Question From ( 101 To 150 )

All Previous Years Krok 2 Papers with Explanations

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Question From ( 101 To 150 )

101. A military unit stopped for 3- day’s rest in inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field conditions.

A. Artesian well water

B. Spring water

C. River water

D. Rain water

E. Water from melted snow

Answer: Artesian well wate

Explanation

The key reasons are: 1. Artesian wells tap into underground aquifers that are usually protected from surface contamination. The water has filtered through layers of soil and rock, which helps purify it. 2. Artesian well water is often found to have good mineral content and high quality, making it suitable for drinking. 3. The water source is protected and contained within the well, minimizing the risk of pathogens entering the water.

4. Artesian wells can provide a steady and reliable source of water. In contrast, the other options: – Spring water, river water and rain water are all exposed surface water sources that are more susceptible to contamination from human and animal activity, runoff, and pathogens. They would pose higher risks. –

Melted snow water could contain contaminants introduced during snowfall and storage, and may lack essential minerals for good drinking quality. So artesian well water would generally offer the highest assurance of hygienic quality and safety among the source options listed.

The underground filtration and contained nature of artesian wells make them a good choice for field drinking water when other treatment is not immediately feasible. Hope this explanation helps! Let me know if you have any other questions.

102. A 10 y.o. boy with hemophilia has signs of acute respiratory viral infection with fever. What of the mentioned antifebrile medications are contraindicated to this patient?

A. Acetylsalicylic acid

B. Analgin

C. Pipolphen

D. Paracetamol

E. Panadol extra

Answer: Acetylsalicylic acid

Explanation

The reasons are: 1. Hemophilia is a bleeding disorder caused by a deficiency of clotting factors, usually factor VIII or IX. Patients with hemophilia are at risk of prolonged or excessive bleeding from minor injuries.

2. Acetylsalicylic acid (aspirin) is an antiplatelet drug that inhibits platelet aggregation and prostaglandin production. This increases the risk of bleeding in patients with hemophilia. 3. In contrast, the other antipyretic options listed – analgin, pipolphen, paracetamol and panadol extra – are not antiplatelet or anticoagulant drugs. They do not further increase the risk of bleeding in hemophilia and can be used safely.

4. Paracetamol (also known as acetaminophen) in particular is considered the first-line antipyretic for patients with bleeding disorders since it does not affect platelet function or coagulation.

So in summary, acetylsalicylic acid should be avoided in this boy with hemophilia due to the increased risk of bleeding complications from its antiplatelet effect. The other antipyretic medications are not contraindicated and can be used to safely manage his fever. Hope this explanation helps! Let me know if you have any other questions.

103. A full-term newborn child has a diagnosis newborn’s Rh-factor hemolytic disease. Bilirubin rate is critical. The child’s blood group is B(III), his mother’s blood group – A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

A. Blood group B(III)Rh−

B. Blood group A(II)Rh−

C. Blood group B(III)Rh+

D. Blood group A(II)Rh+

E. Blood group O(I)Rh−

Answer: Blood group B(III)Rh−

Explanation

The key factors: – The newborn has high bilirubin due to Rh hemolytic disease, where his Rh positive red blood cells are being destroyed – His blood group is B(III) Rh positive, while his mother is A(II) Rh negative – He requires a blood transfusion to manage his hemolytic anemia In this situation, the safest donor blood for the newborn would be: –

The same blood group: B(III) – Rh negative: Because he already has Rh positive blood, receiving Rh positive blood could sensitize him further and worsen his hemolytic anemia. Rh negative blood avoids this risk. So the optimal donor blood is Group B(III) Rh-negative, which: – Matches his blood group to minimize isoimmune hemolytic reactions – Is Rh negative to avoid further Rh sensitization and hemolysis The other options would not be as compatible for the following reasons:

A(II) blood (Option B) is a different blood group B(III) Rh+ blood (Option C) could sensitize him further to Rh A(II) Rh+ blood (Option D) is a different blood group and could sensitize him to Rh O(I) Rh- blood (Option E) is a different blood group So in summary, for this newborn with B(III) Rh+ blood requiring a transfusion, Group B(III) Rh-negative donor blood provides the closest match and lowest risk option. Hope this explanation helps! Let me know if you have any other questions.

104. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patient’s treatment. What index of hospital work can be calculated based upon this data?

A. Bed turnover

B. Bed resources of the hospital

C. Average annual bed occupancy

D. Average duration of patients presence in the hospital

E. Average bed idle time

Answer: Bed turnover

Explanation

Bed turnover is defined as: The number of patients discharged divided by the average number of beds used. It indicates how many times beds were occupied over a period of time. A higher bed turnover means the hospital is treating more patients relative to the number of available beds.

Calculating bed turnover allows the hospital to evaluate: – Efficiency of bed utilization – Adequacy of bed capacity to meet patient demand – Areas where patient flow and discharge processes could be improved In contrast, the other options require additional data: B. Bed resources – would require the total number of beds

C. Bed occupancy – would require the actual number of occupied beds each day D. Duration of stay – would require each patient’s length of stay E. Bed idle time – would require the actual number of empty beds each day Since only the total number of patients and average beds used per year were provided, the index that can be calculated is bed turnover, using that formula:

Bed turnover = (Number of patients discharged) / (Average number of beds used) Hope this explanation helps! Let me know if you have any other questions.

105. A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. Kidney’s contusion

B. Subcapsular kidney’s rupture

C. Multiple kidney’s ruptures

D. Paranephral hematoma

E. Kidney’s abruption

Answer: Kidney’s contusion

Explanation

The key factors that support this: – The patient fell from a height of around 3 meters, landing on his right lumbar (kidney) area – He is complaining of pain in that lumbar region – There is microhematuria (trace blood in the urine), indicating some bleeding from the kidneys –

However, excretory urography showed that kidney function is satisfactory These findings are characteristic of a kidney contusion: – Microhematuria is common due to bruising of the kidney tissue – Pain in the lumbar region is expected with a contused kidney – Yet kidney function typically remains intact, as seen on imaging In contrast: – Subcapsular or multiple kidney ruptures (Options B and C) would be more likely to impair kidney function, which was satisfactory on urography –

A paranephric hematoma (Option D) or kidney abruption (Option E) would show up clearly on imaging, but urography was normal So the combination of: – History of direct trauma to the kidney area – Lumbar pain – Microhematuria –

Normal kidney function on imaging Makes a kidney contusion the most probable diagnosis in this patient, rather than a more severe rupture or hematoma. Hope this explanation is helpful! Let me know if you have any other questions.

106. 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

The key indicators that point to this diagnosis: – The child has weight deficiency, a common feature of cystic fibrosis due to malabsorption and malnutrition. – There is a history of permanent moist cough and recurrent pneumonias with obstruction, both classic symptoms of cystic fibrosis lung disease. – On exam, the chest is distended and there is dullness on percussion, indicating mucus plugging and obstruction within the lungs. –

The presence of multiple rales on auscultation further suggests obstructive lung disease from mucus accumulation. – The high sweat chloride level of 80 mmol/L is strongly suggestive of cystic fibrosis, as elevated sweat chlorides are diagnostic for the condition. In contrast: –

Bronchial asthma (Option B) and recurrent bronchitis (Option C) would not typically cause weight deficiency or an elevated sweat chloride level. – Bronchiectasis (Option D) could be a complication, but would not explain all features on its own, especially the high sweat chloride. –

Pulmonary hypoplasia (Option E) does not match the obstructive lung signs and symptoms described. So the combination of nutritional symptoms, persistently moist cough, obstructive lung findings, and an elevated sweat chloride – in a young child – is highly indicative of cystic fibrosis. The features and test results do not align well with the alternative diagnoses provided. Hope this explanation is helpful! Let me know if you have any other questions.

107. 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

The key details that support this: – The patient is a 14 year old girl with a history of heavy menstrual bleeding since age 12 – She is currently having profuse bleeding and absence of menstruation for 1.5 months. This suggests prolonged, irregular menstrual cycles with excessive blood loss. –

On exam, the internal genitalia appear normal with no obvious pathology. – Her lab results show low hemoglobin (Hb 70 g/L), red blood cell count (RBC 2.3), and hematocrit (Hct 20), consistent with anemia from blood loss. These findings indicate: –

The girl is suffering from excessive menstrual bleeding (menorrhagia) – This has led to post-hemorrhagic anemia due to iron deficiency from the chronic blood loss – The bleeding and anemia are likely from juvenile (functional) causes, given the normal exam and lack of identifiable pathology. In contrast: – Von Willebrand disease (Option B) would show up on coagulation tests – PCOS (Option C) usually presents at a later age and with irregular cycles but not such heavy bleeding –

Ovarian tumor (Option D) would likely cause other symptoms and physical findings – Incomplete abortion (Option E) does not fit the long history of menorrhagia since age 12 So in summary, juvenile bleeding disorder/functional menorrhagia leading to post-hemorrhagic anemia best fits the clinical picture of heavy menstrual bleeding since puberty, normal physical exam, and significant anemia in this 14-year-old girl. Hope this explanation helps! Let me know if you have any other questions.

108. 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 key factors: – The patient had their gallbladder removed (cholecystectomy) 6 years ago for gallstones – They now have right upper quadrant pain and recurrent jaundice for the past 2 weeks – Endoscopy revealed a 0.5 cm stenosis of the papilla of Vater, the opening of the common bile duct These findings suggest: – The patient likely developed stones in the common bile duct after their cholecystectomy – The stenosis of the papilla is due to scarring from these stones obstructing bile flow – T

his obstruction of bile flow is causing the pain, jaundice and recurrent cholangitis Performing endoscopic papillosphincterotomy: – Allows removal of any common bile duct stones causing the obstruction – Corrects the stenosis at the papillary orifice by cutting the muscle ring –

Relieves the blockage of bile flow and resolves the patient’s symptoms Conservative treatment (Option B) would not address the underlying obstruction. External (Option C) or transduodenal (Option D) drainage are higher risk than endoscopic management.

