Amisyl
D. Euphyline
E. Corglicone
Answer: Obsidan
Explanation
| Obsidan is a beta-blocker that works by blocking the effects of adrenaline on the heart and blood vessels. This can help to reduce heart rate and blood pressure, which can be elevated during sympathoadrenal attacks. No-shpa (B) is a medication that is used to relieve muscle spasms and is not effective in reducing sympathoadrenal attacks. Amisyl (C) is not a recognized medication for treating sympathoadrenal attacks or vegetovascular dystonia. Euphyllin (D) is a medication that is used to treat respiratory disorders such as asthma and is not effective in reducing sympathoadrenal attacks. Corglicone (E) is a medication that is used to treat heart failure and is not effective in reducing sympathoadrenal attacks. Therefore, the medication of choice for reducing sympathoadrenal attacks in patients with vegetovascular dystonia is Obsidan (metoprolol). However, the specific treatment plan should be determined by a qualified healthcare provider based on the individual patient’s medical history and condition. |
117. A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC- 2, 7 ∗ 1012/L, Hb- 88 g/L, WBC5, 6 ∗ 109/L, ESR- 15 mm/h. What is the most probable reason of bilirubin level change?
A. Increase of unconjugated bilirubin
B. Increase of conjugated bilirubin
C. Increase of unconjugated and conjugated bilirubin
D. Decrease of conjugated bilirubin
E. Decrease of unconjugated bilirubin
Answer: Increase of unconjugated bilirubin
Explanation
| The symptoms of weakness, dizziness, and sense of heaviness in the left hypochondrium, along with icteric skin and mucous membranes, suggest a possible liver or spleen disorder. The enlarged liver (+2 cm) and the lower pole of the spleen at the level of the navel also support this possibility. The low levels of red blood cells (RBC- 2.7 x 10^12/L) and hemoglobin (Hb- 88 g/L) suggest anemia, which can result from the destruction of red blood cells and the subsequent release of bilirubin. The normal white blood cell count (WBC- 5.6 x 10^9/L) and ESR (15 mm/h) suggest that there is no active infection or inflammation. An increase in unconjugated bilirubin is typically associated with hemolytic anemia, in which red blood cells are destroyed at a faster rate than they can be replaced. This leads to an excess of unconjugated bilirubin, which can cause jaundice and other symptoms. Therefore, based on the clinical presentation and laboratory findings described, the most probable reason for the bilirubin level change is an increase in unconjugated bilirubin. |
118. A 28 y.o. woman consulted a doctor about edematic face, moderate legs edemata; occasionally her urine has colour of “meat slops”. When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36, 80, Ps- 68/min, rhythmic. AP- 170/110 mm Hg. What urine changes are the most probable?
A. Proteinuria, hematuria, cylindrouria
B. Increase of relative density, hematuria, bacteriuria
C. Decrease of relative density, proteinuria, some urinary sediment
D. Erythrocyturia and urinozuria
E. Decrease of relative density, proteinuria
Answer: Proteinuria, hematuria, cylindrouria
Explanation
| The presence of edema, pallor, and low body temperature suggest a possible kidney disorder. The high blood pressure reading (170/110 mm Hg) further supports this possibility. The history of recurrent angina during adolescence may suggest a past streptococcal infection, which can lead to glomerulonephritis, a condition that can cause proteinuria, hematuria, and cylindruria. The occasional presence of urine with the color of “meat slops” (which is a term used to describe urine that is dark and cloudy, often with the appearance of meat broth or soup) is suggestive of hematuria and proteinuria, which can indicate damage to the kidneys or other parts of the urinary system. Cylindruria, which refers to the presence of cylindrical structures in the urine, can be seen in various kidney disorders, including glomerulonephritis. Therefore, based on the clinical presentation and examination findings described, the most probable urine changes are proteinuria, hematuria, and cylindruria. Further testing, such as a urinalysis and renal function tests, may be needed to confirm the diagnosis and determine the underlying cause. |
119. A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?
A. Heightened position of extremity, compressive sterile bandage
B. Distal tourniquet
C. Proximal turniquet
D. Troyanov-Trendelenburg operation
E. Z-shaped stitch on the raptured varicose node
Answer: Heightened position of extremity, compressive sterile bandage
Explanation
| The first aid that should be provided for a 58-year-old woman with voluminous bleeding from a ruptured varicose node on the left crus is A, a heightened position of extremity and a compressive sterile bandage. The goal of first aid in this situation is to control bleeding and prevent further complications. Elevating the affected limb above the level of the heart can help to reduce blood flow to the area and slow down bleeding. A compressive sterile bandage can then be applied to provide direct pressure on the ruptured varicose node and further reduce bleeding. Distal tourniquets (B) and proximal tourniquets (C) are not recommended for controlling bleeding from a ruptured varicose node, as they can cause damage to the surrounding tissue and nerves and may even worsen bleeding. Troyanov-Trendelenburg operation (D) and Z-shaped stitch on the ruptured varicose node (E) are surgical procedures that may be considered in some cases of varicose veins, but they are not appropriate for first aid in a situation of acute bleeding. Therefore, the most appropriate first aid for a 58-year-old woman with voluminous bleeding from a ruptured varicose node on the left crus is to elevate the affected limb and apply a compressive sterile bandage. |
120. It is determined that 30 of a 100 women with risk factor had preterm labor, and of a 100 women without risk factor 5 women had preterm labor. What method of statistic data processing should the doctor use in order to estimate reliability of differences between the compared groups?
