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101. A 40 year old patient complains of yellowish discharges from the vagina. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:

A. Treatment of specific colpitis and subsequent biopsy

B. Diathermocoagulation of the cervix of the uterus

C. Specific treatment of Trichomonas colpitis

D. Cervix ectomy

E. Cryolysis of cervix of the uterus


Answer: Treatment of specific colpitis and subsequent biopsy

Explanation

The most appropriate tactics in this case would be to treat the specific colpitis and perform a subsequent biopsy. The patient’s symptoms of yellowish vaginal discharge and the presence of Trichomonas vaginalis and blended flora on smear suggest an infection, which may be causing the hazy fields seen on colposcopy.   Treatment of the specific colpitis will depend on the underlying cause, which may include antibiotics for Trichomonas vaginalis or other infections.

It is important to perform a subsequent biopsy to rule out any underlying pathology, such as cervical dysplasia or cancer, which may also cause hazy fields on colposcopy.   Diathermocoagulation of the cervix, cervixectomy, cryolysis of the cervix, or other surgical interventions would not be appropriate as the first line of management in this case, as there is no indication of significant cervical pathology at this time.  

It is important for the patient to receive appropriate management of the colpitis and any underlying pathology, as untreated infections or other abnormalities may lead to further complications. The patient should also receive appropriate counseling on safe sex practices and partner treatment to prevent reinfection.


102. A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?

A. Vibration disease

B. Caisson disease

C. Noise disease

D. Overwork symptoms

E. Hypovitaminosis of B1


Answer: Vibration disease

Explanation

The pathology that can be suspected in this case is vibration disease. The patient’s symptoms of pain and tactile sensitivity, particularly in the nail bones at the end of the working day, are consistent with the effects of prolonged exposure to mechanical vibration.  

Vibration disease, also known as hand-arm vibration syndrome, is a condition that can occur in workers who use vibrating tools or machinery for prolonged periods of time. It can cause a range of symptoms including pain, numbness, tingling, and loss of sensation in the hands and fingers, as well as muscle weakness and reduced grip strength.  

Caisson disease, noise disease, overwork symptoms, and hypovitaminosis of B1 can all cause different symptoms and would not be the most likely diagnosis in this case, given the specific symptoms described and the patient’s occupation.  

Management of vibration disease may involve reducing exposure to vibration through changes in work practices or the use of protective equipment, as well as symptom management with medications or physical therapy. It is important for the patient to receive appropriate medical evaluation and management to prevent progression of the disease and potential long-term complications.


103. A 25 year old patient complains about weakness, dizziness, appearance of haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1, 0 · 1012/l, Hb- 37 g/l, colour index – 0,9, leukocytes – 1, 2 · 109/l, thrombocytes – 42 · 109/l. What diagnostic method will be the most effective?

A. Sternal puncture

B. Spleen biopsy

C. Liver biopsy

D. Coagulogram

E. Abdominal ultrasound


Answer: Sternal puncture

Explanation

The most effective diagnostic method in this case would be a sternal puncture. The patient’s symptoms of weakness, dizziness, and haemorrhagic skin rash, along with the blood count findings of severe anaemia, leukopenia, and thrombocytopenia, are suggestive of a serious blood disorder such as aplastic anaemia, myelodysplastic syndrome, or acute leukaemia.  

A sternal puncture, also known as a bone marrow biopsy, involves taking a sample of bone marrow from the sternum to examine the cells and determine the underlying cause of the blood disorder. This procedure is usually performed under local anaesthesia and can provide important diagnostic information.   Spleen biopsy, liver biopsy, coagulogram, and abdominal ultrasound may also be useful diagnostic tools in some cases of blood disorders, but are less likely to provide the information needed to make a definitive diagnosis in this case.  

It is important for the patient to receive appropriate medical evaluation and management, which may include blood transfusions, medications to stimulate blood cell production, or chemotherapy depending on the underlying cause and severity of the disorder. Close monitoring and follow-up care are also important to ensure optimal outcomes.


104. A 28 year old woman had the second labour and born a girl with manifestations of anemia and progressing jaundice. The child’s weight was 3 400 g, the length was 52 cm. The woman’s blood group is B (III) Rh−, the father’s blood group is A (III) Rh+, the child’s blood group is B (III) Rh+. What is the cause of anemia?

A. Rhesus incompatibility

B. Antigen A incompatibility

C. Antigen B incompatibility

D. Antigen AB incompatibility

E. Intrauterine infection


Answer: Rhesus incompatibility

Explanation

The cause of anemia in this case is likely due to Rhesus (Rh) incompatibility between the mother and child. The mother has Rh-negative blood and the father has Rh-positive blood, which means that their child has a 50% chance of inheriting the father’s Rh-positive blood type. If the child is Rh-positive and the mother’s immune system is sensitized to Rh-positive blood, she may produce antibodies that can cross the placenta and attack the baby’s red blood cells, causing hemolytic disease of the newborn.  

The manifestations of anemia and progressing jaundice in the newborn are consistent with hemolytic disease of the newborn, which can occur in cases of Rh incompatibility. The newborn’s blood group of B (III) Rh+ indicates that she has inherited the father’s Rh-positive blood type.  

Antigen A or B incompatibility between the mother and child would not be the cause of anemia in this case, as the mother’s blood group is B and the child’s blood group is also B.   Antigen AB incompatibility is also unlikely, as this would only occur if the mother had blood type AB, which is not the case in this scenario.  

Intrauterine infection may also cause anemia and jaundice in a newborn, but the presence of Rh incompatibility and the newborn’s blood type make this less likely in this case.   Management of hemolytic disease of the newborn may involve close monitoring of the newborn’s bilirubin levels and blood counts, phototherapy to treat jaundice, and exchange transfusions in severe cases. It is important for pregnant women to receive appropriate prenatal care and Rh immune globulin injections to prevent sensitization to Rh-positive blood in future pregnancies.


105. A 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, mydriatic pupils, difficult diglutition, bradycardia, constipation. What is the diagnosis?

A. Botulism

B. Yersiniosis

C. Leptospirosis

D. Salmonellosis, gastrointestinal form

E. Lambliasis


Answer:  Botulism

Explanation

The most likely diagnosis in this case is botulism. The patient’s symptoms of double vision, difficulty breathing, paleness, mydriatic pupils, difficult swallowing, bradycardia, and constipation are consistent with the effects of botulinum toxin, which is produced by the bacteria Clostridium botulinum that can grow on home-made mushrooms.  

Botulism is a rare but serious form of food poisoning caused by ingesting food contaminated with the botulinum toxin. Symptoms usually begin within 6-36 hours after ingestion and can include blurred or double vision, dry mouth, difficulty swallowing and speaking, muscle weakness, respiratory failure, and even death in severe cases.  

Yersiniosis, leptospirosis, salmonellosis, and lambliasis can all cause gastrointestinal symptoms and may be associated with foodborne illness, but would not typically cause the specific symptoms described in this case.   Management of botulism may involve hospitalization for respiratory support and administration of botulism antitoxin, which can help to neutralize the toxin and prevent further damage. It is important for the patient to receive prompt medical attention to prevent severe complications.


106. Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as maximum permissible?

A. 0,1%

B. 0,05%

C. 0,15%

D. 0,2%

E. 0,3%


Answer: 0,1%

Explanation

The maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. The accepted maximum permissible concentration of carbon dioxide in the air is 0.1%, which is equivalent to 1000 parts per million (ppm).  

Carbon dioxide is a naturally occurring gas that is produced by human respiration and combustion processes. High concentrations of carbon dioxide in indoor air can lead to symptoms such as headache, fatigue, and reduced concentration.

Monitoring indoor air quality and ensuring adequate ventilation is important for maintaining a healthy indoor environment, particularly in public buildings such as classrooms where large numbers of people may be present for extended periods of time.  

The maximum permissible concentration of carbon dioxide may vary depending on local regulations and guidelines, but in general, a concentration of 0.1% or less is considered acceptable for maintaining indoor air quality.


107. Study of actual diet of an adult revealed the following: proteins make up 16% of energy value of daily ration, fats – 25%, carbohydrates – 59%. Evaluate compliance of protein, fat and carbohydrate share in the energy value of daily ration with the recommended shares of these nutrients?

A. Carbohydrate share is insufficient, there is excess of proteins

B. Fat share is insufficient

C. Carbohydrate share is insufficicent

D. Carbohydrate share is excessive

E. Nutrient content complies with the recommended shares of energy value


Answer: Carbohydrate share is insufficient, there is excess of proteins

Explanation

The evaluation of the compliance of protein, fat, and carbohydrate share in the energy value of the daily ration with the recommended shares of these nutrients suggests that carbohydrate share is insufficient, and there is an excess of proteins.  