Choledochoduodenostomy (Option E) is a more invasive surgery. So endoscopic papillosphincterotomy – which can be performed safely and effectively – offers the best chance of both diagnosing and treating the likely cause of this patient’s symptoms: common bile duct stones with papillary stenosis after cholecystectomy. Hope this explanation helps! Let me know if you have any other questions.

109. Prevalence of a disease in region N amounted 1156 occurences per 1000 of inhabitants. What of the mentioned indices characterizes the disease prevalence?

A. Intensive

B. Extensive

C. Ratio

D. Visual index

E. Standardized

Answer: Intensive

Explanation

Prevalence is defined as the total number of cases of a disease in a population at a specific point in time. It can be expressed either as an intensive index or an extensive index. An intensive index represents the number of cases per unit of the population. It shows the proportion of the population with the disease.

An extensive index simply reports the total number of cases in the population, without relating it to the population size. In this case, the prevalence of 1156 occurences per 1000 inhabitants is an intensive index. It expresses the number of disease cases per 1000 people in the population. Intensive indices are useful because they allow comparisons of prevalence between populations of different sizes. They indicate the burden of disease independently of the total population.

So the key points are: – Prevalence of 1156/1000 inhabitants expresses the number of cases per unit of the population (1000 people) – This makes it an intensive index, not an extensive index (which would just report 1156 cases) – Intensive indices are more useful for comparing disease burden between different populations –

Ratio, visual index and standardized are not standard terms used to describe prevalence indices. In summary, since the prevalence is expressed as a number of cases per unit of the population (intensive index), the correct answer is A: Intensive. Hope this explanation helps! Let me know if you have any other questions.

110. A patient suffers from chronic recurrent pancreatitis with evident disturbance of exocrinous function. After intake of rich spicy food and spirits his stool becomes fatty. Reduced production of what factor is the most probable cause of steatorrhea?

A. Lipase

B. Tripsin

C. Acidity of gastric juice

D. Amylase

E. Alkaline phosphatase

Answer: Lipase

Explanation

The key details: – The patient has chronic recurrent pancreatitis, indicating longstanding damage to the pancreas – This has resulted in evident disturbance of exocrine pancreatic function – After eating rich, spicy food and alcohol, the patient develops fatty stools (steatorrhea)

These findings suggest: – Impaired production of exocrine enzymes by the pancreas, disrupting fat digestion and absorption – Of the enzymes mentioned, lipase is responsible for the digestion of triglycerides, breaking fats down into fatty acids and monoglycerides that can be absorbed –

Reduced lipase production would allow fats to pass through the digestive tract undigested, leading to fatty stools (steatorrhea) In contrast: – Trypsin (Option B) helps digest proteins, but does not impact fat digestion – Gastric acidity (Option C) is typically normal in pancreatitis – Amylase (Option D) digests carbohydrates and alkaline phosphatase (Option E) is not a digestive enzyme

So the symptom of steatorrhea after eating high-fat meals, in the context of chronic pancreatitis with exocrine dysfunction, is best explained by impaired production of lipase – the pancreatic enzyme directly responsible for digesting and absorbing dietary fats. Reduced lipase is the most probable cause of this patient’s steatorrhea. Hope this explanation helps! Let me know if you have any other questions.

111. A 54 y.o. woman has been ill with osteomyelitis of femoral bone for over 20 years. During the last month there appeared and have been steadily increasing edemata of lower extremities. Urine analysis revealed: proteinuria – 6,6 g/l. Blood analysis: disproteinemia in form of hypoalbuminemia, raise of α2- and γglobulines, ESR- 50 mm/h. What is the most probable diagnosis?

A. Secondary renal amyloidosis

B. Acute glomerulonephritis

C. Myelomatosis

D. Chronic glomerulonephritis

E. Systematic lupus erythematosus

Answer: Secondary renal amyloidosis

Explanation

The key factors that support this: – The patient has a long history of osteomyelitis (bone infection) for over 20 years – She has recently developed progressively worsening edema of the lower extremities – Urine analysis shows significant proteinuria of 6.6 g/L –

Blood tests reveal hypoalbuminemia, elevated alpha-2 and gamma globulins, and an elevated ESR of 50 mm/hr. These findings indicate: – Chronic inflammation from the osteomyelitis, over many years – This likely led to deposition of amyloid protein in the kidneys (secondary amyloidosis), causing the proteinuria – Hypoalbuminemia and abnormal globulins are also characteristic of amyloidosis – The edema and proteinuria developed progressively, reflecting the increasing amyloid deposition In contrast: –

Acute glomerulonephritis (Option B) would not develop over such a protracted course – Multiple myeloma (Option C) usually causes hypercalcemia and Bence Jones proteins – Chronic glomerulonephritis (Option D) would not explain the hypoalbuminemia and globulin changes –

SLE (Option E) typically causes a more varied combination of lab abnormalities So the longstanding nature of the osteomyelitis, combined with the gradually progressive edema, proteinuria, hypoalbuminemia and elevated globulins – in the absence of other typical rheumatologic abnormalities – makes secondary amyloidosis secondary to chronic osteomyelitis the most probable diagnosis in this patient. Hope this explanation helps! Let me know if you have any other questions.

112. 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

The key indicators pointing to this diagnosis: – The patient has a 6 month history of contact bleeding, which is a common symptom of cervical cancer – On bimanual exam, the cervix is enlarged and has reduced mobility, further suggestive of a malignant process –

Mirror exam found the cervix has a “cauliflower” shape, which is characteristic of cervical cancer – Both the Schiller and Chrobak tests are positive, indicating the presence of abnormal, precancerous cells on the cervix In contrast: – A cervical polyp (Option B) would not likely produce positive Pap smear tests or cause immobility of the cervix – Cervical pregnancy (Option C) would present with primary amenorrhea and severe pain, which are not mentioned –

fibroid (Option D) would cause bulk symptoms but not contact bleeding or abnormal cervical cytology – Leukoplakia (Option E) mainly affects the vagina, vulva or glands; it is rare on the cervix So the combination of contact bleeding, enlarged immobile cervix with a cauliflower appearance, and positive Chrobak and Schiller tests – in the absence of signs of other cervical pathology – strongly suggests cervical cancer as the most probable diagnosis in this patient. Hope this explanation helps! Let me know if you have any other questions.

113. After a long periode of subfebrility a patient registered increase of dyspnea, pain in the right hypochondrium, leg edemata. Objectively: neck veins are edematic. Ps is 120 bpm, sometimes it disappears during inspiration. Heart sounds are very weakened. ECG showed lowvoltage waves of ventricular complex. A month ago there was raise of ST V1 − V4 segment. Cardiac silhouette is enlarged, roundish. What is the most probable diagnosis?

A. Exudative pericarditis

B. Small-focal myocardial infarction

C. Postinfarction cardiosclerosis

D. Metabolic postinfection myocardiopathy

E. Primary rheumatic carditis

Answer: Exudative pericarditis

Explanation

Based on the presented symptoms and objective findings, the most probable diagnosis is exudative pericarditis. The patient has been experiencing subfebrile temperature for a long period, which could suggest an ongoing inflammatory process.

The increase in dyspnea and pain in the right hypochondrium could be due to the accumulation of fluid in the pericardial sac, which can cause compression of the lungs and liver. The edema in the legs and neck veins may also be an indication of fluid overload.

The presence of a weakened heart sound, along with a rapid heart rate that disappears during inspiration, could be signs of cardiac tamponade, which is a medical emergency. The low voltage waves of the ventricular complex on ECG and the enlarged, roundish cardiac silhouette are also consistent with pericarditis. Therefore, the most probable diagnosis in this case is exudative pericarditis.

114. 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

The most appropriate medication for reducing sympathoadrenal attacks in a child with vegetovascular dystonia of pubertal period is Obsidan (propranolol). Obsidan is a beta-adrenergic receptor blocker that can help reduce the symptoms of sympathoadrenal attacks, such as rapid heart rate, sweating, and anxiety. It works by blocking the effects of adrenaline and noradrenaline on the heart and blood vessels, which can help to lower blood pressure and heart rate.

No-shpa (drotaverine) is a spasmolytic that is used to relieve smooth muscle spasms. It is not indicated for the treatment of sympathoadrenal attacks. Amisyl (etifoxine) is an anxiolytic that is used to treat anxiety disorders. While it may help to reduce anxiety-related symptoms, it is not indicated for the treatment of sympathoadrenal attacks. Euphyllin (aminophylline) is a bronchodilator and a vasodilator that is used to treat respiratory conditions.

It is not indicated for the treatment of sympathoadrenal attacks. Corglicone (trimetazidine) is an anti-ischemic agent that is used to treat angina pectoris and other conditions that result from impaired blood flow to the heart. It is not indicated for the treatment of sympathoadrenal attacks.

Therefore, the most appropriate medication for reducing sympathoadrenal attacks in a child with vegetovascular dystonia of pubertal period is Obsidan (propranolol). However, the use of any medication should be discussed with a qualified healthcare professional.

115. A patient consulted a doctor about acure respiratory viral infection. The patient was acknowledged to be off work. The doctor issued him a medical certificate for 5 days. The patient is not recovering. What measures should the doctor take in order to legalize the further disability of patient?