A. Student’s criterion calculation
B. Average computing
C. Relative numbers calculation
D. Standardization method
E. Correlation analysis
Answer: Student’s criterion calculation
Explanation
| Student’s t-test is a statistical method used to compare the means of two groups of data and determine whether the differences are statistically significant. In this case, the doctor is comparing the incidence of preterm labor in two groups: women with a risk factor and women without a risk factor. The doctor wants to determine whether the difference in incidence is statistically significant. To conduct a Student’s t-test, the doctor needs to calculate the t-value, which is a measure of the difference between the means of the two groups relative to the variability within the groups. The t-value can then be compared to a critical value from a t-distribution table to determine whether the difference is statistically significant. Average computing (B) and relative numbers calculation (C) are not appropriate methods for comparing the means of two groups and determining statistical significance. Standardization method (D) is used to adjust data to a common scale, and correlation analysis (E) is used to determine the strength and direction of the relationship between two variables, neither of which is appropriate for this situation. Therefore, the most appropriate method of statistical data processing that the doctor should use to estimate the reliability of differences between the compared groups is Student’s t-test. |
121. A patient was admitted to the hospital with complaints of occasional pains at the bottom of abdomen that get worse during menses, weakness, indisposition, nervousness, some dark bloody discharges from vagina on the day before and the day after menses. Bimanual examination results: body of womb is enlarged, appendages cannot be determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries, peritoneum of rectouterine pouches and pararectal fat are covered with “cyanotic spots”. What is the most probable diagnosis?
A. Widespread form of endometriosis
B. Polycystic ovaries
C. Chronic salpingitis
D. Genital organs tuberculosis
E. Ovarian cystoma
Answer: Widespread form of endometriosis
Explanation
| Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside of the uterus, usually on the ovaries, fallopian tubes, or other structures in the pelvic area. The symptoms of occasional pains at the bottom of the abdomen that get worse during menses, weakness, indisposition, nervousness, and dark bloody discharges from the vagina on the day before and the day after menses are all consistent with endometriosis. The bimanual examination findings of an enlarged uterus and a tuberous surface of the posterior fornix are also suggestive of endometriosis. The laparoscopy findings of “cyanotic spots” on the ovaries, peritoneum of rectouterine pouches, and pararectal fat are also typical of endometriosis. Polycystic ovaries (B), chronic salpingitis (C), genital organs tuberculosis (D), and ovarian cystoma (E) are all conditions that can cause pelvic pain and other symptoms, but they are less likely to present with the specific combination of symptoms and examination findings described in this case. Therefore, based on the clinical presentation and examination findings described, the most probable diagnosis is a widespread form of endometriosis. Further testing, such as imaging studies or biopsy, may be needed to confirm the diagnosis and determine the extent of the condition. |
122. A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegar’s dilator № 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?
A. Uterine probing
B. Bimanual examination
C. US examination
D. Laparoscopy
E. Metrosalpingography
Answer: Uterine probing
Explanation
| Uterine perforation is a serious complication of artificial abortion procedures that can occur when the uterine wall is accidentally punctured or torn during the dilation of the cervix or the insertion of instruments into the uterus. Suspected uterine perforation should be taken seriously and promptly confirmed through appropriate diagnostic measures. Uterine probing is a simple and rapid method for confirming uterine perforation. It involves inserting a thin, flexible probe or sound into the uterus to assess the depth of the perforation. If the probe goes beyond the expected depth or encounters resistance, this suggests that the uterus has been perforated. Bimanual examination (B), US examination (C), and laparoscopy (D) are other methods that can be used to confirm uterine perforation, but they are more invasive and time-consuming than uterine probing. Bimanual examination may be used to assess the position and size of the uterus and detect any signs of trauma or bleeding. US examination may be used to visualize the uterus and surrounding structures and detect any signs of fluid collection or other abnormalities. Laparoscopy may be used to directly visualize the uterus and surrounding structures and assess the extent of any damage. Metrosalpingography (E) is a diagnostic imaging test that involves injecting contrast material into the uterus and fallopian tubes to visualize their structure and function. It is not an appropriate method for confirming uterine perforation. Therefore, the immediate tactics for confirmation of suspected uterine perforation during an artificial abortion procedure is uterine probing. |
123. A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He suffers from hemophilia B-type. What antihemophilic medicine should be included in pre- and post-operative treatment plan?
A. Fresh frozen plasma
B. Cryoprecipitate
C. Fresh frozen blood
D. Native plasma
E. Dried plasma
Answer: Fresh frozen plasma
Explanation
| Hemophilia B is a genetic disorder that affects blood clotting, specifically the clotting factor IX. In hemophilia B patients, bleeding can occur spontaneously or as a result of trauma or surgical procedures. Therefore, it is important to manage bleeding episodes in hemophilia B patients with appropriate antihemophilic medications. Fresh frozen plasma contains clotting factors, including factor IX, and is the most appropriate antihemophilic medication for use in hemophilia B patients undergoing surgery or experiencing bleeding episodes. Fresh frozen plasma is derived from donated blood and is frozen shortly after collection to preserve the clotting factors. It is then thawed and transfused to the patient as needed. Cryoprecipitate (B), fresh frozen blood (C), native plasma (D), and dried plasma (E) are other blood products that contain clotting factors and can be used in the management of bleeding episodes in hemophilia B patients. However, fresh frozen plasma is the preferred choice for surgical procedures due to its higher concentration of clotting factors and lower risk of transfusion-related complications. Therefore, in a patient with hemophilia B-type who is admitted to the hospital with acute destructive appendicitis, the antihemophilic medicine that should be included in the pre- and post-operative treatment plan is fresh frozen plasma. |
124. A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fith day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 410, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?
