Question From ( 101 To 150 )
101. 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
| In a patient with hemophilia B who is undergoing surgery for acute destructive appendicitis, fresh frozen plasma (Option A) is the most appropriate antihemophilic medication to include in the pre- and postoperative treatment plan. Hemophilia B is a genetic disorder that affects blood clotting, specifically the clotting factor IX. Patients with hemophilia B are at increased risk of bleeding both spontaneously and following surgical procedures. Fresh frozen plasma contains various clotting factors, including factor IX, and can be used to replace these factors in patients with hemophilia B. Cryoprecipitate (Option B) is another blood product that contains clotting factors, including factor IX, but it is less commonly used than fresh frozen plasma and may be less readily available. Fresh frozen blood (Option C) and native plasma (Option D) are not typically used in the treatment of hemophilia B, as they do not provide concentrated levels of the specific clotting factors that are deficient in this disorder. Dried plasma (Option E) is a blood product that has been freeze-dried and is designed to be reconstituted with water before use. It is not typically used in the treatment of hemophilia B, as fresh frozen plasma is generally preferred due to its higher concentration of clotting factors. It is important for patients with hemophilia B to receive appropriate antihemophilic therapy before and after surgery to minimize the risk of bleeding complications. The specific treatment plan will depend on the patient’s individual needs and the details of the surgical procedure. |
102. A 59 year old female patient applied to a maternity welfare clinic and complained about bloody discharges from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharges came from the cervical canal. Uterus was of normal size, uterine appendages were unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?
A. Separated diagnosic curretage
B. Laparoscopy
C. Puncture of abdominal cavity through posterior vaginal fornix
D. Extensive colposcopy
E. Culdoscopy
Answer: Separated diagnosic curretage
Explanation
| In a postmenopausal woman with bloody vaginal discharge, a separated diagnostic curettage (Option A) is the most appropriate method for diagnosis specification. Bloody vaginal discharge in postmenopausal women is often a sign of underlying pathology, such as endometrial hyperplasia or endometrial cancer. In this case, the presence of bloody discharge from the cervical canal suggests that the bleeding is originating from the endometrium. A separated diagnostic curettage involves scraping the endometrium with a curette to obtain a tissue sample, which can be examined under a microscope for the presence of abnormal cells or tissue. This method allows for a definitive diagnosis of endometrial hyperplasia or cancer. Laparoscopy (Option B) and puncture of the abdominal cavity through the posterior vaginal fornix (Option C) are not indicated in this case, as there are no signs of pelvic or abdominal pathology, and the uterus and adnexa are of normal size and not palpable. Extensive colposcopy (Option D) is a method of examining the cervix and vagina for signs of abnormal tissue or lesions, but it is less likely to provide information about the underlying cause of the bleeding in this case. Culdoscopy (Option E) is a method of examining the pelvic organs through the posterior vaginal fornix using a specialized endoscope. It is not typically used for the diagnosis of postmenopausal bleeding, as it is less invasive and less likely to yield definitive diagnostic information compared to a separated diagnostic curettage. |
103. 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
| In a woman who delivered a child 7 months ago and is experiencing symptoms of nausea, vomiting, and sleepiness, an ultrasound examination (Option A) is the most appropriate method for diagnosis specification. The absence of menstrual periods and lack of contraceptive use suggest the possibility of pregnancy. While breastfeeding can suppress ovulation and delay the return of menstrual periods, it is not a reliable form of contraception. Nausea and vomiting are common symptoms of early pregnancy, and sleepiness may also be related to hormonal changes. An ultrasound examination can confirm or exclude the presence of pregnancy, as well as provide information about the gestational age and location of the pregnancy. It can also detect other abnormalities, such as uterine or ovarian masses, that may be causing the symptoms. Roentgenography of small pelvis organs (Option B) is not typically used for the diagnosis of pregnancy or related symptoms and may expose the patient to unnecessary radiation. Palpation of mammary glands and pressing-out of colostrum (Option C) may be useful for assessing lactation and determining whether the patient is breastfeeding, but it is not a reliable method for diagnosing pregnancy. Bimanual vaginal examination (Option D) and speculum examination (Option E) may provide some information about the condition of the cervix and vagina, but they are less likely to provide definitive information about the presence or absence of pregnancy and related symptoms. An ultrasound examination is a more appropriate first-line diagnostic test in this case. |
104. A boy is 1 year old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh, body temperature rose up to 39oC. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?