The recommended nutrient intake for an adult is typically around 10-35% of daily energy from protein, 20-35% from fat, and 45-65% from carbohydrates. Based on the information provided, the daily ration contains 16% of energy from protein, 25% from fat, and 59% from carbohydrates.  

The carbohydrate share of 59% is within the recommended range, but the protein share of 16% is at the lower end of the recommended range, and the fat share of 25% is slightly higher than the recommended range.

This suggests that the individual may be consuming an excessive amount of protein and insufficient amount of carbohydrates.   It is important to maintain a balanced diet that provides sufficient amounts of all essential nutrients. Consuming an excessive amount of protein and insufficient carbohydrates can lead to negative health effects, such as ketosis, dehydration, and kidney damage.

Therefore, it may be advisable for the individual to adjust their diet to increase their carbohydrate intake and decrease their protein intake to better align with the recommended nutrient intake.


108. A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimol/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

A. Any dietary changes are necessary

B. Decrease of cholesterol consumption

C. Decrease of saturated fats consumption

D. Decrease of carbohydrates consumption

E. Increase of cellulose consumption


Answer: Any dietary changes are necessary

Explanation

Based on the information provided, it appears that the 75-year-old woman has a healthy lipid profile, with a total cholesterol level of 5.1 millimol/l and an HDL cholesterol level of 70 mg/dl. The ECG also reveals no pathology. Therefore, it is likely that no specific dietary changes are necessary at this time.  

While it is generally recommended to limit consumption of saturated and trans fats, and to increase consumption of fiber-rich foods such as fruits, vegetables, and whole grains, it is important to individualize dietary recommendations based on each person’s specific health status, medical history, and personal preferences.  

In this case, since the woman’s lipid profile and ECG are normal, it may be most appropriate to continue with her current dietary habits and lifestyle, while maintaining regular medical check-ups and monitoring her lipid profile and other health parameters over time.

It is also important for her to maintain an overall healthy and balanced diet, engage in regular physical activity, and avoid smoking and excessive alcohol consumption, which can all help to promote cardiovascular health and overall well-being.


109. Periodical survey of a worker of a chemicals plant revealed a malignant neoplasm on the urinary bladder. This occupational disease was the most probably caused by contact with the following industrial poison:

A. Benzidine

B. Vinyl chloride

C. Nickel carbonyl

D. Asbestos

E. Arsenic


Answer: Benzidine

Explanation

The occupational disease of a malignant neoplasm on the urinary bladder in a worker of a chemicals plant is most probably caused by contact with the industrial poison benzidine.   Benzidine is a chemical used in the production of dyes, pigments, and other industrial products. It is a known carcinogen and has been linked to bladder cancer and other forms of cancer. Exposure to benzidine can occur through inhalation, ingestion, or skin contact.  

Workers in the dye and pigment industry, as well as those involved in the production of rubber, leather, and textiles may be at increased risk of benzidine exposure and associated health risks.   Vinyl chloride, nickel carbonyl, asbestos, and arsenic are also industrial poisons that have been linked to various health risks, including cancer. However, in this case, the presence of a malignant neoplasm on the urinary bladder suggests that benzidine exposure is the most probable cause.  

Preventing exposure to benzidine and other industrial poisons is important for protecting workers’ health and safety. This may involve implementing appropriate workplace safety measures, such as personal protective equipment, ventilation systems, and regular monitoring of occupational health risks.


110. A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?

A. Generation of antithrombocytic antibodies

B. Disturbed hemostasis

C. Deficit of the VIII factor of blood coagulation

D. Inherited insufficiency of plasm factors of blood coagulation

E. Iron deficit in blood serum, bone marrow and depot


Answer: Generation of antithrombocytic antibodies

Explanation

The most probable cause of thrombocytopenic purpura in this case is the generation of antithrombocytic antibodies.   Thrombocytopenic purpura is a disorder characterized by a low platelet count, which can lead to hemorrhagic diathesis and the formation of skin hemorrhages in the form of ecchymoses and spots.

In some cases, thrombocytopenic purpura may be caused by the generation of antithrombocytic antibodies, which can lead to destruction of platelets and decreased platelet production.   Other potential causes of thrombocytopenic purpura include disturbances in hemostasis, deficiencies in blood coagulation factors, and iron deficiency.

However, the presence of hemorrhagic diathesis, skin hemorrhages, and nasal and stomachal hemorrhages, along with a low platelet count, suggests that the most probable cause in this case is the generation of antithrombocytic antibodies.  

Treatment for thrombocytopenic purpura may involve administration of corticosteroids or other immunosuppressive drugs to suppress the immune system and prevent the destruction of platelets. In severe cases, platelet transfusions may also be necessary to restore platelet levels and prevent bleeding complications.


111. A child with tetralogy of Fallot is most likely to exhibit:

A. Increased pressure in the right ventricle

B. Increased pulmonary blood flow

C. Increased pulse pressure

D. Normal pressure gradient across the pulmonary valve

E. Normal oxygen tension (P aO2) in the left ventricle


Answer:  Increased pressure in the right ventricl

Explanation

A child with tetralogy of Fallot is most likely to exhibit increased pressure in the right ventricle.   Tetralogy of Fallot is a congenital heart defect that consists of four abnormalities in the heart’s structure: a ventricular septal defect, pulmonary stenosis, an overriding aorta, and right ventricular hypertrophy.

These abnormalities can cause decreased blood flow to the lungs and decreased oxygenation of the blood.   The pulmonary stenosis in tetralogy of Fallot results in a narrowing of the pulmonary valve, which increases resistance to blood flow from the right ventricle to the pulmonary artery.

This increased resistance causes the right ventricle to work harder to pump blood through the narrowed valve, leading to increased pressure in the right ventricle.   As a result of the increased pressure in the right ventricle, blood is diverted from the right ventricle to the left ventricle through the ventricular septal defect.

This can cause cyanosis and reduced oxygen levels in the blood, leading to symptoms such as shortness of breath, fatigue, and fainting.   Treatment for tetralogy of Fallot typically involves surgical repair to correct the abnormalities in the heart’s structure and restore normal blood flow and oxygenation. In some cases, medications may be used to manage symptoms and improve heart function before or after surgery.


112. In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of patients should be observed. Which of these rights is the most significant?

A. The right to the protection of the patient’s interests

B. The right to the free choice

C. The right to the information

D. The right to be heard

E. The right to the protection from incompetence


Answer: The right to the protection of the patient’s interests

Explanation

In treatment and prevention establishments, regardless of their organizational and proprietary form, the most significant right of patients that should be observed is the right to the protection of the patient’s interests.   The right to the protection of the patient’s interests includes ensuring that healthcare providers and staff act in the patient’s best interest, provide appropriate and timely care, respect the patient’s privacy and dignity, and maintain confidentiality of patient information.  

This right is fundamental to the provision of high-quality healthcare, and it encompasses many other important patient rights, such as the right to informed consent, the right to access medical records, and the right to complain or seek redress for any mistreatment or violations of their rights.  

While other patient rights, such as the right to free choice, the right to information, the right to be heard, and the right to protection from incompetence, are also important, they are all ultimately subsumed under the right to the protection of the patient’s interests. This right serves as the foundation for all other patient rights and is essential for ensuring that patients receive safe, effective, and compassionate care.


113. A military unit stopped for 3-day’s rest in an 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. Melt snow water


Answer: Artesian well water

Explanation

Of the options provided, the most suitable source of water that complies with hygienic standards for drinking water in field conditions would be artesian well water.   Artesian well water is typically free of harmful microorganisms and pollutants, as it is sourced from deep underground aquifers that are protected from surface contamination.

This makes it a safe and reliable source of drinking water in field conditions.   Spring water is also generally considered safe for drinking, but it may be contaminated with microorganisms or pollutants if it is located near sources of pollution or if it has not been properly treated or filtered.  

River water, rainwater, and melt snow water are all susceptible to contamination with harmful microorganisms or pollutants, particularly in field conditions where there may be limited access to water treatment or filtration facilities.

While these sources may be suitable for other purposes, such as washing or irrigation, they may not be safe for drinking without appropriate treatment or filtration.   In general, it is important to ensure that any water source used for drinking in field conditions is properly tested, treated, or filtered to ensure safety and compliance with hygienic standards.


114. A man in grave condition was delivered to the admission ward of a hospital on the 2nd day of illness. Examination revealed body temperature of 36, 1oC, sharpened features of face, dry skin that makes a fold, aphonia, convulsive twitching of some muscle groups. Acrocyanosis is present. Heart sounds are muffled, Ps is 102 bpm, AP is 50/20 mm Hg. Abdomen is soft, drawn-in, painless. Anuria is presnt. Stool is liquid in form of rice water. What is the most probable diagnosis?