A. Epidemic typhus
B. Delirium alcoholicum
C. Leptospirosis
D. Measles
E. Typhoid fever
Answer: Epidemic typhus
Explanation
| Epidemic typhus is a bacterial infection caused by the bacteria Rickettsia prowazekii, which is transmitted to humans through the bites of infected lice. The initial symptoms of epidemic typhus are similar to those of influenza, including fever, headache, and muscle pain. However, in the later stages of the disease, a maculopapular petechial rash appears on the body and internal surfaces of extremities, which is a characteristic feature of the disease. The other symptoms described, including hyperemia of the face, reddening of the sclera, tongue tremor, tachycardia, splenomegaly, and excitement, are also consistent with epidemic typhus. Delirium alcoholicum (B), leptospirosis (C), measles (D), and typhoid fever (E) are all conditions that can cause fever and other symptoms, but they are less likely to present with the specific combination of symptoms and examination findings described in this case. Therefore, based on the clinical presentation described, the most probable diagnosis is epidemic typhus. Prompt treatment with antibiotics is essential to prevent complications and reduce the risk of mortality. |
125. An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37, 50C, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal examination with mirrors: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened; fornixes are free. Bacterioscopy test revealed 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 can affect the genital tract, rectum, and throat, and can cause a range of symptoms, including pain in the lower abdomen, fever, mucopurulent discharge from the genital tract, and painful urination. The vaginal examination findings of a hyperemic, erosive cervix, painful and thickened ovaries, and infiltrated urethra are all consistent with acute ascending gonorrhea. The bacterioscopy test revealing diplococcus also supports the diagnosis of gonorrhea. Trichomoniasis (B), candidiasis (C), chronic gonorrhea (D), and chlamydiosis (E) are other sexually transmitted infections that can cause similar symptoms, but the examination findings described in this case are more specific to acute gonorrhea. Therefore, based on the clinical presentation and examination findings described, the most probable diagnosis is recent acute ascending gonorrhea. Treatment with antibiotics is essential to prevent complications and reduce the risk of transmission to sexual partners. |
126. A 28 y.o. patient complains of pain in legs during walking, chill of feet and toes. He has been ill for a year. Objectively: leg skin is pale, cool; turgor is decreased, hypotrichosis. Femoral and popliteal artery pulsation is weak, it is palpable on the foot arteries only after nitroglycerine test. Rheographic index is <1. What is the most probable diagnosis?
A. Obliterating endarteritis
B. Chronic thrombophlebitis
C. Obliterating aterosclerosis
D. Raynaud’s disease
E. Buerger’s disease
Answer: Obliterating endarteritis
Explanation
| The most probable diagnosis for the 28-year-old patient with pain in the legs during walking, chill of feet and toes, and weak pulsations in the femoral and popliteal arteries is obliterating endarteritis, also known as peripheral arterial disease (PAD) or atherosclerotic occlusive disease. Option A, obliterating endarteritis, is correct because it is a condition that causes narrowing or blockage of arteries in the legs due to atherosclerosis, which is the buildup of plaque inside the artery walls. This can result in reduced blood flow to the legs, causing symptoms like pain during walking, cool and pale skin, and weak pulses in the affected areas. Option B, chronic thrombophlebitis, is unlikely as it is characterized by inflammation and clotting in the veins, not arteries, and typically affects the deep veins of the legs. Option C, obliterating atherosclerosis, is similar to option A as it refers to narrowing or blockage of arteries due to plaque buildup, but this is a more general term that can refer to any arteries in the body, not just the peripheral arteries in the legs. Option D, Raynaud’s disease, is also unlikely as it typically causes episodes of cold and numb fingers or toes due to spasms in the small blood vessels, not the larger arteries in the legs. Option E, Buerger’s disease, is a possibility as it also affects the arteries in the legs and can cause similar symptoms, but it is more commonly seen in young male smokers and is associated with inflammation and clotting in the small- to medium-sized arteries. However, based on the patient’s age and the fact that there is no mention of smoking or other risk factors, obliterating endarteritis is the most probable diagnosis. |
127. A 2 m.o. child was delivered in time with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:
A. Corresponding to the age
B. 150 g less than necessary
C. Hypotrophy of the I grade
D. Hypotrophy of the II grade
E. Paratrophy of the I grade
Answer: Corresponding to the age
Explanation
| At 2 months of age, the average weight for a baby is between 4.5 and 6 kg. The child’s current weight of 4900 g falls within this range, indicating that the weight is appropriate for the age. Therefore, option A, corresponding to the age, is the correct answer. Option B, 150 g less than necessary, can be ruled out as the child’s weight is within the expected range for the age. Option C, hypotrophy of the I grade, and option D, hypotrophy of the II grade, are both incorrect as they indicate that the child’s weight is below the expected range for the age. However, as mentioned above, the child’s weight falls within the expected range, so these options can be ruled out. Option E, paratrophy of the I grade, is also incorrect as it refers to excessive weight gain, which is not the case for this child. |
128. A woman consulted a doctor on the 14th day after labor about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 390, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?
A. Lactational mastitis
B. Lacteal cyst with suppuration
C. Fibrous adenoma of the left mammary gland
D. Breast cancer
E. Phlegmon of mammary gland
Answer: Lactational mastitis
Explanation
| The most likely pathology in this case is lactational mastitis, which is an infection of the breast tissue that can occur during breastfeeding. The presence of sudden pain, hyperemia (redness), and induration (hardening) of the left mammary gland, along with a fever, headache, and indisposition, are all consistent with a diagnosis of mastitis. The fissure of the nipple can provide a portal of entry for bacteria into the breast tissue, leading to infection. Option A, lactational mastitis, is the correct answer based on the clinical presentation. Option B, lacteal cyst with suppuration, is unlikely as lacteal cysts are typically painless and do not cause fever or other systemic symptoms. Option C, fibrous adenoma of the left mammary gland, and option D, breast cancer, are both unlikely as they usually do not present with sudden onset of symptoms and fever. Option E, phlegmon of the mammary gland, is a possibility as it refers to a severe bacterial infection that can cause inflammation and tissue damage, but this is less common than lactational mastitis and typically presents with more severe symptoms. |
129. A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical hystory: acute pancreatitis. Body temperature is 38, 20. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner’s and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?
A. Chronic pancreatitis
B. Acute cholangitis
C. Chronic cholecystitis
D. Acute cholecystitis
E. Cancer of pancreas
Answer: Chronic pancreatitis
Explanation
| The patient’s history of acute pancreatitis and current symptoms of severe pain in the right hypochondrium and icteric sclera suggest a possible complication of chronic pancreatitis, such as biliary obstruction or jaundice. The positive Ortner’s and Hubergrits-Skulski’s symptoms are also supportive of a diagnosis of chronic pancreatitis, as they indicate inflammation and scarring of the pancreas and surrounding tissues. Option A, chronic pancreatitis, is the correct answer based on the clinical presentation. Option B, acute cholangitis, is less likely as this is characterized by fever, chills, and jaundice, but typically presents with more severe symptoms than seen in this case. Option C, chronic cholecystitis, is less likely as it typically causes less severe symptoms and does not usually result in icterus. Option D, acute cholecystitis, is also less likely as it typically causes more severe symptoms and is associated with inflammation of the gallbladder, not the pancreas. Option E, cancer of the pancreas, cannot be excluded completely based on the information provided, but chronic pancreatitis is a more likely diagnosis given the patient’s history and current symptoms. |
130. A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly “snored”. There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?