A. Acute haematogenic osteomyelitis
B. Acute coxitis
C. Intermuscular phlegmon
D. Osteosarcoma
E. Brodie’s abscess
Answer: Acute haematogenic osteomyelitis
Explanation
| The most probable diagnosis in this case is acute hematogenous osteomyelitis (Option A). Acute hematogenous osteomyelitis is a bacterial infection of the bone that typically occurs in children and adolescents. The most common site of involvement is the long bones of the lower extremities, such as the femur or tibia. In this case, the patient has a history of purulent otitis, which suggests a possible source of bacterial spread to the bone. The presence of a swollen and painful thigh, inability to move the extremity, and elevated body temperature are all consistent with the diagnosis of acute hematogenous osteomyelitis. The smoothed inguinal fold may indicate lymphatic spread of the infection. Acute coxitis (Option B) is inflammation of the hip joint, which can cause pain and difficulty with movement, but it is less likely in this case given the location of the pain in the upper third of the thigh and the inability to move the extremity. Intermuscular phlegmon (Option C) is a bacterial infection of the soft tissues that can cause pain, swelling, and redness, but it typically does not cause the bony changes seen in acute hematogenous osteomyelitis. Osteosarcoma (Option D) is a type of bone cancer that can cause bone pain and swelling, but it is less likely in this case given the patient’s age and the acute onset of symptoms following a known source of bacterial infection. Brodie’s abscess (Option E) is a type of chronic bone infection that can cause localized pain and swelling, but it is less likely in this case given the acute onset of symptoms and the inability to move the extremity. |
105. 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 2 month old full-term child (4900 g) is corresponding to the age (Option A). The expected weight gain for a full-term infant is approximately 20-30 grams per day or 600-900 grams per month during the first 6 months of life. At 2 months of age, a full-term infant would be expected to weigh between 4200 and 5400 grams. The child’s current weight of 4900 grams falls within this expected range, indicating that the child’s weight is appropriate for their age. Option B, C, D, and E suggest that the child’s weight is not appropriate for their age and suggest varying degrees of malnutrition or growth failure. However, given that the child’s weight is within the expected range for their age, these options are not correct in this case. It is important to monitor an infant’s weight gain over time to ensure that they are growing appropriately. If there are concerns about a child’s growth or weight gain, a healthcare provider may recommend additional assessments or interventions to support healthy growth and development. |
106. 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
| Lactational mastitis is a bacterial infection of the breast tissue that can occur in lactating women, typically within the first few weeks after delivery. Common symptoms include sudden onset of breast pain, redness, and swelling, as well as fever and flu-like symptoms. The presence of a fissure in the nipple may have allowed bacteria to enter the breast tissue, leading to the infection. The enlargement of the left mammary gland, pain on palpation, and other symptoms are consistent with the diagnosis of lactational mastitis. Lacteal cyst with suppuration (Option B) is not a likely diagnosis in this case, as lacteal cysts typically do not cause significant pain or fever, and do not typically result in redness or swelling of the breast tissue. Fibrous adenoma of the left mammary gland (Option C) and breast cancer (Option D) are less likely diagnoses in this case, given the sudden onset of symptoms and the presence of a fissure in the nipple, which are more consistent with an infectious process. Phlegmon of mammary gland (Option E) is another possible diagnosis, as it is a bacterial infection of the breast tissue that can cause pain, redness, and swelling. However, lactational mastitis is a more likely diagnosis in a lactating woman with these symptoms. |
107. A 32 year old patient suffering from chronic viral hepatitis complains about dull pain in the right subcostal area, nausea, dry mouth. Objectively: liver dimensions are 13-21-11 cm (according to Kurlov), spleen is by 2 cm enlarged, aspartate aminotransferase is 3,2 micromole/l·h, alanine aminotransferase – 4,8 millimole/l·h. Serological study revealed HBeAg, high concentration of DNA HBV . What drug should be chosen for treatment of this patient?