A. To prolong the medical certificate at his own discretion but no more than for 10 days in total

B. To prolong the medical certificate at his own discretion but no more than for 6 days in total

C. To prolong the medical certificate together with department superintendent

D. To send the patient to the medical consultative commission

E. To send the patient to the medical social expert comission

Answer: A. To prolong the medical certificate at his own discretion but no more than for 10 days in total

Explanation

If the patient is not recovering after the initial 5-day medical certificate for acute respiratory viral infection, the doctor may need to take additional measures to legalize the further disability of the patient. According to typical medical practice in many countries, the doctor may prolong the medical certificate at their own discretion, but no more than for a total of 10 days.

This would mean that the doctor can issue an additional medical certificate to cover the period beyond the initial 5-day certificate, but not for more than an additional 5 days.

If the patient’s condition does not improve after the additional 5-day certificate, the doctor may need to consider other options, such as referring the patient to a medical consultative commission or a medical social expert commission. However, this would depend on the specific regulations and procedures in the country where the patient is located.

Therefore, the most appropriate measure for the doctor to take in order to legalize the further disability of the patient in this scenario is to prolong the medical certificate at their own discretion, but no more than for 10 days in total.

116. A 58 y.o. patient complains of weakness, leg edemata, dyspnea, anorexia. He has been suffering from chronic bronchitis for many years. During the last 5 years he has been noting intensified discharge of sputum that is often purulent. Objectively: RR- 80/min, AP120/80 mm Hg. Disseminated edemata, skin is dry and pale, low turgor. In urine: intense proteinuria, cylindruria. Specify the most probable pathological process in kidneys:

A. Renal amyloidosis

B. Chronic glomerulonephritis

C. Chronic pyelonephritis

D. Interstitial nephritis

E. Acute glomerulonephritis

Answer: Renal amyloidosis

Explanation

Based on the presented symptoms and objective findings, the most probable pathological process in the kidneys is renal amyloidosis. Renal amyloidosis is a disorder in which abnormal protein deposits, called amyloid, accumulate in the kidneys and other organs.

It can cause proteinuria, or the presence of excess protein in the urine, as well as cylindruria, where casts made of protein and other substances form in the kidney tubules and are excreted in the urine. The patient in this case has a history of chronic bronchitis and has been experiencing intensified discharge of purulent sputum for the past 5 years, which suggests an ongoing chronic inflammatory process in the body.

The presence of disseminated edema, dry and pale skin with low turgor, and intense proteinuria with cylindruria are all consistent with renal amyloidosis. Chronic glomerulonephritis and chronic pyelonephritis are also possible causes of proteinuria and cylindruria, but they are less likely in this case given the patient’s history of chronic bronchitis and the absence of symptoms such as flank pain, fever, or urinary tract infections.

Interstitial nephritis, which is an inflammation of the kidney tubules, can also cause proteinuria and cylindruria, but it is typically accompanied by symptoms such as fever, rash, and eosinophilia, which are not mentioned in this case. Acute glomerulonephritis, which is a sudden inflammation of the glomeruli in the kidneys, can also cause proteinuria and cylindruria, but it typically presents with symptoms such as hematuria, hypertension, and oliguria, which are not mentioned in this case. Therefore, based on the presented symptoms and objective findings, the most probable pathological process in the kidneys in this case is renal amyloidosis.

117. A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability. His anamnesis registers frequent respiratory diseases. On percussion: heart borders are dilatated to the left and upwards. On auscultation: amplification of the SII above pulmonary artery, a harsh systolodyastolic “machine”murmur is auscultated between the II and the III rib to the left of breast bone, this murmur is conducted to all other points including back. AP is 100/20 mm Hg. What is the most probable diagnosis?

A. Opened arterial duct

B. Interventricular septal defect

C. Isolated stenosis of pulmonary arterial orifice

D. Interatrial septal defect

E. Valvar aortic stenosis

Answer: Opened arterial duct

Explanation

Based on the presented symptoms and objective findings, the most probable diagnosis is opened arterial duct (patent ductus arteriosus or PDA).

PDA is a congenital heart defect where a fetal blood vessel, called the ductus arteriosus, fails to close after birth. This results in abnormal blood flow between the aorta and the pulmonary artery, causing an increase in pulmonary blood flow and a decrease in systemic blood flow. The patient in this case has a history of frequent respiratory diseases, which may be related to the increased pulmonary blood flow.

The dilatation of heart borders to the left and upwards on percussion, amplification of SII above the pulmonary artery on auscultation, and the harsh systolodiastolic “machine” murmur between the II and III rib to the left of the breast bone that is conducted to all other points including back are all consistent with PDA.

Interventricular septal defect (IVSD), isolated stenosis of pulmonary arterial orifice, and valvar aortic stenosis are also possible causes of heart murmurs in children, but they typically present with different auscultatory findings.

Interatrial septal defect (IASD) may also cause a heart murmur, but it is usually associated with a fixed split of the second heart sound which is not present in this case. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is opened arterial duct (patent ductus arteriosus or PDA).

118. A patient was admitted to the hospital with complaints of periodical pain in the lower part of abdomen that gets worse during menses, weakness, malaise, nervousness, dark bloody smears from vagina directly before and after menses. Bimanual examination revealed that uterus body is enlarged, appendages cannot be palpated, posterior fornix has tuberous surface. Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and pararectal fat have “cyanotic eyes”. What is the most probable diagnosis?

A. Disseminated form of endometriosis

B. Polycystic ovaries

C. Chronic salpingitis

D. Tuberculosis of genital organs

E. Ovarian cystoma

Answer: Disseminated form of endometriosis

Explanation

Based on the presented symptoms and objective findings, the most probable diagnosis is disseminated form of endometriosis. Endometriosis is a condition where the tissue that normally lines the inside of the uterus (endometrium) grows outside of the uterus, such as on the ovaries, fallopian tubes, or other pelvic structures.

This can cause pain, irregular bleeding, and infertility. The patient in this case presents with periodical pain in the lower part of the abdomen that gets worse during menses, which is a common symptom of endometriosis. The presence of dark bloody smears from the vagina directly before and after menses is also consistent with endometriosis.

Bimanual examination revealed an enlarged uterus body and a tuberous surface of the posterior fornix, which are also consistent with endometriosis. The laparoscopic findings of “cyanotic eyes” on the ovaries, peritoneum of rectouterine pouch, and pararectal fat are characteristic of endometriosis. In this case, the distribution of the lesions suggests a disseminated form of endometriosis, where the endometrial tissue has spread widely throughout the pelvic cavity.

Polycystic ovaries, chronic salpingitis, tuberculosis of genital organs, and ovarian cystoma are all possible differential diagnoses, but they are less likely given the presented symptoms and laparoscopic findings. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is disseminated form of endometriosis.

119. 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

For a patient with hemophilia B-type who is undergoing surgery for acute destructive appendicitis, fresh frozen plasma should be included in the pre- and post-operative treatment plan as an antihemophilic medicine.

Fresh frozen plasma contains clotting factors, including factor IX, which is deficient in hemophilia B. Administration of fresh frozen plasma can help to replace these clotting factors and reduce the risk of bleeding complications during and after surgery.

Cryoprecipitate, native plasma, and dried plasma are other blood products that can be used to treat hemophilia B, but fresh frozen plasma is typically preferred for surgical prophylaxis due to its higher concentration of clotting factors. Fresh frozen blood is not typically used in the treatment of hemophilia B as it mainly contains red blood cells and lacks clotting factors.

Therefore, in the case of a 19-year-old patient with hemophilia B-type who is undergoing surgery for acute destructive appendicitis, fresh frozen plasma should be included in the pre- and post-operative treatment plan as an antihemophilic medicine.

120. A 28 y.o. patient who has no permanent residence was admitted to the hospital with preliminary diagnosis “influenza”, on the 5-th day of disease there are appeared maculopapular and petechial rash on his body and internal surfaces of his extremities. Body temperature is 410, euphoria, hyperemic face, scleras reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A. Spotted fever

B. Delirium alcoholicum

C. Leptospirosis

D. Measles

E. Typhoid fever

Answer: Spotted fever

Explanation

Based on the presented symptoms and objective findings, the most probable diagnosis is spotted fever. Spotted fever is a bacterial infection caused by various species of the genus Rickettsia. It is transmitted to humans through the bite of infected ticks. The disease typically presents with symptoms such as fever, headache, muscle aches, and a characteristic maculopapular rash that may spread to the trunk, palms, and soles of the feet. Petechiae may also be present in severe cases.

The patient in this case initially presented with symptoms of influenza, but the appearance of the maculopapular and petechial rash on the 5th day of illness, along with a high fever, hyperemic face, scleral reddening, tongue tremor, tachycardia, splenomegaly, and excitement, are all consistent with spotted fever.

Delirium alcoholicum, leptospirosis, measles, and typhoid fever are all possible differential diagnoses, but they are less likely given the presented symptoms and objective findings. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is spotted fever.

121. 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

Based on the presented symptoms and objective findings, the most probable diagnosis is recent acute ascending gonorrhea. Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It can affect the cervix, urethra, rectum, and throat.

The patient in this case presents with pain in the lower part of the abdomen, fever, mucopurulent discharges from the genital tracts, and painful urination, which are all consistent with gonorrhea. The vaginal examination reveals a hyperemic and erosive cervix, a painful uterus and ovaries, and an infiltrated urethra, which are all indicative of an acute inflammatory process.

The presence of diplococci on bacterioscopy is also consistent with gonorrhea. Trichomoniasis, candidiasis, chronic gonorrhea, and chlamydiosis are all possible differential diagnoses, but they are less likely given the presented symptoms and objective findings. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is recent acute ascending gonorrhea.