A. Cholera

B. Acute dysentery

C. Salmonellosis

D. Escherichiosis

E. Intestinal amebiasis


Answer: Cholera

Explanation

Based on the symptoms described, the most probable diagnosis in this case is cholera.   Cholera is a bacterial infection caused by the bacterium Vibrio cholerae, which is typically spread through contaminated food or water.

Symptoms of cholera can include high-volume watery diarrhea, vomiting, dehydration, muscle cramps, and in severe cases, shock and organ failure.   The symptoms described in the case, including the presence of watery diarrhea, acrocyanosis, muffled heart sounds, low blood pressure, and anuria, are all consistent with severe cholera. The absence of abdominal pain and the presence of liquid stool in the form of rice water, which is a characteristic feature of cholera, also support this diagnosis.  

Treatment for cholera involves aggressive rehydration with oral or intravenous fluids, as well as antibiotics to reduce the duration and severity of symptoms and prevent complications. In severe cases, hospitalization may be necessary to provide supportive care and monitor for signs of dehydration and organ failure.  

Prompt diagnosis and treatment of cholera are essential for reducing the risk of complications and improving outcomes. It is also important to take appropriate measures to prevent the spread of cholera, such as practicing good hygiene, avoiding contaminated food and water, and properly disposing of human waste.


115. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patients’ treatment. What index of hospital work can be calculated on the base of 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

The index of hospital work that can be calculated based on the annual number of treated patients and the average annual number of beds used for patients’ treatment is the bed turnover.   Bed turnover is a measure of the number of times a hospital bed is occupied by different patients over a specified period of time, typically one year.

It is calculated by dividing the total number of patient admissions by the average number of hospital beds.   Bed turnover is an important indicator of hospital efficiency and resource utilization, as it reflects the hospital’s ability to admit and treat patients in a timely manner and make effective use of available beds.

A high bed turnover rate suggests that the hospital is efficiently managing its bed capacity and providing timely care to patients.   Other indices of hospital work that could be calculated based on this data include the average annual bed occupancy, which reflects the percentage of available beds that are occupied by patients over a specified period of time, and the average duration of patients’ presence in the hospital, which reflects the average length of stay for patients.

However, the bed turnover is the most appropriate index to calculate based on the data provided.


116. A 3 year old 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 millimol/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

Based on the symptoms described, the most probable diagnosis in this case is mucoviscidosis, also known as cystic fibrosis.   Cystic fibrosis is an inherited disorder that affects the production and flow of mucus in the body, leading to the buildup of thick, sticky mucus in the lungs, pancreas, and other organs. Symptoms of cystic fibrosis can include persistent coughing, wheezing, recurrent lung infections, and poor growth and weight gain.  

The presence of a permanent moist cough, history of recurrent pneumonias with obstruction, and distended chest with dullness on percussion over the lower parts of lungs suggest the possibility of chronic lung disease, which is common in cystic fibrosis. The great number of different rales on auscultation also supports this diagnosis.  

The level of sweat chloride, which is typically elevated in individuals with cystic fibrosis, further supports this diagnosis. Sweat chloride testing is used to confirm a diagnosis of cystic fibrosis, as elevated sweat chloride levels are a hallmark of the condition.  

Treatment for cystic fibrosis typically involves a combination of therapies to manage symptoms, prevent complications, and improve quality of life. This may include airway clearance techniques, medications to manage lung infections and inflammation, nutritional support, and lung transplant in severe cases. Early diagnosis and treatment are essential for improving outcomes and maximizing the chances of a good quality of life.


117. A 14 year old 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, RBC2, 3 · 1012/l, Ht – 20. What is the most probable diagnosis?

A. Juvenile bleeding, posthemorrhagic anemia

B. Werlholf’s disease

C. Polycyst ovarian syndrome

D. Hormonoproductive ovary tumor

E. Incomplete spontaneous abortion


Answer: Juvenile bleeding, posthemorrhagic anemia

Explanation

Based on the symptoms described, the most probable diagnosis in this case is juvenile bleeding, also known as dysfunctional uterine bleeding, and posthemorrhagic anemia.   Juvenile bleeding is a common cause of abnormal uterine bleeding in adolescents and young women.

It is characterized by irregular, heavy, or prolonged bleeding that occurs outside of normal menstrual periods. The bleeding may be caused by hormonal imbalances or other factors, such as stress or weight changes.  

In this case, the prolonged suppression of menses followed by profuse bloody discharges suggests the possibility of hormonal imbalances or other menstrual irregularities. The recurrence of similar bleedings since the age of 12 further supports this diagnosis. The rectal examination finding of no pathology of the internal genitalia also suggests that the bleeding is likely due to a functional cause rather than a structural abnormality.  

The low hemoglobin, RBC count, and hematocrit levels are consistent with posthemorrhagic anemia, which is a type of anemia caused by acute or chronic blood loss. The prolonged bleeding in this case could have led to iron deficiency anemia, which can cause symptoms such as fatigue, weakness, and shortness of breath.  

Treatment for juvenile bleeding and posthemorrhagic anemia typically involves hormonal therapy to regulate menstrual cycles and reduce bleeding, as well as iron supplementation to address anemia. In some cases, further testing may be necessary to identify any underlying hormonal imbalances or other factors contributing to the bleeding.


118. A 43 year old 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. Stenosing 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

Based on the symptoms described, the best treatment option for this patient would be to perform endoscopic papillosphincterotomy.  

Endoscopic papillosphincterotomy (EPS) is a minimally invasive procedure that involves using an endoscope to access the bile duct and make a small incision in the sphincter of Oddi, which is the muscle that controls the flow of bile from the liver and gallbladder into the small intestine.

This procedure can help to relieve obstructions in the bile duct, which can cause symptoms such as jaundice and abdominal pain.   In this case, the presence of stenosing papillitis, which is a narrowing of the sphincter of Oddi, suggests that an obstruction is preventing the flow of bile from the liver and gallbladder into the small intestine. This can result in recurrent jaundice and abdominal pain. EPS can help to relieve the obstruction and improve the patient’s symptoms.  

Conservative treatment with antibiotics, spasmolytics, and anti-inflammatory drugs may be appropriate in some cases, but it is unlikely to be effective in the long term if there is a structural obstruction in the bile duct. External choledoch drainage and choledochoduodenostomy are more invasive surgical options that may be considered in some cases, but EPS is typically the preferred treatment due to its minimally invasive nature and high success rate.  

Transduodenal papillosphincterotomy is an older surgical technique that is less commonly used today due to its higher risk of complications compared to EPS. Therefore, EPS is the most appropriate and effective treatment option for this patient.


119. A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky’s symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?

A. Exfoliative dermatitis

B. Phlegmon of newborn

C. Finger’s pseudofurunculosis

D. Impetigo neonatorum

E. Mycotic erythema


Answer:  Exfoliative dermatitis

Explanation

Based on the symptoms described, the most probable diagnosis in this case is exfoliative dermatitis, also known as staphylococcal scalded skin syndrome.   Exfoliative dermatitis is a rare but serious bacterial skin infection that is caused by certain strains of Staphylococcus aureus. It typically affects infants and young children, and is characterized by a widespread rash, fever, and skin peeling. Nikolsky’s sign, which is the ability to cause blistering or sloughing of the skin with slight pressure, is also positive in this condition.  

Scalded skin syndrome is a severe form of exfoliative dermatitis that is characterized by extensive skin peeling and blistering, often accompanied by fever and other signs of systemic illness. The erosive spots, cracks, and areas of peeling skin described in this case are consistent with this condition.  

Phlegmon of the newborn, Finger’s pseudofurunculosis, and mycotic erythema are unlikely diagnoses in this case as they are not typically associated with the symptoms described. Impetigo neonatorum, which is a bacterial skin infection that can occur in newborns, can cause similar symptoms as exfoliative dermatitis, but it typically presents as localized lesions rather than a widespread rash.  

Treatment for exfoliative dermatitis typically involves antibiotics to target the underlying bacterial infection, as well as supportive care to manage symptoms such as fever and pain. In severe cases, hospitalization may be necessary to provide intravenous antibiotics and intensive supportive care. Early diagnosis and treatment are essential for improving outcomes and preventing complications.


120. An outpatient hospital made record of 11600 diseases within one year. Among them influenza and ARD make up 5800, circulatory system diseases – 3480, digestion diseases – 1300, other diseases – 1020. What relative index can be calculated according this data?