A. Electric defibrillation
B. Saphar’s triple airway maneuver
C. ECG record
D. Intracardiac introduction of adrenalin with atropine
E. Precardiac stroke
Answer: Electric defibrillation
Explanation
| The patient’s sudden “snoring” and tonic contraction of skeletal muscles, along with dilated pupils and absence of pulse in the carotid artery, suggest that he has gone into cardiac arrest. Electric defibrillation is the most effective treatment for restoring normal heart rhythm in a patient experiencing cardiac arrest. Option A, electric defibrillation, is the correct answer based on the clinical presentation. Option B, Saphar’s triple airway maneuver, is a method used to clear the airway in a patient who is unconscious and not breathing on their own. While this may be necessary in some cases of cardiac arrest, it is not the appropriate immediate tactic in this case. Option C, ECG record, is not immediately necessary when a patient is in cardiac arrest and requires immediate intervention. Option D, intracardiac introduction of adrenaline with atropine, and option E, precordial stroke, are not recommended as first-line treatments for cardiac arrest and are generally reserved for use when other methods have failed. Therefore, the correct immediate tactic in this case is to perform electric defibrillation to attempt to restore a normal heart rhythm and circulation. |
131. A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37, 50. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in Xray pictures of her joints are the most probable?
A. Constriction of joint space, usura
B. Constriction of joint space, subchondral osteosclerosis
C. Cysts in subchondral bone
D. Multiple marginal osteophytes
E. Epiphysis osteolysis
Answer: Constriction of joint space, usura
Explanation
| The most probable X-ray changes in a patient with rheumatoid arthritis would be constriction of joint space and usura (erosions) of the joint surfaces. Option A, constriction of joint space and usura, is the correct answer based on the typical X-ray findings in rheumatoid arthritis. Constriction of joint space occurs due to joint destruction and cartilage loss, while usura refers to the erosions of the joint surfaces that occur as a result of chronic inflammation. Option B, constriction of joint space and subchondral osteosclerosis, can also occur in rheumatoid arthritis, but subchondral osteosclerosis is more commonly seen in osteoarthritis. Option C, cysts in subchondral bone, are more commonly seen in other types of arthritis, such as osteoarthritis or psoriatic arthritis. Option D, multiple marginal osteophytes, are more commonly seen in osteoarthritis and are not typically seen in rheumatoid arthritis. Option E, epiphysis osteolysis, is a finding that can occur in other types of arthritis, such as psoriatic arthritis, but is not typically seen in rheumatoid arthritis. Therefore, the most probable X-ray changes in a patient with rheumatoid arthritis would be constriction of joint space and usura (erosions) of the joint surfaces. |
132. 8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region – 3,0х1,0 cm, neck muscles rigidity, Ps- 58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?
A. Intracranial hemorrhage
B. Anisocoria
C. Unconsciousness
D. Wounds
E. Intensification of convulsions
Answer: Intracranial hemorrhage
Explanation
| The most important indication for the immediate surgical procedure in this case is intracranial hemorrhage. The patient’s history of closed craniocerebral trauma and current symptoms of anisocoria, neck muscle rigidity, and convulsive syndrome all suggest the possibility of intracranial bleeding. Anisocoria is a condition in which the pupils are different sizes, which can indicate pressure on the cranial nerves and the need for urgent intervention. Option A, intracranial hemorrhage, is the correct answer based on the clinical presentation. Option B, anisocoria, is a symptom that can occur as a result of intracranial pressure and bleeding, but it is not the most important indication for immediate surgical intervention. Option C, unconsciousness, is a symptom that indicates a serious condition but does not necessarily require immediate surgical intervention. Option D, wounds, may be important to address but are not the most important indication for immediate surgical intervention in this case. Option E, intensification of convulsions, is a symptom that can indicate the need for treatment with anticonvulsants but is not the most important indication for immediate surgical intervention in this case. Therefore, the most important indication for immediate surgical intervention in this case is the possibility of intracranial hemorrhage, which can cause serious complications and requires urgent medical attention. |
133. A girl, aged 13, consulted 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 hemorrhage
C. Haemophilia
D. Endometrium cancer
E. Werlhof’s disease
Answer: Menarche
Explanation
| The most probable cause of bloody discharge in a 13-year-old girl with developed secondary sexual characteristics is menarche, which refers to the onset of menstruation. Option A, menarche, is the correct answer based on the typical age of onset for menstruation and the presence of developed secondary sexual characteristics. Option B, juvenile hemorrhage, is a rare condition that can cause abnormal uterine bleeding in adolescent girls, but it typically presents with more severe bleeding than what is described in this case. Option C, hemophilia, is an inherited bleeding disorder that affects primarily males and is characterized by a deficiency in clotting factors. It is unlikely to be the cause of bloody discharge in a girl with developed secondary sexual characteristics. Option D, endometrial cancer, is extremely rare in adolescent girls and is not a likely cause of the symptoms described. Option E, Werlhof’s disease (idiopathic thrombocytopenic purpura), is a bleeding disorder characterized by a low platelet count, but it is also unlikely to be the cause of bloody discharge in an adolescent girl. Therefore, the most probable cause of bloody discharge in this case is menarche, which is a normal and expected occurrence in adolescent girls with developed secondary sexual characteristics. |