122. An infant is 2 d.o. It was full-term born with signs of intrauterine infection, that’s why it was prescribed antibiotics. Specify, why the gap between antibiotic introductions to the new-born children is longer and dosage is smaller compared to the older children and adults?

A. The newborns have a lower level of glomerular filtration

B. The newborns have lower concentration of protein and albumins in blood

C. The newborns have reduced activity of glucuronil transferase

D. The newborns have diminished blood pH

E. The newborns have bigger hematocrit

Answer: The newborns have a lower level of glomerular filtration

Explanation

The gap between antibiotic introductions to newborn children is longer and the dosage is smaller compared to older children and adults because newborns have a lower level of glomerular filtration. The kidneys are responsible for filtering and excreting medications from the body.

In newborns, the level of glomerular filtration, which is the rate at which the kidneys filter blood, is lower compared to older children and adults. This means that drugs, including antibiotics, are eliminated from the body more slowly in newborns.

Therefore, a longer gap between antibiotic introductions and a smaller dosage are necessary to prevent drug accumulation and potential toxicity. The reduced activity of glucuronil transferase, lower concentration of protein and albumins in blood, diminished blood pH, and bigger hematocrit may also affect drug metabolism, distribution, and elimination in newborns, but the lower level of glomerular filtration is the primary factor that affects antibiotic dosing in newborns.

Therefore, the gap between antibiotic introductions to newborn children is longer and the dosage is smaller compared to older children and adults because newborns have a lower level of glomerular filtration.

123. A district doctor keeps the record of reconvalescents after infectious diseases, people who are disposed to frequent and long-lasting diseases, patients with chronic pathologies. What category of patients should belong to the III health group?

A. People with chronic diseases

B. People disposed to frequent and longlasting diseases

C. People with chronic pathologies and disposed to frequent and long-lasting diseases D. Reconvalescents after infectious diseases and patients with chronic pathologies

E. All above mentioned categories

Answer: People with chronic diseases

Explanation

The health groups are used to classify individuals based on their health status and the level of medical and social assistance they require. The III health group typically includes individuals with chronic diseases that require ongoing medical care and management.

People disposed to frequent and long-lasting diseases, patients with chronic pathologies, and reconvalescents after infectious diseases and patients with chronic pathologies may also require medical attention and ongoing management, but they may not necessarily have a chronic disease that requires continuous care. Therefore, based on the given information, the III health group should include people with chronic diseases.

124. 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

The normal weight gain for infants varies depending on their age, birth weight, and feeding method. According to the World Health Organization (WHO) growth charts, the average weight of a 2-month-old infant is around 5 kg, with a range of 4.2-6.2 kg. In this case, the child was born at a normal weight of 3500 g and has gained 1400 g in 2 months.

This weight gain is within the normal range for a 2-month-old infant, and therefore the current weight of the child corresponds to the age. Hypotrophy refers to a failure to thrive or inadequate weight gain, while paratrophy refers to excessive weight gain.

Neither of these conditions applies to the child in this case, as the weight gain is within the normal range for the age. Therefore, based on the presented information, the current weight of the 2-month-old child, which is 4900 g, corresponds to the age.

125. A 46 y.o. patient complains of colicky pain in the right lumbar region that is irradiating to the lower part of abdomen, nausea. She didn’t have such pains before. Survey radiograph of abdominal cavity organs didn’t reveal any pathological stains. Ultrasonic sonogram revealed in the enlarged right renal pelvis a hyperechoic mass approximately 1,5 cm large that gives rise to an “ultrasonic track”. What is the most probable diagnosis?

A. Renal calculus

B. Benign tumor of kidney

C. Renal cyst

D. Renal tuberculosis

E. Malignant tumor of kidney

Answer: Renal calculus

Explanation

Renal calculus, also known as kidney stone, is a common condition that can cause colicky pain in the flank or lower abdomen. The pain may be accompanied by nausea and vomiting. The pain can occur suddenly and may be severe.

In this case, the patient complains of colicky pain in the right lumbar region that is radiating to the lower part of the abdomen, along with nausea. The ultrasound revealed an enlarged right renal pelvis with a hyperechoic mass that is approximately 1.5 cm large and gives rise to an “ultrasonic track.”

These findings are consistent with a renal calculus. A benign or malignant tumor of the kidney may also present with similar symptoms, but the ultrasound findings are not consistent with a solid mass. Renal cysts are usually asymptomatic and are unlikely to cause colicky pain.

Renal tuberculosis is rare in developed countries and is typically associated with other symptoms such as hematuria and weight loss. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is renal calculus.

126. A woman consulted a doctor on the 14-th 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

Lactational mastitis is a common condition that can occur in breastfeeding women. It is caused by inflammation or infection of the breast tissue, often due to milk stasis or a cracked nipple. Symptoms may include sudden onset of breast pain, redness, swelling, and a flu-like illness with fever and headache.

In this case, the patient presented with sudden pain, hyperemia, and induration of the left mammary gland, along with a high fever, headache, and indisposition. The presence of a fissure of the nipple and pain on palpation are also consistent with lactational mastitis.

Lacteal cyst with suppuration, fibrous adenoma, and breast cancer are less likely given the presented symptoms and objective findings. A lacteal cyst is a benign lesion that is usually asymptomatic and does not cause systemic symptoms.

Fibrous adenoma and breast cancer are solid masses that are not typically associated with fever or flu-like symptoms. Phlegmon of the mammary gland is a possible differential diagnosis, but it is less likely given the presence of a fissure of the nipple, which suggests lactational mastitis as the underlying cause.

Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is lactational mastitis.

127. A 42 y.o. patient complains of weakness, heartbeat, nasal hemorrhages, cutaneous hemorrhages. His condition has been worsening progressively for a month. Objectively: grave condition, the extremities and body skin has spotted and petechial hemorrhages, lymph nodes are not palpable, Ps- 116/min, liver is +2 cm enlarged, spleen is not palpable. Blood has evident pancytopenia. What disease should you think about first of all?

A. Hypoplastic anemia

B. Acute leukosis

C. Werlhof’s disease

D. Hemorrhagic vasculitis

E. Acute agranulocytosis

Answer: Hypoplastic anemia

Explanation

Hypoplastic anemia is a rare disorder characterized by a decrease in the production of red blood cells, white blood cells, and platelets in the bone marrow. It can result in pancytopenia, which is a reduction in all three blood cell types.

The symptoms of hypoplastic anemia include weakness, fatigue, increased heart rate, and bleeding tendencies, such as nasal hemorrhages and cutaneous hemorrhages. In this case, the patient complains of weakness, increased heart rate, and bleeding tendencies, such as nasal hemorrhages and cutaneous hemorrhages.

The objective findings reveal spotted and petechial hemorrhages on the skin, liver enlargement, and pancytopenia on the blood test. These symptoms and objective findings are consistent with hypoplastic anemia. Acute leukosis,

Werlhof’s disease (also known as immune thrombocytopenic purpura), hemorrhagic vasculitis, and acute agranulocytosis are possible differential diagnoses, but they are less likely given the presented symptoms and objective findings. Therefore, based on the presented symptoms and objective findings, the most probable diagnosis in this case is hypoplastic anemia.

128. A 63 y.o. patient was operated on account of big multinodular euthyroid goiter. Despite of techical difficulties a forced subtotal resection of both parts of the thyroid gland was performed. On the 4-th day after the operation the woman had cramps of face muscles and upper extremities, stomach ache. Positive Chvostek’s and Trousseau’s signs. What is the most probable cause of such condition?

A. Insufficiency of parathyroid glands

B. Postoperative hypothyroidism

C. Thyrotoxic crisis

D. Injury of recurrent nerve

E. Tracheomalacia

Answer: Insufficiency of parathyroid glands

Explanation

The most probable cause of the patient’s condition is insufficiency of parathyroid glands, which is also known as hypoparathyroidism. Chvostek’s sign is a contraction of facial muscles in response to tapping on the facial nerve, while Trousseau’s sign is carpopedal spasm that occurs after inflating a blood pressure cuff above systolic pressure. Both of these signs are characteristic of hypocalcemia, which is a common complication of hypoparathyroidism.

During thyroid surgery, there is a risk of injury or accidental removal of the parathyroid glands, which are small glands located near the thyroid gland that play a crucial role in calcium homeostasis. If the parathyroid glands are damaged or removed, the patient may develop hypoparathyroidism, leading to hypocalcemia, which can cause the symptoms described in the question. Therefore, option A (Insufficiency of parathyroid glands) is the most likely cause of the patient’s symptoms.

129. A girl 13 y.o. 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 the girl’s bloody discharge is menarche, which is the first menstrual period in girls. The onset of menarche usually occurs between the ages of 11 and 14 years, and it is characterized by the appearance of vaginal bleeding.

The bleeding may be light or heavy, and it may be accompanied by abdominal cramps, mood swings, and other symptoms. Given that the girl is 13 years old and has developed secondary sexual characteristics, it is likely that she has reached puberty and is experiencing her first menstrual period. Therefore, option A (Menarche) is the most probable cause of the girl’s bloody discharge. The other options listed in the question are less likely causes of the girl’s symptoms.

Juvenile hemorrhage (option B) refers to abnormal bleeding from the uterus that occurs in girls before the onset of puberty, while haemophilia (option C) is a rare genetic disorder that affects blood clotting and is more commonly seen in males.

Endometrial cancer (option D) is extremely rare in young girls, and Werlhof’s disease (option E), also known as idiopathic thrombocytopenic purpura, is a bleeding disorder that is characterized by low platelet counts and is typically not associated with vaginal bleeding.