A. Extensive

B. Intensive

C. Visualization

D. Correlation

E. –


Answer: Extensive

Explanation

The relative index that can be calculated based on this data is an extensive index.   An extensive index is a measure of the total number or quantity of a particular phenomenon, without regard to any other factors. In this case, the total number of diseases recorded in the outpatient hospital within one year is 11,600.   The number of diseases in each category can be used to calculate the proportion or percentage of diseases in each category relative to the total number of diseases recorded.

For example, the proportion of influenza and ARD cases is 5800/11600, or 50% of all recorded diseases.   However, since an extensive index does not take into account any other factors, it may not provide a complete picture of the underlying trends or patterns in the data. For example, the proportion of diseases in each category may vary depending on the demographic characteristics of the patients, the time of year, or other factors.  

Other types of indices, such as intensive indices or correlation indices, may be more appropriate for analyzing and interpreting the data in a more nuanced way. However, based on the information provided, the most appropriate index to calculate is an extensive index, which simply reflects the total number of diseases recorded in the outpatient hospital within one year.


121. A 35 year old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent “Lotos”. The patient has been using it for a month. She hasn’t suffered from dermatological diseases before. What is the most probable diagnosis?

A. Allergic dermatitis

B. Dermatitis simplex

C. Toxicoallergic dermatitis

D. Microbial eczema

E. Localized neurodermatitis


Answer: Allergic dermatitis

Explanation

Basedon the symptoms described, the most probable diagnosis in this case is allergic dermatitis.   Allergic dermatitis is a type of skin inflammation that occurs in response to an allergen or irritant. In this case, the use of a laundry detergent containing “Lotos” appears to be the trigger for the development of the skin symptoms. The large edema, hyperemia, vesiculation, and maceration of the arm and lower third of the forearm are consistent with an allergic reaction.  

Dermatitis simplex, microbial eczema, and localized neurodermatitis are less likely diagnoses in this case, as they are not typically associated with exposure to specific allergens or irritants. Toxicoallergic dermatitis, which is a type of allergic dermatitis caused by exposure to chemicals or other toxic substances, is a possibility, but the use of the laundry detergent strongly suggests an allergic reaction to one of its components.  

Treatment for allergic dermatitis typically involves avoiding the allergen or irritant that is causing the reaction, as well as using topical or oral medications to relieve symptoms such as itching and inflammation. In some cases, patch testing may be necessary to identify the specific allergen responsible for the reaction. Preventive measures such as using fragrance-free or hypoallergenic laundry detergents may also be helpful in reducing the risk of future allergic reactions.


122. A 32 year old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?

A. Chelicobacterial infection

B. Dietary allergy

C. Autoantibody production

D. Reduced prostaglandin synthesis

E. Disorder of gastric motor activity


Answer: Chelicobacterial infection

Explanation

Based on the symptoms described, the most probable leading mechanism of disease development in this case is chelicobacterial infection.   A chelicobacterial infection is a type of bacterial infection caused by Helicobacter pylori (H. pylori), which is a common cause of peptic ulcer disease. The symptoms of heartburn and epigastric pain that worsen after meals, as well as the presence of a duodenal ulcer detected by endoscopy, are all consistent with this diagnosis.

The positive urease test also supports the presence of H. pylori infection.   Dietary allergy, autoantibody production, reduced prostaglandin synthesis, and disorder of gastric motor activity are all less likely mechanisms of disease development in this case. Food intolerance to eggs and fish may contribute to the patient’s symptoms, but it is unlikely to be the primary cause of the duodenal ulcer.

Autoimmune mechanisms may rarely cause peptic ulcer disease, but this is uncommon. Reduced prostaglandin synthesis and disorder of gastric motor activity are also possible contributing factors, but they are less likely to be the primary cause of the ulcer.  


Treatment for H. pylori infection typically involves a combination of antibiotics and proton pump inhibitors to eradicate the bacteria and promote healing of the ulcer. Lifestyle modifications, such as avoiding trigger foods and reducing stress, may also be helpful in managing symptoms and preventing recurrence of the ulcer.

123. A 48 year old woman complains about weakness, weight loss, appetite loss, headache. The patient had acute glomerulonephritis when she was young. She has been suffering from arterial hypertension since she was 25. She didn’t undergo systematic treatment, consulted a doctor rarely. Examination revealed signs of chronic renal insufficiency of the I stage (creatinine – 0,43 millimole/l). What dietary recommendations are the most reasonable?

A. Restriction of protein consumption

B. Restriction of fat consumption

C. Restriction of carbohydrate consumption

D. Diet with high content of “alkaline”dishes

E. Consumption of higher amounts of liquid


Answer: Restriction of protein consumption

Explanation

Based on the patient’s history of chronic renal insufficiency and hypertension, the most reasonable dietary recommendation in this case would be to restrict protein consumption.   Reducing protein intake is a common dietary recommendation for patients with chronic kidney disease (CKD), as it can help to slow the progression of renal damage and reduce the risk of complications such as cardiovascular disease.

In this case, the patient’s creatinine level suggests mild CKD stage 1, which means that there is some loss of kidney function but it is still relatively mild.   Restricting protein intake can help to reduce the workload on the kidneys and prevent further damage.

The exact amount of protein restriction will depend on the severity of the patient’s kidney disease and other individual factors, such as body weight and activity level. A registered dietitian can work with the patient to develop an individualized nutrition plan that meets her specific needs and preferences.  

Restricting fat or carbohydrate consumption is not typically recommended as a primary dietary intervention for CKD, although some modifications may be necessary depending on the patient’s overall health status and individual needs. A diet with a high content of “alkaline” dishes or consumption of higher amounts of liquid may have some benefits for overall health and well-being, but they are not specific dietary recommendations for CKD.


124. A 50 year old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38oC. She had influenza a week ago. Objectively: Ps – 100 bpm, dropped-beat pulse during inspiration. AP – 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?

A. Exudative pericarditis

B. Myocardium infarction

C. Dilatation cardiomyopathy

D. Myocarditis

E. Stenocardia


Answer: Exudative pericarditis

Explanation

Based on the symptoms and findings described, the most probable diagnosis in this case is exudative pericarditis.   Exudative pericarditis is a type of inflammation of the pericardium, which is the sac that surrounds the heart. It is typically characterized by chest pain, fever, and other signs of systemic illness, as well as muffled heart sounds and other abnormalities on physical examination.

The dropped-beat pulse during inspiration, reduced voltage and ST segment elevation on ECG, extensively enlarged cardiac silhouette on X-ray, and small-amplitude palmus are all consistent with this diagnosis.   Myocardial infarction, dilated cardiomyopathy, myocarditis, and stenocardia are less likely diagnoses in this case, as they typically present with different symptoms and findings.

Myocardial infarction, for example, is typically characterized by severe chest pain, ST segment elevation on ECG, and elevated cardiac enzymes. Dilated cardiomyopathy may cause symptoms such as fatigue and shortness of breath, but it is less likely to cause fever or muffled heart sounds.

Myocarditis may cause similar symptoms to exudative pericarditis, but it is less likely to cause an extensively enlarged cardiac silhouette on X-ray. Stenocardia, or angina pectoris, may cause chest pain and other symptoms similar to exudative pericarditis, but it typically does not cause muffled heart sounds or dropped-beat pulse during inspiration.  

Treatment for exudative pericarditis typically involves addressing the underlying cause of the inflammation, such as a viral infection or autoimmune disorder, and managing symptoms such as chest pain and fever with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine. In severe cases, drainage of the pericardial fluid may be necessary to relieve pressure on the heart.


125. Examination of a 4 month old child revealed some lemon-yellow squamae with fatty crusts on the scalp. What is the most probable diagnosis?

A. Gneiss

B. Milk crust

C. Strophulus

D. Pseudofurunculosis

E. Infantile eczema


Answer: Gneiss

Explanation

Based on the description, the most probable diagnosis in this case is gneiss.   Gneiss, also known as cradle cap, is a common skin condition that affects young infants. It is characterized by the presence of yellowish scales or crusts on the scalp, often with a greasy or oily appearance.

The exact cause of gneiss is not fully understood, but it is thought to be related to an overproduction of sebum, the natural oil that lubricates the skin.   Milk crust, also known as infantile seborrheic dermatitis, is a similar condition that can also cause scaly or crusty patches on the scalp. However, milk crust can also affect other areas of the body, such as the face or diaper area, and may be associated with redness or inflammation.  

Strophulus, pseudofurunculosis, and infantile eczema are less likely diagnoses in this case, as they typically present with different symptoms and findings. Strophulus, also known as “baby heat rash,” is a type of rash that is caused by excessive heat or sweating and is characterized by small red bumps or pimples. Pseudofurunculosis, or “false boils,” is a type of skin infection that can cause tender, red bumps or lesions that resemble boils.