A. α-interferon
B. Acyclovir
C. Remantadinum
D. Arabinoside monophosphate
E. Essentiale-forte
Answer: α-interferon
Explanation
| In a patient with chronic viral hepatitis, HBeAg positivity, high concentration of HBV DNA, and elevated liver enzymes, the most appropriate treatment option is α-interferon (Option A). α-Interferon is a type of immunomodulatory therapy that can help to suppress viral replication and reduce liver inflammation in patients with chronic hepatitis B. It is typically used in patients who have evidence of active viral replication, such as HBeAg positivity and high levels of HBV DNA. Acyclovir (Option B) is an antiviral medication that is primarily used to treat herpes virus infections, and is not effective against hepatitis B. Remantadinum (Option C) is an antiviral medication that is primarily used to treat influenza virus infections, and is not effective against hepatitis B. Arabinoside monophosphate (Option D) is an antiviral medication that is primarily used to treat cytomegalovirus infections, and is not effective against hepatitis B. Essentiale-forte (Option E) is a nutritional supplement that contains essential phospholipids, which are important components of cell membranes. While it may have some beneficial effects on liver function, it is not considered a specific treatment for chronic hepatitis B. Therefore, α-interferon is the most appropriate treatment option in this case, as it can help to suppress viral replication and reduce liver inflammation in patients with chronic hepatitis B. |
108. 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
| Iron deficiency anemia is a common type of anemia that occurs when the body does not have enough iron to produce hemoglobin, which is necessary for oxygen transport in the blood. Premature infants are at increased risk of iron deficiency anemia due to low iron stores at birth and rapid growth during the first few months of life. The presence of paleness of skin, sleepiness, and laboratory findings of low hemoglobin, low erythrocyte count, and low serum iron are all consistent with the diagnosis of iron deficiency anemia. The low colour index and osmotic stability of erythrocytes may also support this diagnosis. Hematopoiesis immaturity (Option B) is less likely in this case, as the patient is 5 months old and would be expected to have mature hematopoietic cells by this time. An infectious process (Option C) can cause anemia, but it would typically be associated with other symptoms such as fever, malaise, or evidence of an active infection. Erythrocyte hemolysis (Option D) can also cause anemia, but it would typically be associated with other laboratory findings such as elevated bilirubin or evidence of hemolysis on a peripheral blood smear. B12 deficiency (Option E) can cause a macrocytic anemia, but this is less likely in this case given the laboratory findings of microcytic anemia and low serum iron. |
109. A 45 year old woman complains about unbearable pain attacks in the left part of face lasting 1-2 minutes. Such attacks are provoked by mastication. These symptoms appeared 2 months ago after exposure to cold. Objectively:the pain is localized in the ending points of trigeminus on the left. A touch near nose wing provokes another pain attack and tonic spasm of face muscles. What is the most probable diagnosis?
A. Neuralgia of trigeminus
B. Neuralgia of glossopharyngeal nerve
C. Arthritis of mandibular joint
D. Facial migraine
E. Maxillary sinusitis
Answer: Neuralgia of trigeminus
Explanation
| Trigeminal neuralgia is a type of nerve pain that affects the trigeminal nerve, which is responsible for sensation in the face and motor functions such as chewing. The pain is typically described as sharp, shooting, or electric shock-like, and is often triggered by activities such as chewing, speaking, or touching the face. The fact that the pain attacks in this case are provoked by mastication, and that a touch near the nose wing provokes another pain attack and tonic spasm of face muscles, are both consistent with the diagnosis of trigeminal neuralgia. Neuralgia of glossopharyngeal nerve (Option B) typically presents with pain in the back of the throat, tongue, and ear, and is less likely in this case given the location of the pain in the face. Arthritis of the mandibular joint (Option C) can cause pain in the jaw and face, but it typically does not present with the sharp, shooting pain or triggers seen in trigeminal neuralgia. Facial migraine (Option D) is a type of migraine headache that can cause pain in the face, but it typically presents with other symptoms such as nausea, vomiting, or sensitivity to light or sound. Maxillary sinusitis (Option E) can cause pain in the face, but it typically presents with other symptoms such as nasal congestion, sinus pressure, or postnasal drip. |
110. A 38 year old man was delivered to the hospital in unconscious state. The symptoms of illness turned up a day before: headache, nausea, vomiting, t o- 38, 5oC, dizziness, delusion. For the last 4 days he had been complaining of pain and hearing loss in the left ear. Objectively: sopor, rigidity of occipital muscles, bilateral Kernig’s symptom, general hyperesthesia, purulent discharges from the left ear. What is the most probable diagnosis?