130. A 30 y.o. victim of fire has thermal burns of III-A and III-B degree that amount 20% of total skin coverlet. AP is 110/70 mm Hg, HR- 120/min. What transfusion means shoul be used for blind infusion correction during transportation?

A. Salines

B. Polyglucine

C. 10% glucose solution

D. Fresh frozen plasma

E. Albumin

Answer: Salines

Explanation

For blind infusion correction during transportation of a burn victim with thermal burns of III-A and III-B degree, the most appropriate transfusion solution would be Salines, also known as normal saline or 0.9% sodium chloride solution.

Salines are a sterile, isotonic solution that contains sodium chloride and water in a concentration similar to that of human blood. They are commonly used for fluid resuscitation in burn patients to replace lost fluids and electrolytes and to maintain blood pressure.

The other options listed in the question are less appropriate for fluid resuscitation in this scenario. Polyglucine (option B) is a type of synthetic colloid solution that is not commonly used for fluid resuscitation in burn patients.

10% glucose solution (option C) is a hypertonic solution that is not appropriate for fluid resuscitation in burn patients because it can cause cellular dehydration. Fresh frozen plasma (option D) is a blood product that is not typically used for fluid resuscitation in burn patients unless there is evidence of coagulopathy.

Albumin (option E) is a type of colloid solution that may be used for fluid resuscitation in some cases, but it is not the first-line choice for burn patients and may be associated with potential adverse effects. Therefore, option A (Salines) is the most appropriate transfusion solution for blind infusion correction during transportation of a burn victim with thermal burns.

131. 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. in terms of natural light would be the natural light coefficient. The natural light coefficient is a measure of the ratio of natural light to total light in a room, expressed as a percentage.

It is calculated by dividing the natural light intensity by the total light intensity. A higher natural light coefficient indicates a greater proportion of natural light in the room, which can have a positive impact on visual comfort and performance. In this scenario, students are studying during the daylight hours, so the natural light coefficient would be more informative than other factors such as the light coefficient, depth of the study room, time of the room insolation, or presence of mixed (upper-lateral) light.

The light coefficient (option B) is a measure of the ratio of artificial light to natural light in a room, which may not be as relevant in this scenario where the focus is on natural light. The depth of the study room (option C) and time of the room insolation (option D) may be important factors to consider for overall visual comfort, but they do not specifically address the natural light component.

The presence of mixed (upper-lateral) light (option E) may be a relevant factor to consider, but it is not as specific as the natural light coefficient in evaluating the impact of natural light on visual comfort and performance. Therefore, option A (Natural light coefficient) is the most informative index for evaluating the visual regimen of students studying from 9 a.m. to 3 p.m. in terms of natural light.

132. A 25 y.o. man who has been suffering from disseminated sclerosis for 4 years complains of increasing unsteadyness, weakness of his lower extremities, urinary retention. Objectively: central tetraparesis. Cerebellar ataxia. Disturbed function of pelvic organs. What is the most appropriate therapy in this case?

A. Glucocorticoids

B. Antibiotics

C. Nootropics

D. Desensitizing medications

E. Vitamins

Answer: Glucocorticoids

Explanation

The most appropriate therapy for a 25-year-old man with disseminated sclerosis who presents with increasing unsteadiness, weakness of lower extremities, urinary retention, central tetraparesis, cerebellar ataxia, and disturbed function of pelvic organs would be glucocorticoids.

Disseminated sclerosis, also known as multiple sclerosis (MS), is an autoimmune disorder that affects the central nervous system and can lead to a wide range of neurological symptoms.

Glucocorticoids, such as methylprednisolone, are commonly used in the treatment of acute exacerbations of MS to reduce inflammation and improve symptoms. In this case, the patient’s symptoms suggest that he is experiencing an acute exacerbation of his MS, and glucocorticoids would be the most appropriate therapy to address the underlying inflammation and reduce the severity of his symptoms.

Antibiotics (option B) would not be appropriate in this case, as MS is not caused by a bacterial infection. Nootropics (option C) and desensitizing medications (option D) are not commonly used in the treatment of MS. Vitamins (option E) may be beneficial in managing symptoms of MS, but they would not be the first-line therapy for an acute exacerbation. Therefore, option A (Glucocorticoids) is the most appropriate therapy for this patient with an acute exacerbation of disseminated sclerosis.

133. 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

The main psychopathologic syndrome in the case of a 70-year-old man with ischemic heart disease who is experiencing symptoms of depressed mood, anxiety, sleeplessness, fears, suicidal thoughts, and physical manifestations of suffering, pain, and fear would be depressive syndrome.

Depressive syndrome is a group of symptoms that are commonly associated with depression, including depressed mood, loss of interest or pleasure in activities, insomnia or hypersomnia, feelings of worthlessness or guilt, decreased energy, and suicidal ideation. In this case, the patient’s symptoms of depressed mood, anxiety, sleeplessness, fears, and suicidal thoughts suggest that he is experiencing a depressive syndrome.

Paranoid syndrome (option B), asthenic syndrome (option C), phobic syndrome (option D), and obsessive syndrome (option E) are less likely to be the main psychopathologic syndrome in this case, as the patient’s symptoms are more consistent with depressive syndrome. Paranoid syndrome is characterized by delusions of persecution or grandeur, while asthenic syndrome is characterized by fatigue, weakness, and lack of energy.

Phobic syndrome is characterized by persistent and irrational fears, and obsessive syndrome is characterized by intrusive and repetitive thoughts or behaviors. Therefore, option A (Depressive syndrome) is the most likely main psychopathologic syndrome in this case of a 70-year-old man with ischemic heart disease who is experiencing symptoms of depressed mood, anxiety, and suicidal thoughts.

134. A 32 y.o. patient has been suffering from systematic scleroderma for 14 years. She was repeatedly exposed to treatment in the in-patient department. Complains of periodical dull cardiac pain, dyspnea, headache, eyelid edemata, weight loss, pain and deformation of extremities joints. What organ’s lesion deteriorates the prognosis for the disease?

A. Kidneys

B. Heart

C. Lungs

D. Gastrointestinal tract

E. Skin and joints

Answer: Kidneys

Explanation

In a 32-year-old patient with systemic scleroderma who has been suffering from the disease for 14 years and presents with periodic dull cardiac pain, dyspnea, headache, eyelid edema, weight loss, and pain and deformation of extremity joints, the organ lesion that would deteriorate the prognosis for the disease would be the kidneys. Systemic scleroderma is an autoimmune disease that can affect multiple organs and tissues, including the skin, blood vessels, lungs, heart, gastrointestinal tract, and kidneys.

The kidneys are particularly vulnerable to damage in systemic scleroderma, as the disease can cause fibrosis and narrowing of the blood vessels that supply the kidneys, leading to renal insufficiency and failure. In this case, the patient’s symptoms suggest that she may be experiencing renal involvement, such as hypertension, proteinuria, or decreased renal function. Renal involvement in systemic scleroderma is associated with a poorer prognosis and increased mortality, so it is important to monitor kidney function and manage any renal complications promptly.

While skin and joint involvement (option E) are common in systemic scleroderma, they are not necessarily associated with a poorer prognosis. Heart involvement (option B) and lung involvement (option C) can be serious and life-threatening in systemic scleroderma, but renal involvement is generally considered to be a more significant prognostic factor.

Gastrointestinal tract involvement (option D) can also be a complication of systemic scleroderma, but it is unlikely to be the primary factor affecting the prognosis in this case. Therefore, option A (Kidneys) is the organ lesion that would deteriorate the prognosis for systemic scleroderma in this patient.

135. A 2 m.o. child with birth weight 5100 g has jaundice, hoarse cry, umbilical hernia, physical development lag. Liver is +2 cm enlarged, spleen is not enlarged. In anamnesis: delayed fallingaway of umbilical cord rest. In blood: Hb- 120 g/L, erythrocytes – 4, 5 · 1012/L, ESR- 3 mm/h. Whole serum bilirubin is 28 mcmole/L, indirect – 20 mcmole/L, direct – 8 mcmole/L. What is the most probable diagnosis?

A. Congenital hypothyreosis

B. Congenital hepatitis

C. Hemolitic anemia

D. Conjugated jaundice

E. Cytomegalovirus infection

Answer: Congenital hypothyreosis

Explanation

In a 2-month-old child with jaundice, hoarse cry, umbilical hernia, physical development lag, an enlarged liver (+2 cm), and delayed falling away of the umbilical cord rest, the most probable diagnosis would be congenital hypothyroidism. Congenital hypothyroidism (CH) is a condition in which there is a deficiency of thyroid hormone production that is present at birth.

It can cause a wide range of symptoms, including jaundice, hoarse cry, umbilical hernia, physical development lag, and an enlarged liver. CH can also cause delayed falling away of the umbilical cord rest.

The blood test results in this case show a normal hemoglobin level and erythrocyte count, as well as a low erythrocyte sedimentation rate (ESR). The serum bilirubin levels are elevated, with an indirect bilirubin level higher than the direct bilirubin level, suggesting unconjugated or indirect hyperbilirubinemia.

Congenital hepatitis (option B) and cytomegalovirus infection (option E) are less likely in this case, as the child’s liver function tests are normal and there are no other symptoms or risk factors to suggest viral infection. Hemolytic anemia (option C) is also less likely, as the child’s hemoglobin level and erythrocyte count are normal, and there are no other signs of hemolysis. Conjugated jaundice (option D) is also less likely, as the direct bilirubin level is only mildly elevated compared to the indirect bilirubin level.

Therefore, the most probable diagnosis in this case would be congenital hypothyroidism (option A), which is a common cause of neonatal jaundice, and can also cause hoarse cry, umbilical hernia, and physical development lag.