Infantile eczema, also known as atopic dermatitis, is a chronic skin condition that can cause red, itchy, and inflamed patches on the skin, often in the creases of the elbows or knees.   Treatment for gneiss typically involves gentle washing of the affected area with a mild shampoo and regular brushing or combing of the scalp to remove the scales or crusts. In some cases, medicated shampoos or topical creams may be recommended to help reduce inflammation and improve the appearance of the skin.


126. A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages. The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, pallor of skin and mucous membranes. What chemestry test has the greatest diagnostic importance in this case?

A. Blood creatinine

B. Blood bilirubin

C. Blood sodium

D. Uric acid

E. Fibrinogen


Answer:  Blood creatinine

Explanation

Based on the symptoms and findings described, the chemistry test that would have the greatest diagnostic importance in this case is blood creatinine.   The patient’s history of acute glomerulonephritis and current symptoms, including morning headache, nausea, and hypertension, suggest the possibility of renal involvement and kidney damage. Creatinine is a waste product that is normally filtered and excreted by the kidneys, so measuring blood creatinine levels can provide important information about kidney function.  

In this case, a high blood creatinine level would suggest that the patient’s kidney function is impaired, which could be due to a variety of underlying causes, such as glomerulonephritis, kidney infection, or hypertension-related kidney damage. The presence of skin hemorrhages and pallor of skin and mucous membranes may also indicate thrombocytopenia or anemia, which can be a complication of renal disease.  

Blood bilirubin, blood sodium, uric acid, and fibrinogen may also be important diagnostic tests in certain situations, but they are less likely to be the most informative test in this case. Blood bilirubin is typically used to evaluate liver function, while blood sodium and uric acid levels can provide information about electrolyte balance and metabolic function.

Fibrinogen is a protein that is involved in blood clotting and may be elevated in some inflammatory or thrombotic conditions. However, in this case, the patient’s symptoms and history suggest that kidney function is the most important factor to evaluate.


127. A 14 year old child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for attack reduction?

A. Obsidan

B. No-shpa

C. Amysyl

D. Aminophylline

E. Corglicone


Answer: Obsidan

Explanation

Based on the description, the medicine that should be used for attack reduction in this case is Obsidan.   Obsidan, also known as propranolol, is a beta-blocker medication that is commonly used to treat various conditions related to the sympathetic nervous system, including vegetovascular dystonia. It works by blocking the action of certain hormones, such as adrenaline, that can cause the symptoms of a sympathoadrenal attack.  

No-shpa, also known as drotaverine, is a medication that is used to treat spasms in the smooth muscles of the digestive and urinary systems. It is not typically used to treat sympathoadrenal attacks or vegetovascular dystonia.   Amysyl, also known as amyl nitrite, is a medication that is used to treat certain types of chest pain and heart conditions. It is not typically used to treat sympathoadrenal attacks or vegetovascular dystonia.   Aminophylline is a medication that is used to treat respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD).

It is not typically used to treat sympathoadrenal attacks or vegetovascular dystonia.   Corglicone, also known as quinidine, is a medication that is used to treat heart rhythm disorders such as atrial fibrillation or ventricular tachycardia. It is not typically used to treat sympathoadrenal attacks or vegetovascular dystonia.  

Therefore, Obsidan would be the most appropriate medication for reducing the symptoms of a sympathoadrenal attack in a patient with vegetovascular dystonia. However, it is important to note that medication use should be based on individual patient factors and should be prescribed and monitored by a qualified healthcare professional.


128. A 23 year old man complains about face edemata, headache, dizziness, reduced urination, change of urine colour (dark-red). These presentations appeared after pharyngitis. Objectively: face edemata, pale skin, temperature – 37, 4oC; heart rate – 86/min, AP – 170/110 mm Hg. Heart sounds are muffled, the II sound is accentuated above aorta. What etiological factor is probable in this case?

A. β-hemolytic streptococcus

B. Staphylococcus aureus

C. Alpha-hemolytic streptococcus

D. Pyogenic streptococcus

E. Saprophytic staphylococcus


Answer:  β-hemolytic streptococcus

Explanation

Based on the symptoms and findings described, the most probable etiological factor in this case is β-hemolytic streptococcus.   The patient’s symptoms, including face edema, headache, dizziness, reduced urination, and dark-red urine, suggest the possibility of acute glomerulonephritis, which is a type of kidney inflammation that can occur after a streptococcal infection such as pharyngitis. The elevated blood pressure, muffled heart sounds, and accentuated second heart sound above the aorta are also consistent with acute glomerulonephritis.  

β-hemolytic streptococcus is a type of bacteria that is commonly associated with streptococcal infections, including pharyngitis. In some cases, the infection can lead to the development of acute glomerulonephritis, which is thought to be caused by an immune response to the streptococcal antigens.  

Staphylococcus aureus, alpha-hemolytic streptococcus, pyogenic streptococcus, and saprophytic staphylococcus are less likely etiological factors in this case, as they are not commonly associated with acute glomerulonephritis or the symptoms described.  

Treatment for acute glomerulonephritis typically involves managing the underlying infection, such as with antibiotics for streptococcal pharyngitis, and controlling symptoms such as high blood pressure and fluid retention with medications such as diuretics or ACE inhibitors. In severe cases, hospitalization may be necessary for close monitoring and supportive care.


129. A 12 year old girl complains about abrupt weakness, nausea, dizziness, vision impairment. The day before she ate home-made stockfish, beef. Examination revealed skin pallor, a scratch on the left knee, dryness of mucous membranes of oral pharynx, bilateral ptosis, mydriatic pupils. The girl is unable to read a simple text (mist over the eyes). What therapy would be the most adequate in this case?

A. Parenteral introduction of polyvalent antibotulinic serum

B. Parenteral disintoxication

C. Parenteral introduction of antibiotics

D. Gastric lavage

E. Parenteral introduction of antitetanus serum


Answer:  Parenteral introduction of polyvalent antibotulinic serum

Explanation

The symptoms described in the case are consistent with botulism, a serious and potentially life-threatening condition caused by the toxin produced by the bacterium Clostridium botulinum. The ingestion of home-made stockfish and beef may have provided a source of contamination with the bacteria or its spores.  

The most adequate therapy in this case would be parenteral introduction of polyvalent antibotulinic serum. This serum contains antibodies that can neutralize the botulinum toxin and prevent further damage. Antibiotics are not effective against the toxin itself, and gastric lavage may not be effective in removing the toxin that has already been absorbed by the body.

Antitetanus serum would not be effective in treating botulism.   Prompt treatment with polyvalent antibotulinic serum is important in order to prevent further progression of the symptoms and potential respiratory failure. Therefore, the patient should be hospitalized immediately and treated with the serum as soon as possible.


130. A 19 year old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and postoperative treatment plan?

A. Fresh frozen plasma

B. Cryoprecipitate

C. Fresh frozen blood

D. Native plasma

E. Dried plasma


Answer: Fresh frozen plasma

Explanation

The patient in this case has hemophilia B, which is also known as Christmas disease. Hemophilia is a bleeding disorder that is caused by a deficiency or dysfunction of clotting factors. In hemophilia B, there is a deficiency of clotting factor IX. Patients with hemophilia are at increased risk of bleeding during surgical procedures.  

The most appropriate antihemophilic medication for pre- and postoperative treatment of a patient with hemophilia B is fresh frozen plasma. Fresh frozen plasma contains clotting factors, including factor IX, which can help to prevent bleeding during and after surgery.

Cryoprecipitate, fresh frozen blood, and dried plasma may also contain clotting factors, but fresh frozen plasma is the preferred treatment option.   The patient should receive fresh frozen plasma prior to surgery to raise the levels of clotting factors in their blood. The dosage and frequency of administration will depend on the severity of the patient’s hemophilia and the type of surgery being performed. After surgery, the patient should continue to receive fresh frozen plasma until their clotting factors have returned to normal levels.  

It is important to note that the use of antihemophilic medications should be closely monitored by a hematologist or other healthcare professional experienced in the treatment of hemophilia. This is to ensure that the patient receives appropriate and timely treatment to prevent bleeding complications.


131. An 18 year old woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37, 5oC, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal and speculum examination results: 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

The symptoms and examination findings described in the case are consistent with recent acute ascending gonorrhea, which is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae.   The presence of lower abdominal pain, fever, and mucopurulent discharge from the genital tracts indicates an infection of the reproductive system.

The urethral infiltration, hyperemic and erosive cervix, and painful uterus and ovaries are all signs of a bacterial infection, which is confirmed by the presence of diplococci on bacterioscopy.   Trichomoniasis and candidiasis are also sexually transmitted infections that can cause vaginal discharge and discomfort, but they typically do not cause the same degree of inflammation and pain as gonorrhea.