134. A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?
A. Exchange card
B. Appointment card for hospitalization
C. Individual prenatal record
D. Medical certificate
E. Sanitary certificate
Answer: Exchange card
Explanation
| The document that must be given to a pregnant woman to authorize her hospitalization in a maternity hospital is an exchange card. Option A, exchange card, is the correct answer as it is the document that contains information about the woman’s pregnancy and prenatal care, including her due date, medical history, and any complications or concerns that may require hospitalization. Option B, appointment card for hospitalization, is not the correct answer as it does not contain the necessary information about the woman’s pregnancy and prenatal care. Option C, individual prenatal record, is a document that contains information about the woman’s prenatal care but is not specifically used for authorizing hospitalization. Option D, medical certificate, is a document that certifies a person’s medical condition but is not specific to pregnancy or prenatal care. Option E, sanitary certificate, is a document that certifies a person’s health status with regard to infectious diseases but is not specific to pregnancy or prenatal care. Therefore, the correct document that must be given to a pregnant woman to authorize her hospitalization in a maternity hospital is an exchange card. |
135. In course of 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 most informative index for evaluating the visual regimen of students studying from 9 a.m. to 3 p.m. is the natural light coefficient. Option A, natural light coefficient, is the correct answer as it is a measure of the ratio of natural light to artificial light in a room, which can affect the quality of lighting and visual comfort for students. Option B, light coefficient, is a general measure of the amount of light in a room and does not specifically take into account the source of the light. Option C, depth of study room, is a measure of the physical dimensions of a room and is not directly related to the visual regimen of students. Option D, time of the room insolation, is a measure of the amount of sunlight that enters a room at different times of the day and is important for regulating the natural light coefficient, but is not the most informative index for evaluating the visual regimen of students. Option E, presence of mixed (upper-lateral) light, is a factor that can affect the quality of lighting in a room, but it is not an index that can be quantified in the same way as the natural light coefficient. Therefore, the most informative index for evaluating the visual regimen of students studying from 9 a.m. to 3 p.m. is the natural light coefficient, which is a measure of the ratio of natural light to artificial light in a room. |
136. A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of continious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?
A. Depressive syndrome
B. Paranoid syndrome
C. Asthenic syndrome
D. Phobic syndrome
E. Obsessive syndrome
Answer: Depressive syndrome
Explanation
| Option A, depressive syndrome, is the correct answer based on the patient’s symptoms of depressed mood, anxiety, sleeplessness, fears, and suicidal thoughts, as well as his facial expression of suffering, pain, and fear. Option B, paranoid syndrome, is characterized by delusions of persecution or grandeur, which are not described in this case. Option C, asthenic syndrome, is characterized by physical and mental fatigue and weakness, which are not the main symptoms described in this case. Option D, phobic syndrome, is characterized by irrational fears of specific situations or objects, which are not described in this case. Option E, obsessive syndrome, is characterized by persistent and intrusive thoughts or rituals, which are not described in this case. Therefore, the main psychopathologic syndrome in this case is depressive syndrome, which is characterized by symptoms of depressed mood, anxiety, sleeplessness, fears, and suicidal thoughts. |
137. 200 patients suffering from essential hypertension were examined in order to obtain data about patients’ arterial pressure and age. What statistic value should be applied in order to measure relation between these characteristics?
A. Correlation coefficient
B. Student’s coefficient
C. Coefficient of variation
D. Representation error
E. Sygmal deviation
Answer: Correlation coefficient
Explanation
| The statistic value that should be applied in order to measure the relation between arterial pressure and age in 200 patients with essential hypertension is the correlation coefficient. Option A, correlation coefficient, is the correct answer as it is a statistical measure of the strength and direction of the linear relationship between two variables, in this case, arterial pressure and age. Option B, Student’s coefficient (t-test), is a statistical test used to determine if there is a significant difference between the means of two groups and is not appropriate for measuring the relationship between arterial pressure and age. Option C, coefficient of variation, is a measure of the relative variability of a data set and is not appropriate for measuring the relationship between arterial pressure and age. Option D, representation error, is a measure of the accuracy of a sample in representing the population and is not appropriate for measuring the relationship between arterial pressure and age. Option E, sigma deviation, is not a statistical measure and is not appropriate for measuring the relationship between arterial pressure and age. Therefore, the most appropriate statistic value that should be applied in order to measure the relationship between arterial pressure and age in 200 patients with essential hypertension is the correlation coefficient. |
138. A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood count: leukocytes – 2, 2 ∗ 109/L. What disease can be suspected?
A. HIV-infection
B. Lymphogranulomatosis
C. Tuberculosis
D. Infectionous mononucleosis
E. Chroniosepsis
Answer: HIV-infection
Explanation
| Option A, HIV-infection, is the correct answer based on the patient’s symptoms of continued fever, night sweats, weight loss, and the presence of enlarged lymph nodes and hepatosplenomegaly. The low leukocyte count also suggests a possible immunodeficiency, which is commonly seen in HIV-infection. Option B, lymphogranulomatosis (Hodgkin’s lymphoma), can also cause enlarged lymph nodes and systemic symptoms, but the low leukocyte count is not typical of this condition. Option C, tuberculosis, can cause fever and weight loss, as well as enlarged lymph nodes, but the low leukocyte count is not typical of this condition. Option D, infectious mononucleosis, can cause fever, weight loss, and enlarged lymph nodes, but the low leukocyte count is not typical of this condition, and the patient’s sexual history raises concern for other sexually transmitted infections such as HIV. Option E, chroniosepsis, is not a recognized medical term, and it is unclear what condition it refers to. Therefore, based on the symptoms and clinical findings described in the case, the most likely diagnosis is HIV-infection, which should be confirmed with appropriate diagnostic tests such as HIV serology. |
139. A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?
A. Kidneys
B. Heart
C. Lungs
D. Gastrointestinal tract
E. Skin and joints
Answer: Kidneys
Explanation
| Option A, kidneys, is the correct answer as renal involvement in systemic scleroderma can lead to renal crisis, which is a life-threatening condition characterized by sudden onset of severe hypertension, renal failure, and microangiopathic hemolytic anemia. Option B, heart, can be affected in systemic scleroderma and may cause symptoms such as palpitations and dyspnea, but it is not typically associated with a significant worsening of prognosis. Option C, lungs, are commonly affected in systemic scleroderma and can cause pulmonary hypertension and interstitial lung disease, which can worsen the prognosis if left untreated. Option D, gastrointestinal tract, can be affected in systemic scleroderma and can cause symptoms such as dysphagia and gastroesophageal reflux disease, but it is not typically associated with a significant worsening of prognosis. Option E, skin and joints, are commonly affected in systemic scleroderma but do not typically affect the prognosis significantly unless they are associated with other organ involvement. Therefore, in systemic scleroderma, the organ affection that worsens the prognosis the most is the kidneys due to the risk of renal crisis. |
140. A 2 month old child who was born with body weight 5100 g has jaundice, hoarse cry, umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are of normal color. In anamnesis: delayed falling-away of umbilical rest. Blood count: Hb- 120 g/L, RBC- 4, 5 ∗ 1012/L, ESR- 3 mm/h. General level of serum bilirubin – 28 mcmol/L, unconjugated bilirubin – 20 mcmol/L, conjugated bilirubin – 8 mcmol/L. What disease would you think about first of all?