136. A 13 y.o. girl complains of having temperature rises up to febrile figures for a month, joint ache, periodical skin rash. Examination revealed steady enhancing of ESR, LE-cells. What is the most probable diagnosis?

A. Systematic lupus erythematosus

B. Juvenile rheumatoid arthritis

C. Systematic scleroderma

D. Acute lymphoblast leukosis

E. Rheumatics

Answer: Systematic lupus erythematosus

Explanation

In a 13-year-old girl with temperature rises up to febrile figures for a month, joint ache, and periodic skin rash, along with steady enhancement of ESR and LE-cells, the most probable diagnosis would be systemic lupus erythematosus (SLE). SLE is an autoimmune disease that can affect multiple organs and tissues, including the skin, joints, and blood vessels.

It is characterized by a wide range of symptoms, including fever, joint pain, skin rash, and increased levels of inflammatory markers such as ESR and LE-cells. SLE is more common in females than males, and it often presents in adolescence or young adulthood.

Juvenile rheumatoid arthritis (option B) is another possible diagnosis, as it can also cause joint pain and fever in children and adolescents. However, the periodic skin rash and increased inflammatory markers make SLE a more likely diagnosis in this case.

Systemic scleroderma (option C) is less likely, as it is more commonly seen in adults and is characterized by skin thickening, Raynaud’s phenomenon, and internal organ involvement. Acute lymphoblastic leukemia (option D) is also less likely, as it typically presents with symptoms such as fatigue, fever, and bleeding, rather than joint pain and skin rash. Rheumatism (option E) is a non-specific term that can refer to a variety of musculoskeletal conditions, and it is not a specific diagnosis.

Therefore, the most probable diagnosis in this case would be systemic lupus erythematosus (option A), which is a common autoimmune disease that can cause fever, joint pain, skin rash, and elevated inflammatory markers, particularly in adolescent and young adult females.

137. 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 antibiotics in a 50-year-old woman with chronic pyelonephritis may cause acute renal insufficiency. Gentamicin is an aminoglycoside antibiotic that can cause nephrotoxicity, especially when given for prolonged periods or in combination with other nephrotoxic agents.

Biseptol, also known as trimethoprim-sulfamethoxazole, is a combination of two antibiotics that can also cause renal toxicity, particularly in patients with pre-existing renal impairment.

When given in combination, gentamicin and biseptol can increase the risk of renal toxicity, including acute renal insufficiency. This is particularly true in patients with pre-existing renal impairment, such as those with chronic pyelonephritis. Glomerulosclerosis (option B), chronic renal insufficiency (option C), and acute suprarenal insufficiency (option E) are less likely to be caused by this combination of antibiotics.

Glomerulosclerosis is a type of kidney damage that can be caused by a variety of factors, including hypertension and diabetes, but it is not typically associated with the use of these antibiotics. Chronic renal insufficiency may develop over time with ongoing kidney damage, but it is less likely to be caused by a short course of antibiotics. Acute suprarenal insufficiency is a rare condition that is caused by dysfunction of the adrenal glands, and it is not typically associated with the use of these antibiotics.

Therefore, the combination of gentamicin and biseptol antibiotics in a patient with chronic pyelonephritis may cause acute renal insufficiency (option A), and it is important to monitor renal function closely during treatment to detect any signs of renal toxicity.

138. A patient has been suffering from morning cough accompanied by discharge of small amount of sputum, dyspnea for 8 years. He has been smoking for 10 years. Objectively: cyanosis, prolonged expiration, dry rales. What is the most probable diagnosis?

A. Chronic obstructive bronchitis

B. Chronic non-obstructive bronchitis

C. Idiopatic fibrosing alveolitis

D. Multiple bronchiectasis

E. Bronchial asthma

Answer: Chronic obstructive bronchitis

Explanation

In a patient with a history of morning cough accompanied by the discharge of small amounts of sputum, dyspnea for 8 years, and a 10-year history of smoking, along with cyanosis, prolonged expiration, dry rales on physical examination, the most probable diagnosis would be chronic obstructive bronchitis (COPD).

COPD is a chronic lung disease that is often caused by smoking and is characterized by chronic bronchitis and/or emphysema. Chronic bronchitis is defined as a cough with sputum production for at least 3 months in each of 2 consecutive years. The prolonged expiration, dry rales, and cyanosis observed in this patient are typical features of COPD.

Chronic non-obstructive bronchitis (option B) is a less likely diagnosis, as it is a rare form of bronchitis that is not associated with airflow obstruction or emphysema. Idiopathic fibrosing alveolitis (option C) is a type of interstitial lung disease that typically presents with dyspnea and cough, but it is less likely in this case given the patient’s smoking history and the presence of cyanosis, which are more suggestive of COPD.

Multiple bronchiectasis (option D) is a condition in which the airways become permanently widened and damaged, leading to recurrent infections and cough, but it is less likely in this case given the patient’s symptoms and history. Bronchial asthma (option E) can cause cough and dyspnea, but it is less likely in this case given the patient’s history of smoking and the absence of wheezing on physical examination.

Therefore, the most probable diagnosis in this case would be chronic obstructive bronchitis (option A), which is a common and serious lung disease that is often caused by smoking and can cause chronic cough, sputum production, dyspnea, and other respiratory symptoms.

139. A 70 y.o. patient complains of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area. Objectively: HR- 40 bpm, heart sounds are rhythmic, the S1 is dull, periodically amplified. AP is 180/90 mm Hg. What is the most probable cause of hemodynamic disturbances?

A. Atrioventricular block type III

B. Atrioventricular block type I

C. Bradysystolic form of ciliary arrhythmia

D. Sinus bradycardia

E. Complete left bandle-branch block

Answer: Atrioventricular block type III

Explanation

In a 70-year-old patient with complaints of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area, and hemodynamic disturbances such as bradycardia and hypertension, the most probable cause would be atrioventricular block type III.

Atrioventricular block type III, also known as complete heart block, is a condition in which there is a complete block of electrical impulses between the atria and ventricles. This results in a slow and irregular heartbeat, with periods of bradycardia and even asystole.

The symptoms of weakness, dizziness, and unconsciousness are typical of atrioventricular block, as the heart is unable to pump enough blood to meet the body’s demands. On physical examination, the dull and periodically amplified S1 heart sound is also suggestive of atrioventricular block. The high blood pressure (180/90 mm Hg) observed in this patient is likely due to compensatory mechanisms of the body to maintain adequate blood flow despite the slow heart rate.

Atrioventricular block type I (option B) is a less severe form of atrioventricular block, in which there is a delay in the conduction of electrical impulses between the atria and ventricles, but not a complete block. Bradysystolic form of ciliary arrhythmia (option C) is a rare form of arrhythmia that is characterized by a very slow and irregular heartbeat, but it is less likely in this case given the patient’s age and symptoms.

Sinus bradycardia (option D) is a condition in which the heart rate is slower than normal (less than 60 bpm), but it is not typically associated with hemodynamic instability. Complete left bundle-branch block (option E) is a conduction abnormality that can cause a wide QRS complex on the ECG, but it is not typically associated with hemodynamic instability.

Therefore, the most probable cause of hemodynamic disturbances in this patient would be atrioventricular block type III (option A), which is a serious condition that can cause symptoms of weakness, dizziness, and unconsciousness, along with a slow and irregular heartbeat and high blood pressure.

140. A child is 1 y.o. Within the last months after the begining of supplemental feeding the child has appetite loss, diarrhea with massive defecation, sometimes vomiting. Objectively: body temperature is normal. Body weight is 7 kg. Evident pallor of skin, leg edemata, enlarged abdomen. Coprogram shows a lot of fatty acids and soaps. The child was diagnosed with celiac disease and prescribed gluten-free diet. What shoul be excluded from the dietary intake in this case?

A. Cereals – wheat, oats

B. Milk and dairy produce

C. Fruit

D. Animal protein

E. Digestible carbohydrates

Answer: Cereals – wheat, oats

Explanation

In a 1-year-old child with appetite loss, diarrhea with massive defecation, vomiting, evident pallor of skin, leg edema, and an enlarged abdomen, along with fatty acids and soaps in the coprogram, the most probable diagnosis would be celiac disease.

Celiac disease is an autoimmune disorder that affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, barley, and rye. The symptoms of celiac disease can vary widely and may include gastrointestinal symptoms such as diarrhea, abdominal pain, and bloating, as well as non-gastrointestinal symptoms such as skin rash, anemia, and growth failure.

In this case, the child’s symptoms and coprogram findings are consistent with celiac disease, and a gluten-free diet has been prescribed. Therefore, the dietary intake of cereals such as wheat and oats (option A) should be excluded from the child’s diet, as these grains contain gluten and can trigger symptoms in individuals with celiac disease.

Milk and dairy produce (option B) do not typically contain gluten and can be included in a gluten-free diet, unless the child also has lactose intolerance or another dairy allergy or sensitivity. Fruits (option C) are also naturally gluten-free and can be included in a gluten-free diet. Animal protein (option D) is also gluten-free and can be included in the diet, as long as it does not contain any gluten-containing ingredients or additives.

Digestible carbohydrates (option E) can also be included in a gluten-free diet, as long as they do not contain gluten-containing grains. Therefore, in this case, cereals such as wheat and oats (option A) should be excluded from the child’s dietary intake, while other food groups such as milk and dairy produce, fruits, animal protein, and digestible carbohydrates can be included in a gluten-free diet.

141. Fluorography of a 45 y.o. man revealed some little intensive foci with indistinct outlines on the top of his right lung for the first time. The patient doesn’t feel worse. He has been smoking for many years. Objectively: pulmonary sound above lungs on percussion, respiration is vesicular, no rales. Blood count is unchanged. What is the most probable diagnosis?