Chronic gonorrhea and chlamydiosis are also possible diagnoses, but the acute onset of symptoms and the presence of diplococci on bacterioscopy suggest a recent infection with Neisseria gonorrhoeae.  

Therefore, the most probable diagnosis in this case is recent acute ascending gonorrhea. The patient should be treated promptly with antibiotics to prevent further complications and transmission of the infection. Sexual partners should also be tested and treated if necessary.  


132. A 26 year old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasn’t applied any contraceptives. What method should be applied in order to specify her diagnosis?

A. Ultrasonic examination

B. Roentgenography of small pelvis organs

C. Palpation of mammary glands and pressing-out of colostrum

D. Bimanual vaginal examination

E. Speculum examination


Answer: Ultrasonic examination

Explanation

Given the patient’s symptoms and recent delivery of a child, there is a possibility that she may be pregnant again. In order to confirm or rule out pregnancy, an ultrasonic examination would be the most appropriate diagnostic method.  

Ultrasound is a non-invasive, safe, and widely available imaging technique that can detect the presence of a gestational sac in the uterus as early as 5-6 weeks after the last menstrual period. It can also provide information about the size and location of the gestational sac, as well as the presence of any abnormalities.   Roentgenography of small pelvis organs and speculum examination are not typically used for diagnosing pregnancy.

Palpation of mammary glands and pressing-out of colostrum may indicate lactation but are not specific for pregnancy. Bimanual vaginal examination may be useful in evaluating the size and position of the uterus, but may not definitively confirm or rule out pregnancy.   Therefore, an ultrasonic examination would be the most appropriate method to confirm or rule out pregnancy in this case. Depending on the results of the ultrasound, further testing or evaluation may be necessary to determine the cause of the patient’s symptoms.


133. A 2 month old full-term child was born 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 current weight of the child is 4900 g, which is within the expected range for a 2-month-old infant. The expected weight gain for a full-term infant during the first 3 months is approximately 20-30 grams per day, or about 600-900 grams per month. Based on the initial weight of 3500 g and the current weight of 4900 g, the infant has gained approximately 1400 g, which is within the expected range.  

Therefore, the current weight of the child is corresponding to the age. Hypotrophy refers to inadequate growth or weight gain, while paratrophy refers to excessive growth or weight gain. Neither of these conditions is present in this case, as the child’s weight is within the expected range for their age and gender.


134. A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39oC, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

A. Lactational mastitis

B. Lacteal cyst with suppuration

C. Fibrous adenoma of the left mammary gland

D. Breast cancer

E. Phlegmon of mammary gland


Answer: Lactational mastitis

Explanation

The symptoms and examination findings described in the case are consistent with lactational mastitis, which is an infection of the breast tissue that can occur during lactation.   The presence of sudden pain, hyperemia, induration, and enlargement of the left mammary gland, as well as the fissure of the nipple, indicate inflammation and infection of the breast tissue. The fever, headache, and indisposition are also common symptoms of lactational mastitis.  

Lactational mastitis is typically caused by bacteria that enter the breast tissue through a cracked or sore nipple. Breastfeeding can also contribute to the development of mastitis if milk is not sufficiently drained from the breast, leading to engorgement and the growth of bacteria in the milk.  

Fibrous adenoma and breast cancer are both types of breast tumors that can cause breast pain and enlargement, but they typically do not present with the acute onset of symptoms seen in lactational mastitis. Lacteal cyst with suppuration and phlegmon of the mammary gland are also possible diagnoses, but lactational mastitis is the most likely cause given the patient’s recent delivery and breastfeeding.  

Therefore, the most probable diagnosis in this case is lactational mastitis. The patient should receive prompt treatment with antibiotics to control the infection, along with measures to help drain the breast, such as frequent breastfeeding or pumping. Pain relievers and warm compresses may also be helpful in reducing discomfort.


135. A 32 year old patient complains about pain in small joints of her hands, paresthesia at the tips of fi- ngers, weakness, difficult diglutition. She has been suffering from this for 13 years. Objectively: face amimia, shortening of nail bones, skin indurations in the area of shoulder girdle are present. Roentgenological examination of lungs revealed basal pneumosclerosis. Fibrogastroscopy revealed esophagus constriction in its cardial part. Blood count: leukocytes – 9, 8 · 109/l, ESR – 22 mm/h, γ-globulin – 22%. What is the most probable diagnosis?

A. Systemic scleroderma

B. Systemic lupus erythematosus

C. Rheumatoid arthritis

D. Dermatomyositis

E. Myxedema


Answer: Systemic scleroderma

Explanation

The symptoms and examination findings described in the case are consistent with systemic scleroderma, which is a rare autoimmune disease that affects the connective tissue and blood vessels.   The presence of pain in the small joints of the hands, paresthesia, weakness, and difficulty swallowing are all symptoms of systemic scleroderma, which can affect multiple organ systems.

The facial amimia, shortening of nail bones, and skin indurations in the area of the shoulder girdle are characteristic physical findings in patients with systemic scleroderma. The esophageal constriction seen on fibrogastroscopy is also a common complication of the disease.   The roentgenological examination of lungs revealing basal pneumosclerosis, elevated ESR, and increased γ-globulin levels are additional findings that support the diagnosis of systemic scleroderma.  

Systemic lupus erythematosus and rheumatoid arthritis are also autoimmune diseases that can affect multiple organ systems, but the symptoms and physical findings described in the case are more consistent with systemic scleroderma. Dermatomyositis is a rare autoimmune disease that primarily affects the muscles and skin, but it is less likely in this case given the absence of muscle weakness or skin rash. Myxedema, which is caused by hypothyroidism, typically presents with different symptoms and physical findings than those described in the case.  

Therefore, the most probable diagnosis in this case is systemic scleroderma. The patient should be referred to a rheumatologist for further evaluation and management. Treatment may include immunosuppressive drugs, physical therapy, and management of complications.


136. A 30 year old woman ill with influenza felt palpitation and dull cardiac pain during moderate physical exercise. Objectively: Ps – 96 bpm, AP – 100/60 mm Hg. The first sound is quiet above the apex, soft systolic murmur is present. What complication is indicated by these clinical presentations?

A. Acute viral myocarditis

B. Acute allergic infectious myocarditis

C. Idiopathic myocarditis

D. Myocardiopathy

E. Neurocirculatory dystonia


Answer: Acute viral myocarditis

Explanation

The clinical presentation described in the case is suggestive of acute viral myocarditis, which is an inflammation of the heart muscle caused by a viral infection.   The palpitations, dull cardiac pain, and soft systolic murmur are all common symptoms of myocarditis, which can lead to a variety of cardiac abnormalities including arrhythmias, heart failure, and valvular dysfunction.

The presence of a soft systolic murmur suggests that there may be a leak of blood across one of the heart valves.   Influenza is a viral infection that can cause myocarditis, particularly in young adults. The combination of influenza and cardiac symptoms strongly suggests that the patient may have developed acute viral myocarditis as a complication of the infection.  

Acute allergic infectious myocarditis, idiopathic myocarditis, and myocardiopathy are all possible diagnoses, but acute viral myocarditis is the most likely cause in this case given the patient’s recent history of influenza.  

Neurocirculatory dystonia is a non-specific diagnosis that refers to a group of symptoms related to dysfunction of the autonomic nervous system, which may include palpitations and other cardiac symptoms. However, the presence of a soft systolic murmur in this case suggests that there may be an underlying cardiac abnormality that is causing the symptoms.   Therefore, the most probable diagnosis in this case is acute viral myocarditis. The patient should be evaluated by a cardiologist and treated


137. A 5 month old boy was born prematurely, he didn’t suffer from any disease at the infant age and later on. Examination at an outpatient’s hospital revealed paleness of skin, sleepiness. Blood count: Hb – 95 g/l, erythrocytes – 3, 5 · 1012/l, reticulocytes – 90/00, colour index – 0,7, osmotic stability of erythrocytes – 0,44-0,33%, serum iron – 4,9 micromole/l. What is the most probable cause of anemia?

A. Iron deficit

B. Hemogenesis immaturity

C. Infectious process

D. Erythrocyte hemolysis

E. B12 deficit

]


Answer:  Iron deficit

Explanation

The most probable cause of anemia in this case is iron deficiency. The low hemoglobin level, decreased erythrocyte count, and low serum iron level are all consistent with iron-deficiency anemia. The low color index and high reticulocyte count suggest that the anemia is hypochromic and likely due to inadequate iron supply for erythropoiesis.  

Premature infants are at increased risk for iron deficiency due to inadequate iron stores at birth and the rapid growth and cellular proliferation that occurs during early infancy. Symptoms of iron-deficiency anemia may include paleness of the skin and general fatigue or sleepiness.  