A. Congenital thyreoid deficiency
B. Congenital hepatitis
C. Hemolitic anemia
D. Conjugated jaundice
E. Cytomegalovirus infection
Answer: Congenital thyreoid deficiency
Explanation
| Option A, congenital thyroid deficiency, is the correct answer based on the symptoms of developmental lag, hoarse cry, delayed falling-away of umbilical rest, and the presence of jaundice, which can be a sign of hypothyroidism. The normal stool and urine color suggest that the jaundice is not due to liver disease, and the liver and spleen findings are not suggestive of a hepatic or hematological disorder. Option B, congenital hepatitis, is less likely given the normal liver function tests and the absence of hepatosplenomegaly. Option C, hemolytic anemia, may cause jaundice and anemia, but the normal RBC count and hemoglobin level make this diagnosis less likely. Option D, conjugated jaundice, is less likely given the predominance of unconjugated bilirubin in the serum. Option E, cytomegalovirus infection, is less likely given the absence of other symptoms such as fever, rash, or hepatosplenomegaly. Therefore, based on the symptoms and findings described in the case, the most likely diagnosis in this 2-month-old child is congenital thyroid deficiency, which should be confirmed with appropriate diagnostic tests such as thyroid function tests and thyroid imaging. |
141. The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min,tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?
A. Cardiac glycosides
B. Nonsteroidal antiinflammatory drugs
C. Potassium preparations
D. β-adrenoceptor blockers
E. Glucocorticoids
Answer: Cardiac glycosides
Explanation
| Option A, cardiac glycosides, is the correct answer as they are used to treat heart failure and improve cardiac function in patients with congenital heart disease. They can reduce heart rate, increase cardiac output, and improve symptoms such as dyspnea. Option B, nonsteroidal anti-inflammatory drugs, are not appropriate in this case as they do not have a role in the treatment of heart failure. Option C, potassium preparations, are not appropriate in this case as they are not indicated for the treatment of heart failure in newborns. Option D, β-adrenoceptor blockers, are not appropriate in this case as they can worsen heart failure in newborns with congenital heart disease. Option E, glucocorticoids, are not appropriate in this case as they are not indicated for the treatment of heart failure in newborns with congenital heart disease. Therefore, in a newborn boy with a congenital heart disease and dyspnea, tachycardia, and hepatomegaly, the immediate treatment that should be prescribed is cardiac glycosides to improve cardiac function and reduce symptoms such as dyspnea. |
142. A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation – gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?
A. Acute renal insufficiency
B. Glomerulosclerosis
C. Chronic renal insufficiency
D. Antibiotic combination is optimal and absolutely safe
E. Acute suprarenal insufficiency
Answer: Acute renal insufficiency
Explanation
| The combination of gentamicin and biseptol in a patient with chronic pyelonephritis may cause acute renal insufficiency as a potential consequence. Option A, acute renal insufficiency, is the correct answer as the combination of gentamicin and biseptol can cause nephrotoxicity, especially in patients with pre-existing renal impairment such as chronic pyelonephritis. Option B, glomerulosclerosis, is less likely to be caused by this antibiotic combination. Option C, chronic renal insufficiency, may occur as a consequence of recurrent episodes of acute renal insufficiency due to nephrotoxicity, but it is not a direct consequence of this antibiotic combination. Option D, the antibiotic combination is not absolutely safe and may cause adverse effects such as nephrotoxicity. Option E, acute suprarenal insufficiency, is not related to the use of this antibiotic combination. Therefore, in a patient with chronic pyelonephritis, the combination of gentamicin and biseptol may cause acute renal insufficiency as a potential consequence, and monitoring of renal function is recommended during treatment. |
143. A 60 y.o. patient complains of having passing reduction of strength in his left extremities for a month. Some time later he has got persistent weakness of extremities in the mornings. Objectively: AP140/90 mm Hg, conscious, central paresis of the VII and XII pair of left-side cranial nerves, central hemiparesis and hemihyperesthesia also on the left side. What medicines should be chosen for the differentiated treatment of the patient?
A. Anticoagulants
B. Hemostatics
C. Hypotensive
D. Diuretics
E. Corticosteroids
Answer: Anticoagulants
Explanation
| In a 60-year-old patient with central paresis and hemiparesis on the left side, the appropriate medicine for differentiated treatment is anticoagulants. Option A, anticoagulants, is the correct answer as the symptoms described suggest a possible ischemic stroke, and anticoagulants such as heparin and warfarin are indicated for the prevention of thromboembolic events in stroke patients. Option B, hemostatics, are not appropriate in this case as they are used to stop bleeding and are not indicated in the treatment of stroke. Option C, hypotensive medicines, may be used to lower blood pressure in patients with hypertension, but they are not the first-line treatment for stroke. Option D, diuretics, are not appropriate in this case as they are not indicated in the treatment of stroke. Option E, corticosteroids, are not indicated in the treatment of acute stroke and may even be harmful in some cases. Therefore, in a 60-year-old patient with central paresis and hemiparesis on the left side, the appropriate medicine for differentiated treatment is anticoagulants for the prevention of thromboembolic events in stroke patients. The patient should also be evaluated for possible thrombolysis or endovascular treatment options depending on the time of onset of the stroke and other factors. |
144. 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 exercises. He has had it for 1 year. On examination: heart borders are enlargement to the left side, sounds are muffled, Ps- 76 bpm, rhythmic, AP- 155/80 mm Hg, ECG: the left type, the rest signs are normal. What additional examination is necessary to confirm the diagnosis?