A. Focal pulmonary tuberculosis

B. Peripheral cancer of lung

C. Eosinophilic pneumonia

D. Bronchopneumonia

E. Disseminated pulmonary tuberculosis

Answer: Focal pulmonary tuberculosis

Explanation

In a 45-year-old man with a history of smoking and little intensive foci with indistinct outlines on the top of his right lung detected on fluorography, the most probable diagnosis would be focal pulmonary tuberculosis.

Focal pulmonary tuberculosis is a type of tuberculosis that affects a localized area of the lung and is characterized by small nodules or infiltrates on chest imaging studies. The symptoms of focal pulmonary tuberculosis can be mild or absent, and the diagnosis is usually made based on imaging studies and microbiological testing. In this case, the patient’s fluorography showed little intensive foci with indistinct outlines on the top of his right lung, which are suggestive of focal pulmonary tuberculosis.

The absence of symptoms and normal blood count do not rule out the diagnosis of tuberculosis, as many patients with tuberculosis do not have symptoms or may have only mild symptoms. Peripheral cancer of the lung (option B) is less likely in this case, as it typically presents with a solitary pulmonary nodule or mass on chest imaging studies, which is not consistent with the multiple foci seen in this patient.

Eosinophilic pneumonia (option C) is a rare condition that is characterized by the accumulation of eosinophils in the lungs and can cause cough, dyspnea, and fever, but it is less likely in this case given the absence of symptoms and normal blood count. Bronchopneumonia (option D) is a type of pneumonia that affects multiple areas of the lung and is typically associated with fever, cough, and purulent sputum production, but it is less likely in this case given the absence of symptoms and normal blood count.

Disseminated pulmonary tuberculosis (option E) is a more severe form of tuberculosis that affects multiple areas of the lungs and other organs, and it is less likely in this case given the absence of symptoms and normal blood count. Therefore, the most probable diagnosis in this case would be focal pulmonary tuberculosis (option A), and further diagnostic testing, such as sputum culture and chest CT scan, may be necessary to confirm the diagnosis and determine the extent of the disease.

142. An 8 y.o. boy complains of constant cough along with discharge of greenish sputum, dyspnea during physical activities. At the age of 1 year and 8 months he fell ill for the first time with bilateral pneumonia that had protracted course. Later on there were recurrences of the disease 5-6 times a year, during the remission periods there was constant productive cough. What examination results will be the most important for making a final diagnosis?

A. Bronchography

B. Roentgenography of thorax organs

C. Bacterial inoculation of sputum

D. Bronchoscopy

E. Spirography

Answer: Bronchography

Explanation

In an 8-year-old boy with a history of recurrent pneumonia and constant productive cough, the most important examination for making a final diagnosis would be bronchography. Bronchography is a radiographic imaging technique that involves the administration of contrast material into the airways to visualize the bronchial tree.

This procedure can help to identify any structural abnormalities or blockages in the airways, which may be contributing to the patient’s symptoms. In this case, the patient’s history of recurrent pneumonia and constant productive cough suggest an underlying respiratory condition that may be causing obstruction or inflammation of the airways.

Bronchography can help to identify any structural abnormalities, such as bronchial stenosis or bronchiectasis, which may be contributing to the patient’s symptoms. Roentgenography of thorax organs (option B) can provide information about the presence of pneumonia or other lung abnormalities, but it may not be sufficient to identify any structural abnormalities in the airways.

Bacterial inoculation of sputum (option C) can help to identify the presence of bacterial infection, but it may not provide information about the underlying cause of the recurrent pneumonia. Bronchoscopy (option D) is another imaging technique that involves the insertion of a flexible tube with a camera into the airways, but it may not be appropriate for all patients, especially children.

Spirometry (option E) is a pulmonary function test that can help to assess lung function, but it may not be as useful for identifying structural abnormalities in the airways. Therefore, in this case, the most important examination for making a final diagnosis would be bronchography (option A), which can help to identify any structural abnormalities or blockages in the airways that may be contributing to the patient’s symptoms and recurrent pneumonia.

143. A 35 y.o. patient who suffers from chronic glomerulonephritis and has been hemodialysis-dependent for the last three years developed intermissions of heart activity, hypotension, increasing weakness, dyspnea. ECG showed bradycardia, atrioventricular block type I, high pointed waves T. The day before the flagrant violation of diet took place. What is the most probable cause of these changes?

A. Hyperkaliemia

B. Hyperhydratation

C. Hypokaliemia

D. Hypernatriemia

E. Hypocalciemia

Answer: Hyperkaliemia

Explanation

In a 35-year-old patient with chronic glomerulonephritis and hemodialysis dependency who developed intermissions of heart activity, hypotension, increasing weakness, and dyspnea, along with bradycardia, atrioventricular block type I and high pointed T waves on ECG, the most probable cause of these changes would be hyperkalemia. Hyperkalemia is a condition in which there is an abnormally high level of potassium in the blood, which can cause a wide range of symptoms, including arrhythmias, weakness, and dyspnea.

Patients with chronic kidney disease who are undergoing hemodialysis are at increased risk of developing hyperkalemia, as they are unable to excrete potassium normally and can accumulate potassium between dialysis sessions. In this case, the patient’s history of chronic glomerulonephritis and hemodialysis dependency, along with the recent flagrant violation of diet, suggest that hyperkalemia may be the underlying cause of the patient’s symptoms and ECG changes.

The high pointed T waves on ECG are a characteristic finding in hyperkalemia, and the atrioventricular block type I is also consistent with this diagnosis. Hyperhydration (option B), hypokalemia (option C), hypernatremia (option D), and hypocalcemia (option E) are less likely to be the cause of the patient’s symptoms and ECG changes, given the patient’s history of chronic kidney disease and hemodialysis dependency.

However, it is important to note that these electrolyte imbalances can also occur in patients with chronic kidney disease and may require monitoring and management. Therefore, based on the patient’s history, symptoms, and ECG changes, the most probable cause of these changes would be hyperkalemia (option A), and urgent medical intervention, such as administration of intravenous calcium and/or insulin and glucose, may be necessary to lower the potassium level and prevent further complications.

144. A 60 y.o. patient cpmplains of weakness, dizziness, heaviness in the upper part of abdomen, paresthesia of toes and fingers. Objectively: skin icteritiousness, tongue is crimson, smooth. Hepatomegaly. In blood: Hb- 90 g/l, erythrocytes – 2, 3 · 1012/l, reticulocytes – 0,2%; color index – 1,2, macrocytosis; Jolly’s bodies, Cabot’s ring bodies. What medication is the most appropriate for treatment?

A. Vitamin 12

B. Feroplex

C. Packed red blood cells

D. Prednisolone

E. Dyspherol

Answer: Vitamin 12

Explanation

In a 60-year-old patient with weakness, dizziness, upper abdominal heaviness, paresthesia of toes and fingers, skin icteric, crimson, smooth tongue, hepatomegaly, and laboratory findings consistent with megaloblastic anemia (low Hb, low erythrocyte count, macrocytosis, Jolly’s bodies, Cabot’s ring bodies), the most appropriate medication for treatment would be vitamin B12.

Megaloblastic anemia is a type of anemia that is characterized by the production of abnormally large and immature red blood cells due to a deficiency in vitamin B12 or folate. In this case, the patient’s clinical presentation and laboratory findings are consistent with vitamin B12 deficiency, which can cause neurological symptoms such as paresthesia and weakness, as well as gastrointestinal symptoms such as upper abdominal heaviness and smooth, crimson tongue.

The treatment for vitamin B12 deficiency is vitamin B12 supplementation, which can be given either by injection or orally. In this case, vitamin B12 supplementation is the most appropriate medication for treatment, as it can correct the underlying deficiency and improve the patient’s symptoms and laboratory findings.

Feroplex (option B) is an iron supplement and would not be appropriate for the treatment of megaloblastic anemia. Packed red blood cells (option C) may be necessary in severe cases of anemia, but they will not address the underlying vitamin B12 deficiency.

Prednisolone (option D) is a steroid medication that may be used in some types of anemia, but it is not indicated for the treatment of megaloblastic anemia. Dyspherol (option E) is not a recognized medication for the treatment of anemia. Therefore, in this case, the most appropriate medication for treatment would be vitamin B12 (option A), which can correct the underlying deficiency and improve the patient’s symptoms and laboratory findings.

145. A 30 y.o. primigravida woman has got intensive labor pain every 1-2 minutes that lasts 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?

A. Episiotomy

B. Perineum protection

C. Perineotomy

D. Vacuum extraction of fetus

E. Expectant management

Answer: Episiotomy

Explanation

In a 30-year-old primigravida woman with intensive labor pain every 1-2 minutes, disengagement that has started, and a pale perineum with a height of 4 cm, the most appropriate action in this situation would be episiotomy. Episiotomy is a surgical incision made in the perineum to widen the vaginal opening during childbirth, which can help to prevent perineal tears and reduce the risk of complications such as postpartum hemorrhage. In this case, the pale perineum is a sign of decreased blood flow, which may increase the risk of perineal tears and complications during childbirth.

Therefore, episiotomy is necessary to prevent these complications and facilitate the delivery of the baby. Perineum protection (option B) is a technique used during the second stage of labor to support the perineum and prevent perineal tears, but it may not be sufficient in this case, given the pale perineum and the intensity of the labor pain. Perineotomy (option C) is a surgical incision made in the perineum to facilitate the delivery of the baby, but episiotomy is preferred in this case as it is associated with fewer complications.