Hemogenesis immaturity, infectious process, erythrocyte hemolysis, and B12 deficiency are all possible causes of anemia, but are less likely in this case given the laboratory findings and clinical presentation.   Therefore, the most probable cause of anemia in this case is iron deficiency, and the patient should be treated with iron supplements to restore iron stores and alleviate symptoms. Follow-up monitoring of hemoglobin levels and iron status is also recommended.


138. A 13 year old girl 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 bloody discharge in this case is menarche, which is the onset of menstrual periods in adolescent girls.   The age of the patient, development of secondary sexual characteristics, and timing of the onset of the discharge are all consistent with the start of menstruation.

Menarche typically occurs between the ages of 9 and 15 years, and is often associated with mild to moderate bleeding from the genital tract.   Juvenile hemorrhage, haemophilia, endometrial cancer, and Werlhof’s disease (also known as immune thrombocytopenic purpura) are all possible causes of bleeding in adolescents, but are less likely in this case given the absence of other symptoms or risk factors.  

Therefore, the most probable cause of the bloody discharge in this case is menarche. The patient should be advised on menstrual hygiene, and provided with appropriate menstrual products. If the bleeding is excessive or accompanied by severe pain or other symptoms, further evaluation may be necessary to rule out other potential causes.


139. An 8 year old girl complains about joint pain, temperature rise up to 38oC, dyspnea. Objectively: the left cardiac border is deviated by 2,5 cm to the left, tachycardia, systolic murmur on the apex and in the V point are present. Blood count: leukocytes – 20, 0 · 109/l, ESR – 18 mm/h. What sign gives the most substantial proof for rheumatism diagnosis?

A. Carditis

B. Arthralgia

C. Leukocytosis

D. Fever

E. Accelerated ESR


Answer: Carditis

Explanation

The most substantial proof for rheumatism diagnosis in this case is the presence of carditis, which is inflammation of the heart muscle (myocarditis) and/or heart valves (valvulitis).   The leftward deviation of the cardiac border, tachycardia, and systolic murmur on the apex and in the V point are all indicative of carditis.

Carditis is a major diagnostic criteria for rheumatic fever, which is an inflammatory disease that can develop following a group A streptococcal infection.   Arthralgia, fever, leukocytosis, and accelerated ESR are all common findings in rheumatic fever, but are less specific than the presence of carditis.  

Therefore, the most substantial proof for rheumatism diagnosis in this case is the presence of carditis. The patient should be evaluated by a cardiologist and treated with appropriate antibiotics and anti-inflammatory medications to manage the acute symptoms and prevent further complications. Long-term management may also be necessary to prevent recurrent episodes of rheumatic fever.


140. During inspection of sanitary conditions of studying at a 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 (superolateral) light


Answer:  Natural light coefficient

Explanation

The most informative index of natural light for evaluating the visual regimen of students in this case would be the natural light coefficient.   The natural light coefficient is a measure of the amount of natural light that enters a space, expressed as a ratio of the luminous flux of natural light to the total luminous flux in the space. It takes into account the size and orientation of windows, as well as the transparency of any shading devices or glazing.  

In this case, the natural light coefficient would be the most informative index because it directly reflects the amount of natural light available to the students during their study period. A higher natural light coefficient indicates that there is more natural light entering the space, which can have positive effects on visual comfort, mood, and productivity.  

The other indices listed (light coefficient, depth of study room, time of room insolation, and presence of mixed light) may also be relevant to evaluating the visual regimen of students, but are less specific to the amount of natural light available in the space.   Therefore, the natural light coefficient would be the most informative index of natural light for evaluating the visual regimen of students in this case.


141. A 70 year old man is suffering from coronary 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 this case is likely a depressive syndrome. The patient’s evident depression, anxiety, sleeplessness, fears, and suicidal thoughts are all characteristic symptoms of depression.   In addition, the patient’s slow speech, low monotonous voice, and facial expression of suffering, pain, and fear are all consistent with a depressive syndrome.

The patient’s tendency to sit in the same pose for long periods of time may also be a symptom of depression.   Paranoid syndrome, asthenic syndrome, phobic syndrome, and obsessive syndrome are all possible diagnoses, but are less likely given the patient’s symptoms and clinical presentation.  

Therefore, the most probable diagnosis in this case is a depressive syndrome, and the patient should be evaluated by a mental health professional and treated with appropriate medications and/or psychotherapy to manage the symptoms and improve quality of life.


142. A 37 year old farmer complains about general weakness, spastic pain in the lower parts of his abdomen, mainly in the left iliac area, frequent defecations up to 18 times a day, feces contain admixtures of mucus and blood. The illness began abruptly 3 days ago with chill, fever, headache. General condition is moderately severe, body temperature is 37, 8oC. Sigmoid colon is spasmed and painful. What is the most probable diagnosis?

A. Dysentery

B. Amebiasis

C. Nonspecific ulcerative colitis

D. Yersiniosis E. Salmonellosis


Answer: Dysentery

Explanation

The most probable diagnosis in this case is dysentery, which is an infectious disease of the gastrointestinal tract caused by certain types of bacteria, such as Shigella, that can lead to inflammation and ulceration of the colon.  

The patient’s clinical presentation of general weakness, spastic pain in the lower abdomen, frequent defecations with mucus and blood in the stool, and moderately severe fever are all consistent with dysentery. The spasmed and painful sigmoid colon is also a characteristic finding in dysentery.  

Amebiasis, nonspecific ulcerative colitis, yersiniosis, and salmonellosis are all possible differential diagnoses, but are less likely in this case given the acute onset of symptoms and presence of blood and mucus in the stool, which are more specific to dysentery.  

Therefore, the most probable diagnosis in this case is dysentery, and the patient should be evaluated by a healthcare provider and treated with appropriate antibiotics and supportive care to manage the symptoms and prevent complications.


143. A 3 year old child fell acutely ill, body temperature rose up to 39, 5oC, the child became inert, there appeared recurrent vomiting, headache. Examination revealed positive meningeal symptoms, after this lumbal puncture was performed. Spinal fluid is turbid, runs out under pressure, protein concentration is 1,8 g/l; Pandy reaction is +++, sugar concentration is 2,2 millimole/l, chloride concentration – 123 millimole/l, cytosis is 2, 35 · 109 (80% of neutrophils, 20% of lymphocytes). What is the most probable diagnosis?

A. Purulent meningitis

B. Serous viral meningitis

C. Serous tuberculous meningitis

D. Subarachnoid haemorrhage

E. Brain tumour


Answer: Purulent meningitis

Explanation

The most probable diagnosis in this case is purulent meningitis, which is a bacterial infection of the meninges that can cause inflammation and swelling of the brain and spinal cord.   The patient’s clinical presentation of high fever, lethargy, recurrent vomiting, and headache, along with positive meningeal symptoms, are all consistent with purulent meningitis.

The turbid appearance of the spinal fluid, high protein concentration, and positive Pandy reaction are also characteristic findings of purulent meningitis. The high neutrophil count in the cerebrospinal fluid is also suggestive of a bacterial infection.  

Serous viral meningitis, serous tuberculous meningitis, subarachnoid hemorrhage, and brain tumor are all possible differential diagnoses, but are less likely in this case given the presence of bacterial infection markers in the cerebrospinal fluid.   Therefore, the most probable diagnosis in this case is purulent meningitis, and the patient should be treated with appropriate antibiotics and supportive care to manage the symptoms and prevent complications.


144. A 39 year old patient suffering from hypertension felt suddenly intense headache in the region of occiput; there appeared recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps – 88 bpm, AP – 205/100 mm Hg, painfulness of occipital points, rigidity of occipital muscles are present. Kernig’s symptom is bilaterally positive. Subarachnoid haemorrhage is also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?

A. Lumbar puncture

B. Examination of eye fundus

C. Ultrasonic dopplerography

D. EEG

E. Computer tomography


Answer:  Lumbar puncture

Explanation

The diagnostic method of greatest importance for confirmation of the provisional diagnosis in this case is lumbar puncture.   The patient’s sudden onset of intense headache in the region of occiput, recurrent vomiting, high blood pressure, painfulness of occipital points, and rigidity of occipital muscles are all suggestive of subarachnoid hemorrhage, which is a type of stroke caused by bleeding into the space between the brain and the membranes that cover it.  

The presence of bilateral positive Kernig’s sign is also indicative of subarachnoid hemorrhage. Lumbar puncture is the most important diagnostic method for confirming the diagnosis of subarachnoid hemorrhage, as it allows for the examination of the cerebrospinal fluid for the presence of blood, which is a hallmark of this condition.  