A. Veloergometry
B. Echocardiography
C. Lipoprotein test
D. General blood count
E. Transaminases of blood
Answer: Veloergometry
Explanation
| In a 52-year-old male patient with squeezing pain attacks in the substernal area that irradiate to the left hand and occur occasionally and on physical exercise, the additional examination that is necessary to confirm the diagnosis is veloergometry. Option A, veloergometry, is the correct answer as it is a stress test that can help diagnose coronary artery disease by assessing the patient’s response to physical exercise. Option B, echocardiography, may be helpful to assess cardiac function and structure, but it may not be sufficient to diagnose coronary artery disease. Option C, lipoprotein test, may be helpful in assessing the patient’s cardiovascular risk factors, but it may not be sufficient to diagnose coronary artery disease. Option D, general blood count, and option E, transaminases of blood, are not specific tests for diagnosing coronary artery disease. Therefore, in a 52-year-old male patient with squeezing pain attacks in the substernal area that irradiate to the left hand and occur occasionally and on physical exercise, the additional examination that is necessary to confirm the diagnosis is veloergometry to assess the patient’s response to physical exercise and help diagnose coronary artery disease. |
145. A 70 y.o. patient complains of weakness, dizziness, short periods of loss of consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP- 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?
A. III degree atrioventricular heart block
B. I degree atrioventricular heart block
C. Bradysystolic form of the atrial fibrillation
D. Sinus bradycardia
E. Complete block of the left branch of His bundle
Answer: III degree atrioventricular heart block
Explanation
| In a 70-year-old patient with weakness, dizziness, short periods of loss of consciousness, pain in the region of the heart, HR- 40/min, sounds are rhythmic, the 1st sound is dull, occasionally very intensive, and AP- 180/90 mm Hg, the most probable reason for hemodynamic disorders is III degree atrioventricular heart block. Option A, III degree atrioventricular heart block, is the correct answer as the patient’s symptoms and findings suggest a complete block of electrical impulses between the atria and ventricles, leading to a slow and irregular heartbeat and hemodynamic instability. Option B, I degree atrioventricular heart block, is less likely given the patient’s slow heart rate and symptoms of hemodynamic instability. Option C, bradysystolic form of the atrial fibrillation, may cause bradycardia and hemodynamic instability, but it is not the most likely diagnosis based on the patient’s symptoms and findings. Option D, sinus bradycardia, may cause a slow heart rate, but it is not the most likely diagnosis given the patient’s symptoms of hemodynamic instability. Option E, complete block of the left branch of His bundle, is not likely to cause the patient’s symptoms and findings. Therefore, in a 70-year-old patient with weakness, dizziness, short periods of loss of consciousness, pain in the region of the heart, HR- 40/min, sounds are rhythmic, the 1st sound is dull, occasionally very intensive, and AP- 180/90 mm Hg, the most probable reason for hemodynamic disorders is III degree atrioventricular heart block, and urgent treatment such as pacemaker implantation may be necessary to improve cardiac function and prevent complications. |
146. A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right lung suddenly felt pain after coughing in the right half of thorax, he got heavy breathing, cyanosis. What complication is the most probable?
A. Pyopneumothorax
B. Infarction-pneumonia
C. Myocardial infarction
D. Esophagus perforation
E. Exudative pleurisy
Answer: Pyopneumothorax
Explanation
| In a 32-year-old patient who has been staying in a hospital on account of acute abscess of his right lung and suddenly felt pain after coughing in the right half of thorax, heavy breathing, and cyanosis, the most probable complication is pyopneumothorax. Option A, pyopneumothorax, is the correct answer as the patient’s symptoms suggest the possibility of air and pus in the pleural space due to the rupture of a lung abscess or a bronchopleural fistula. Option B, infarction-pneumonia, may cause similar symptoms, but the sudden onset of pain and respiratory distress is more suggestive of pyopneumothorax. Option C, myocardial infarction, is less likely given the patient’s symptoms and history of lung abscess. Option D, esophagus perforation, may cause chest pain and respiratory symptoms, but it is less likely given the patient’s history of lung abscess. Option E, exudative pleurisy, may cause respiratory symptoms and chest pain, but the sudden onset of pain and respiratory distress is more suggestive of pyopneumothorax. Therefore, in a 32-year-old patient who has been staying in a hospital on account of acute abscess of his right lung and suddenly felt pain after coughing in the right half of thorax, heavy breathing, and cyanosis, the most probable complication is pyopneumothorax, and urgent intervention such as chest tube placement may be necessary to relieve the pressure in the pleural space and improve respiratory function. |
147. Fluorography of a 45 y.o. man revealed some foci of small intensity with nondistinct outlines on the top of his right lung. The patient doesn’t feel worse. He has been smoking for many years. Objectively: vesicular resonance over lungs, respiration is vesicular, rales are absent. Blood count is not changed. What is the most probable diagnosis?
A. Focal pulmonary tuberculosis
B. Peripheral cancer of lung
C. Eosinophilic pneumonia
D. Bronchiolitis
E. Disseminated pulmonary tuberculosis
Answer: Focal pulmonary tuberculosis
Explanation
| In a 45-year-old man with a history of smoking and foci of small intensity with nondistinct outlines on the top of his right lung detected on fluorography, the most probable diagnosis is focal pulmonary tuberculosis. Option A, focal pulmonary tuberculosis, is the correct answer as the patient’s age, smoking history, and radiographic findings are suggestive of possible active tuberculosis, which may present with pulmonary infiltrates or nodules. Option B, peripheral cancer of lung, may present with similar radiographic findings, but it is less likely given the patient’s age and smoking history. Option C, eosinophilic pneumonia, may present with peripheral nodules on chest imaging, but it is less likely given the absence of eosinophilia in the blood count and the patient’s lack of symptoms. Option D, bronchiolitis, is less likely to cause the patient’s radiographic findings. Option E, disseminated pulmonary tuberculosis, may present with multiple nodules or infiltrates on chest imaging, but the patient’s lack of symptoms and normal blood count make this diagnosis less likely. Therefore, in a 45-year-old man with a history of smoking and foci of small intensity with nondistinct outlines on the top of his right lung detected on fluorography, the most probable diagnosis is focal pulmonary tuberculosis, and further evaluation and testing such as sputum culture and chest CT may be necessary to confirm the diagnosis and initiate appropriate treatment. |
148. An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 390, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0,5 cm, t 0- 380. Blood count: Нb- 98g/L, RBC2, 9 ∗ 1012/L, leukocytes – 32 ∗ 109/L, stab neutrophils – 0%, segmental leukocytes – 28%, monocytes – 2%, lymphocytes – 39%, blasts – 31%, reticulocytes – 31%, thrombocytes – 120∗109/L, ESR- 36 mm/h. What form of leukosis does the patient have?