Vacuum extraction of the fetus (option D) may be necessary in some cases of difficult delivery, but it is not indicated in this case, as the disengagement has already started and episiotomy is the most appropriate intervention. Expectant management (option E) may be appropriate in some cases of slow or delayed labor, but it is not appropriate in this case given the intensity of the labor pain and the risk of complications. Therefore, in this case, the most appropriate action would be episiotomy (option A) to widen the vaginal opening, prevent perineal tears, and facilitate the delivery of the baby.

146. A doctor of the general practice has registered the following death causes for the previous year: the first place was taken by cardiovascular diseases (60%), the second – by tumors (18%), then – traumas (8,3%) etc. What diagrams will provide the most substantial information about the registered ocurrences?

A. Pie diagram

B. Cartogram

C. Line diagram

D. Circle diagram

E. Column diagram

Answer: Pie diagram

Explanation

In order to represent the proportion of different causes of death registered by a general practice doctor, the most appropriate diagram would be a pie diagram. A pie diagram is a circular chart divided into sectors, with each sector representing a proportion of the whole.

This type of diagram is useful for showing the relative size of different categories or groups, and is often used to represent percentages or proportions. In this case, a pie diagram would be ideal for representing the proportion of different causes of death, as it can clearly show the relative size of each category and how they contribute to the total number of deaths. For example, the largest sector would represent cardiovascular diseases, the second largest sector would represent tumors, and so on.

Other diagrams, such as cartograms (option B), line diagrams (option C), circle diagrams (option D), or column diagrams (option E) could also be used to represent the data, but they may not be as effective as a pie diagram in showing the proportion of different categories.

Cartograms are typically used to represent geographic data, line diagrams are used to show trends over time, circle diagrams are similar to pie diagrams but may not be as clear, and column diagrams are typically used to show quantitative data. Therefore, in this case, a pie diagram would provide the most substantial information about the registered occurrences.

147. A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?

A. Cancer of prostate

B. Prostate sclerosis

C. Urolithiasis, stone of the right lobe of prostate

D. Prostate tuberculosis

E. Chronic congestive prostatitis

Answer: Cancer of prostate

Explanation

In a patient with nycturia, constant boring pain in the perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination, and an enlarged prostate on rectal examination (mostly owing to the right lobe), the most likely diagnosis is cancer of the prostate. Prostate cancer is a malignant tumor that develops in the cells of the prostate gland, which is located below the bladder and in front of the rectum.

It is the most common cancer in men and can cause a variety of urinary symptoms, including weak urine flow, frequent urination, and pain during urination. In this case, the patient’s symptoms and the findings on rectal examination, including an enlarged prostate with a dense, asymmetric, tuberous right lobe and a flattened central sulcus, are highly suggestive of prostate cancer. The presence of pain in the perineum and suprapubic region and the duration of symptoms for several months also support this diagnosis.

Prostate sclerosis (option B) is a benign condition in which the prostate becomes hardened and enlarged, but it does not typically cause the painful and obstructive urinary symptoms seen in this patient. Urolithiasis, or stones in the prostate (option C), can cause similar symptoms, but the asymmetric, tuberous, and dense nature of the prostate on rectal examination suggests a different diagnosis.

Prostate tuberculosis (option D) is a rare condition that can cause similar symptoms, but it is more likely to present with systemic symptoms such as fever and weight loss. Chronic congestive prostatitis (option E) is a non-specific term that refers to inflammation of the prostate gland, but it is less likely to cause the specific findings seen on rectal examination in this case.

Therefore, based on the patient’s symptoms and rectal examination findings, the most likely diagnosis is cancer of the prostate (option A), and further evaluation, such as a prostate-specific antigen (PSA) blood test and a prostate biopsy, may be necessary to confirm the diagnosis and determine the appropriate treatment.

148. A 43 y.o. patient complains of periodical pain attacks in the right half of her face. The attack is characterized by spasm of mimetic muscles of the right face’s half, reddening of skin on this side. Blood has no pathologies. She was diagnosed with right-sided trifacial neuralgia. What medication should be prescribed?

A. Finlepsin

B. Prednisolone

C. Actovegine

D. Analgine

E. Indometacin

Answer: Finlepsin

Explanation

In a 43-year-old patient with periodical pain attacks in the right half of her face, spasm of mimetic muscles of the right face’s half, and reddening of skin on this side, the most appropriate medication to prescribe would be Finlepsin.

Trigeminal neuralgia, also known as tic douloureux, is a condition characterized by sudden, severe, and sharp pain in one side of the face. The pain is often triggered by touch, chewing, or other facial movements. Finlepsin, also known as carbamazepine, is an anticonvulsant medication that is commonly used to treat trigeminal neuralgia. It works by stabilizing the nerve cells and reducing the transmission of pain signals.

Prednisolone (option B) is a steroid medication that has anti-inflammatory properties, but it is not typically used to treat trigeminal neuralgia. Actovegine (option C) is a medication derived from calf blood that is used to improve tissue oxygenation and promote healing, but it is not indicated for the treatment of trigeminal neuralgia. Analgine (option D) is a pain medication that is not typically effective for the severe pain associated with trigeminal neuralgia. Indometacin (option E) is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat pain and inflammation, but it is not typically used to treat trigeminal neuralgia. Therefore, in this case, the most appropriate medication to prescribe would be Finlepsin (option A) to help control the severe pain associated with trigeminal neuralgia.

149. A 35 y.o. patient experienced a strong nervous stress that resulted in formation of reddened and edematic areas on the back surface of her hands with further formation of small inflammated nodules, vesicles and then erosions accompanied by profuse discharge of serous liquid. The process is also accompanied by intense itching. What is the most probable diagnosis?

A. Common eczema

B. Allergic dermatitis

C. Microbial eczema

D. Common contact dermatitis

E. Toxicodermia

Answer: Common eczema

Explanation

In a 35-year-old patient who experienced a strong nervous stress resulting in reddened and edematous areas on the back surface of her hands with the further formation of small inflamed nodules, vesicles, and then erosions accompanied by profuse discharge of serous liquid and intense itching, the most probable diagnosis is common eczema.

Common eczema, also known as atopic eczema or atopic dermatitis, is a chronic inflammatory skin condition characterized by red, itchy, and inflamed patches of skin that can progress to form small, fluid-filled blisters or vesicles. It is often triggered by environmental factors, such as stress, and can be exacerbated by scratching or other forms of skin irritation.

In this case, the patient’s symptoms, including the appearance of inflamed nodules, vesicles, and erosions on the back surface of her hands, along with the presence of a profuse discharge of serous liquid and intense itching, are highly suggestive of common eczema. The fact that the condition was triggered by a nervous stress also supports this diagnosis.

Allergic dermatitis (option B) is a type of eczema that is caused by an allergic reaction to a substance that comes into contact with the skin, such as poison ivy or nickel. Microbial eczema (option C) is a type of eczema that is caused by a bacterial or fungal infection of the skin. Common contact dermatitis (option D) is a type of eczema that is caused by contact with an irritant or allergen, such as soap or latex. Toxicodermia (option E) is a non-specific term that refers to a skin reaction caused by exposure to a toxic substance, such as a medication or chemical.

Therefore, based on the patient’s symptoms and medical history, the most probable diagnosis is common eczema (option A), and treatment may include topical corticosteroids, emollients, and avoiding triggers that exacerbate the condition.

150. A 42 y.o. patient lifted a heavy object that resulted in acute pain in the right half of his chest, increased dyspnea. The patient’s condition is grave: cyanosis of lips and mucous membranes, RR is 28 pm, Ps122 bpm. On percussion there is tympanitis above the right half of chest, on auscultation – stongly diminished breath sounds; accent of the II heart sound above the pulmonary artery. AP is 80/40 mm Hg. What is the main emergency action at the pre-admission stage?

A. Air aspiration from the pleural cavity

B. Adrenaline introduction

C. Aminophylline introduction

D. Calling a cardiological brigade

E. Oxygen inhalation

Answer: Air aspiration from the pleural cavity

Explanation

In a 42-year-old patient who lifted a heavy object resulting in acute pain in the right half of his chest, increased dyspnea, and a grave condition with cyanosis of lips and mucous membranes, rapid respiratory rate, tachycardia, tympanitis on percussion above the right half of the chest, strongly diminished breath sounds, accent of the II heart sound above the pulmonary artery, and low blood pressure, the main emergency action at the pre-admission stage would be air aspiration from the pleural cavity.

The patient’s symptoms and physical examination findings suggest the presence of a tension pneumothorax, which is a medical emergency that can rapidly lead to respiratory failure and death. A tension pneumothorax occurs when air enters the pleural space and cannot escape, leading to a buildup of pressure that compresses the lung and heart on the affected side.

Air aspiration from the pleural cavity, also known as needle decompression or thoracentesis, involves inserting a needle into the pleural space to release the trapped air and relieve the pressure. This procedure should be performed immediately in a patient with a suspected tension pneumothorax to prevent further complications and stabilize the patient’s condition. Adrenaline introduction (option B) is a medication used to treat anaphylaxis and cardiac arrest, but it is not indicated for the treatment of a tension pneumothorax.

Aminophylline introduction (option C) is a medication used to treat asthma and other respiratory conditions, but it is not indicated for the treatment of a tension pneumothorax. Calling a cardiological brigade (option D) may be necessary in some cases, but it is not the main emergency action in a patient with a suspected tension pneumothorax.

Oxygen inhalation (option E) may be helpful in providing respiratory support, but it is not sufficient to treat a tension pneumothorax. Therefore, in this case, the main emergency action at the pre-admission stage would be air aspiration from the pleural cavity (option A) to relieve the pressure and stabilize the patient’s condition.

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