Examination of the eye fundus, ultrasonic dopplerography, EEG, and computer tomography may also be useful in evaluating the patient’s condition and ruling out other potential causes of the symptoms, but are less specific to subarachnoid hemorrhage than lumbar puncture.  

Therefore, lumbar puncture is the diagnostic method of greatest importance for confirmation of the provisional diagnosis in this case. The patient should be evaluated and treated by a neurologist and/or neurosurgeon as soon as possible to manage the symptoms and prevent complications.


145. A 10 year old girl complains about abdominal pain that is arising and getting worse after eating rough or spicy food. She complains also about sour eructation, heartburn, frequent constipations, headache, irritability. She has been suffering from this for 12 months. Objectively: the girl’s diet is adequate. Tongue is moist with white deposit at the root. Abdomen is soft, painful in its epigastric part. What study method will help to make a diagnosis?

A. Esophagogastroduodenoscopy

B. Intragastral pH-metry

C. Fractional examination of gastric juice

D. Contrast roentgenoscopy

E. Biochemical blood analysis


Answer: Esophagogastroduodenoscopy

Explanation

The study method that will help to make a diagnosis in this case is esophagogastroduodenoscopy (EGD).   The patient’s complaints of abdominal pain, sour eructation, heartburn, and constipation, along with the presence of white deposit on the tongue and epigastric pain on examination, are all suggestive of gastroesophageal reflux disease (GERD), which is a condition in which the stomach acid flows back into the esophagus and causes irritation and inflammation.  

EGD is the most useful diagnostic method for evaluating GERD, as it allows for direct visualization of the esophagus, stomach, and duodenum to look for signs of inflammation, ulceration, or other abnormalities.   I

ntragastral pH-metry and fractional examination of gastric juice may also be useful in evaluating GERD, but are less specific and less commonly used than EGD.   Contrast roentgenoscopy and biochemical blood analysis are generally not as useful for diagnosing GERD as they do not provide direct visualization of the affected organs.  

Therefore, esophagogastroduodenoscopy is the study method that will help to make a diagnosis in this case. The patient should be evaluated and treated by a gastroenterologist to manage the symptoms and prevent complications.


146. A 35 year old patient who suffers from chronic glomerulonephritis and has been hemodialysis-dependent for the last three years developed intermissions of heart activity, hypotension, progressing 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

The most probable cause of these changes is hyperkalemia, which is a condition characterized by abnormally high levels of potassium in the blood.   The patient’s chronic glomerulonephritis and dependence on hemodialysis make them more susceptible to hyperkalemia, which can occur due to the accumulation of potassium in the blood as a result of kidney failure and/or failure to adhere to dietary restrictions.  

The patient’s intermissions of heart activity, hypotension, progressing weakness, dyspnea, and ECG findings of bradycardia, atrioventricular block type I, and high pointed T waves are all consistent with hyperkalemia. The flagrant violation of diet the day before may have contributed to the development of hyperkalemia in this case.   Hyperhydration, hypokalemia, hypernatremia, and hypocalcemia are all possible differential diagnoses, but are less likely given the patient’s clinical presentation and medical history.  

Therefore, the most probable cause of these changes is hyperkalemia, and the patient should be evaluated and treated by a nephrologist and/or cardiologist to manage the symptoms and prevent complications, such as arrhythmias and cardiac arrest.


147. A 34 year old coal miner who has been in service for 10 years was discharged from an occupational disease clinic after examination and treatment. He was diagnosed with the I stage of anthracosilicosis, peribronchitis, 0 stage of respiratory failure. What expert decision should be taken about his working capacity?

A. He should be referred to the local medical expert comission for determination of his disability group for the period of re-training

B. He can continue working as coal miner provided that sanitary and hygienic conditions are observed

C. He should be given medical certificate for the further out-patient treatment

D. He should stay on the sick-list to consolidate treatment results

E. He should be referred to the local medical expert comission for determination of percentage of working capacity loss

]


Answer: A. He should be referred to the local medical expert comission for determination of his disability group for the period of re-training

Explanation

The most probable cause of these changes is hyperkalemia, which is a condition characterized by abnormally high levels of potassium in the blood.   The patient’s chronic glomerulonephritis and dependence on hemodialysis make them more susceptible to hyperkalemia, which can occur due to the accumulation of potassium in the blood as a result of kidney failure and/or failure to adhere to dietary restrictions.  

The patient’s intermissions of heart activity, hypotension, progressing weakness, dyspnea, and ECG findings of bradycardia, atrioventricular block type I, and high pointed T waves are all consistent with hyperkalemia. The flagrant violation of diet the day before may have contributed to the development of hyperkalemia in this case.  

Hyperhydration, hypokalemia, hypernatremia, and hypocalcemia are all possible differential diagnoses, but are less likely given the patient’s clinical presentation and medical history.   Therefore, the most probable cause of these changes is hyperkalemia, and the patient should be evaluated and treated by a nephrologist and/or cardiologist to manage the symptoms and prevent complications, such as arrhythmias and cardiac arrest.


148. A 52 year old woman complains about face distortion. It appeared 2 days ago after supercooling. Objectively: body temperature is 38, 2oC. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn’t close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes – 10 · 109/l, ESR – 20 mm/h. What is the most probable diagnosis?

A. Facial neuritis

B. Trigeminus neuralgia

C. Hemicrania (migraine)

D. Ischemic stroke

E. Brain tumour


Answer: Facial neuritis

Explanation

The most probable diagnosis in this case is facial neuritis, also known as Bell’s palsy, which is a condition characterized by sudden onset of facial muscle weakness or paralysis.   The patient’s complaint of face distortion, which appeared after supercooling, along with the presence of asymmetry, flattened frontal folds, and weakness/paralysis of the left eye, left nasolabial fold, and mouth corner, are all consistent with facial neuritis. The absence of other pathologies on examination and blood count findings are also suggestive of facial neuritis.  

Trigeminal neuralgia, hemicrania (migraine), ischemic stroke, and brain tumor are all possible differential diagnoses, but are less likely given the specific symptoms and signs of facial neuritis in this case.  

Therefore, the most probable diagnosis in this case is facial neuritis, and the patient should be evaluated and treated by a neurologist to manage the symptoms and prevent complications. Treatment may include corticosteroids, antiviral medications, and/or physical therapy to improve facial muscle function.


149. A patient complained about general weakness, fever, painful rash on his trunk skin . He has been suffering from this for 3 days. Objectively: lateral surface of trunk on the left is hyperemic and edematic, there are some groups of vesicles with serous and haemorrhagic contents. What is the most probable diagnosis?

A. Herpes zoster

B. Contact dermatitis simplex

C. Contact allergic dermatitis

D. Microbial eczema

E. Herpetiform Duhring’s dermatosis

Answer: Herpes zoster


 Explanation

The most probable diagnosis in this case is herpes zoster, also known as shingles, which is a viral infection caused by the reactivation of the varicella-zoster virus (VZV) that causes chickenpox.  

The patient’s complaints of general weakness, fever, and painful rash on the trunk skin, along with the presence of hyperemia, edema, and vesicles with serous and hemorrhagic contents, are all consistent with herpes zoster. The distribution of the rash on one side of the body is also a characteristic finding of herpes zoster.  

Contact dermatitis simplex, contact allergic dermatitis, microbial eczema, and herpetiform Duhring’s dermatosis are all possible differential diagnoses, but are less likely given the specific symptoms and signs of herpes zoster in this case.  
Therefore, the most probable diagnosis in this case is herpes zoster, and the patient should be evaluated and treated by a healthcare provider to manage the symptoms and prevent complications, such as postherpetic neuralgia. Treatment may include antiviral medications, pain relievers, and/or topical treatments to relieve itching and discomfort.


150. Internal obstetric examination of a parturient woman revealed that the sacrum hollow was totally occupied with fetus head, ischiadic spines couldn’t be detected. Sagittal suture is in the straight diameter, occipital fontanel is directed towards symphysis. In what plane of small pelvis is the presenting part of the fetus?

A. Plane of pelvic outlet

B. Wide pelvic plane

C. Narrow pelvic plane

D. Plane of pelvic inlet

E. Over the pelvic inlet


Answer: Plane of pelvic outlet

Explanation

Based on the information provided, the presenting part of the fetus is in the plane of pelvic outlet.   The fact that the sacrum hollow is totally occupied with the fetal head, and the ischial spines cannot be detected, suggests that the fetal head has descended into the pelvis and is in the lowermost part of the birth canal.

The sagittal suture being in the straight diameter and the occipital fontanel directed towards the symphysis also support the conclusion that the fetal head is in the plane of pelvic outlet.   Therefore, the presenting part of the fetus is in the plane of pelvic outlet. This information is important for assessing progress during labor and for determining the optimal delivery position for the mother and baby.
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