A. Acute lymphoblastic leukosis
B. Acute myeloblastic leukosis
C. Chronic lympholeukosis
D. Chronic myeloleukosis
E. Undifferentiated leukosis
Answer: Acute lymphoblastic leukosis
Explanation
| In an 18-year-old patient with complaints of headache, general weakness, poor appetite, body temperature rise up to 390, neck swelling, extremely pale skin and mucous membranes, lymph nodes on both sides of the neck up to 1 cm large, painless, an enlarged liver +1 cm, painless spleen +0.5 cm, and abnormal blood count with 31% blasts, the form of leukosis that the patient most likely has is acute lymphoblastic leukemia. Option A, acute lymphoblastic leukemia, is the correct answer as the patient’s symptoms, physical examination findings, and blood count suggest the possibility of a rapidly progressing lymphoid malignancy affecting the bone marrow and leading to the accumulation of immature lymphoblasts in the blood and tissues. Option B, acute myeloblastic leukemia, may also present with similar symptoms and blood count abnormalities, but the lack of myeloid lineage involvement and the presence of lymphoblasts make this diagnosis less likely. Option C, chronic lymphocytic leukemia, is not likely given the patient’s young age and the acute onset of symptoms. Option D, chronic myeloid leukemia, is less likely given the lack of myeloid lineage involvement and the acute onset of symptoms. Option E, undifferentiated leukemia, is not a specific type of leukemia and does not provide a clear diagnosis. Therefore, in an 18-year-old patient with symptoms of headache, general weakness, poor appetite, body temperature rise up to 390, neck swelling, extremely pale skin and mucous membranes, lymph nodes on both sides of the neck up to 1 cm large, painless, an enlarged liver +1 cm, painless spleen +0.5 cm, and abnormal blood count with 31% blasts, the most likely form of leukosis is acute lymphoblastic leukemia, and further testing such as bone marrow biopsy and cytogenetic analysis may be necessary for confirmation and treatment planning. |
149. A mother of a 5 y.o. girl consulted a doctor about doughter’s involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition, intellectual development is good, the girl can read and explains common situations quite adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithiasis. What type of diathesis is the most probable in the child’s case?
A. Gouty diathesis
B. Urine acid diathesis
C. Exudative diathesis
D. Allergic diathesis
E. Lymphohypoplastic diathesis
Answer: Gouty diathesis
Explanation
| In a 5-year-old girl with involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight, malnutrition, pale skin, an enlarged liver, and a family history of cholelithiasis, the most probable type of diathesis is gouty diathesis. Option A, gouty diathesis, is the correct answer as the patient’s symptoms and findings suggest the possibility of a metabolic disorder characterized by the accumulation of uric acid in the body, which may lead to joint pain, kidney stones, and other complications. Option B, urine acid diathesis, is less likely given the patient’s young age and the absence of urinary symptoms. Option C, exudative diathesis, may cause skin and mucous membrane changes, but it is less likely given the patient’s symptoms and findings. Option D, allergic diathesis, may cause skin and respiratory symptoms, but it is less likely given the patient’s symptoms and findings. Option E, lymphohypoplastic diathesis, is not a recognized medical term and does not provide a clear diagnosis. Therefore, in a 5-year-old girl with involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight, malnutrition, pale skin, an enlarged liver, and a family history of cholelithiasis, the most probable type of diathesis is gouty diathesis, and further evaluation and testing, such as measurement of uric acid levels and imaging studies, may be necessary to confirm the diagnosis and initiate appropriate treatment. |
150. After manual reposition and application of plaster splint a patient with fractures of forearm bones had an edema of hand and fingers, he felt pain and lack of sensitivity. What tactics should the doctor choose?
A. To cut the bandage that fastens the splint
B. To prescribe analgetics and diuretics
C. To remove the plaster
D. It’s a natural phenomena, the edema will dissipate in a day
E. To repeat reposition
Answer: To cut the bandage that fastens the splint
Explanation
| In a patient with fractures of forearm bones who developed hand and finger edema, pain, and lack of sensitivity after manual reposition and application of a plaster splint, the appropriate tactic for the doctor is to cut the bandage that fastens the splint. Option A, to cut the bandage that fastens the splint, is the correct answer as the development of hand and finger edema, pain, and lack of sensitivity suggests the possibility of compartment syndrome, which is a serious condition that occurs when pressure within a closed space, such as a plaster splint, builds up and compresses nerves and blood vessels. Cutting the bandage that fastens the splint can relieve pressure and prevent further damage. Option B, to prescribe analgesics and diuretics, may provide some relief of symptoms but does not address the underlying issue of compartment syndrome. Option C, to remove the plaster, may be necessary in severe cases of compartment syndrome, but cutting the bandage that fastens the splint is the first step to relieve pressure and assess the severity of the condition. Option D, it’s a natural phenomenon, the edema will dissipate in a day, is incorrect as the symptoms of hand and finger edema, pain, and lack of sensitivity suggest the possibility of compartment syndrome, which requires immediate medical attention. Option E, to repeat reposition, is not appropriate in this situation as it does not address the underlying issue of compartment syndrome. Therefore, in a patient with fractures of forearm bones who developed hand and finger edema, pain, and lack of sensitivity after manual reposition and application of a plaster splint, the appropriate tactic for the doctor is to cut the bandage that fastens the splint and assess the severity of the condition. |