A. Secondary purulent meningitis
B. Primary purulent meningitis
C. Tuberculous meningitis
D. Subarachnoidal haemorrhage
E. Parenchymatous subarachnoidal haemorrhage
Answer: Secondary purulent meningitis
Explanation
| Purulent meningitis is an inflammation of the meninges, the membranes that surround the brain and spinal cord, caused by a bacterial or fungal infection. Secondary purulent meningitis refers to meningitis that develops as a complication of another infection, such as otitis media (infection of the middle ear), which can spread to the meninges. The presence of headache, fever, vomiting, dizziness, delirium, and a recent history of ear pain and hearing loss are all consistent with the diagnosis of secondary purulent meningitis. The purulent discharges from the left ear may also indicate otitis media as the source of the infection. The presence of sopor, rigidity of occipital muscles, bilateral Kernig’s symptom, and general hyperesthesia are all signs of meningeal irritation and support the diagnosis of meningitis. Primary purulent meningitis (Option B) refers to meningitis that develops without a preceding infection, and is less likely in this case given the recent history of ear pain and hearing loss. Tuberculous meningitis (Option C) is a form of meningitis caused by Mycobacterium tuberculosis, and typically presents with a more subacute onset of symptoms, such as headache, fever, and altered mental status over several weeks to months. Subarachnoidal hemorrhage (Option D) and parenchymatous subarachnoidal hemorrhage (Option E) typically present with a sudden onset of severe headache, and may be associated with other symptoms such as neck stiffness or loss of consciousness. However, the presence of purulent discharges from the ear in this case suggests an infectious etiology, such as meningitis. |
111. 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 depressive syndrome (Option A). Depressive syndrome is a group of symptoms that are associated with depression, a common mental health disorder. The symptoms of depressive syndrome include low mood, loss of interest or pleasure in activities, sleep disturbances, changes in appetite or weight, feelings of guilt or worthlessness, difficulty concentrating, and suicidal thoughts or behaviors. The presence of low mood, anxiety, sleeplessness, fears, suicidal thoughts, and a facial expression of suffering, pain, and fear are all consistent with the diagnosis of depressive syndrome. The patient’s slow speech and monotonous voice may also be indicative of depression. Paranoid syndrome (Option B) is characterized by delusions of persecution or grandeur, and is less likely in this case given the absence of delusional thinking or other symptoms of psychosis. Asthenic syndrome (Option C) refers to a group of symptoms that are associated with physical and mental fatigue, and is less likely in this case given the presence of other symptoms such as low mood, anxiety, and suicidal thoughts. Phobic syndrome (Option D) is characterized by persistent, irrational fears of specific objects or situations, and is less likely in this case given the absence of specific phobias. Obsessive syndrome (Option E) is characterized by intrusive, unwanted thoughts or repetitive behaviors, and is less likely in this case given the absence of these symptoms. |
112. A 23 year old female patient complains about periodical chill and body temperature rise up to 40oC, sense of heat taking turns with profuse sweating. The patient has had already 3 attacks that came once in two days and lasted 12 hours. She has lived in Africa for the last 2 months. Liver and spleen are enlarged. In blood: erythrocytes – 2, 5 · 1012/l. What is the most probable diagnosis?
A. Malaria
B. Spotted fever
C. Sepsis
D. Haemolytic anaemia
E. Leptospirosis
Answer: Malaria
Explanation
| Malaria is a parasitic infection that is transmitted to humans through the bite of infected mosquitoes. The symptoms of malaria typically include fever, chills, headache, muscle pain, and fatigue, and can occur in cycles that last for several hours at a time. The presence of periodical chill and body temperature rise up to 40oC, sense of heat taking turns with profuse sweating, and attacks that come once in two days and last for 12 hours are all consistent with the diagnosis of malaria. The fact that the patient has lived in Africa for the last 2 months also increases the suspicion for malaria, as it is endemic in many parts of Africa. The enlargement of liver and spleen and low erythrocyte count seen in the blood test are also consistent with malaria, as the parasites can infect and replicate within these organs and cause hemolysis of red blood cells. Spotted fever (Option B) is a bacterial infection that is transmitted by ticks, and typically presents with fever, rash, and headache. Sepsis (Option C) is a severe infection that can cause fever, chills, and other symptoms, but it typically presents with other signs of systemic inflammation such as low blood pressure, elevated heart rate, and organ dysfunction. Haemolytic anaemia (Option D) can cause a low erythrocyte count, but it is less likely in this case given the patient’s other symptoms and the fact that malaria is endemic in the region where she has been living. Leptospirosis (Option E) is a bacterial infection that can cause fever, muscle pain, and other symptoms, but it is less likely in this case given the patient’s history of living in Africa and the characteristic periodicity of her symptoms. |
113. A 39 year old patient suffering from hypertension suddenly gotb 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
| Subarachnoid hemorrhage is a type of bleeding that occurs in the space between the brain and the thin tissues that cover the brain (the arachnoid mater). It can cause sudden, severe headache and vomiting, and is often associated with hypertension. The presence of intense headache in the occipital region, recurrent vomiting, pain in the occipital points, rigidity of occipital muscles, and positive Kernig’s sign are all consistent with the diagnosis of subarachnoid hemorrhage. Computer tomography (CT) (Option E) is the gold standard imaging modality for detecting subarachnoid hemorrhage, but it may not be immediately available or may be negative in the early stages of the bleed. Therefore, lumbar puncture is often used as a diagnostic method in suspected cases of subarachnoid hemorrhage. In subarachnoid hemorrhage, the cerebrospinal fluid obtained through lumbar puncture will often show signs of blood, such as xanthochromia (yellow discoloration) or red blood cells, even if the CT scan is negative. Examination of eye fundus (Option B) and ultrasonic dopplerography (Option C) may be useful in evaluating the extent of the hemorrhage and identifying any associated complications, such as vasospasm. However, they are not useful for confirming the diagnosis of subarachnoid hemorrhage. EEG (Option D) is a test that measures electrical activity in the brain, and is not useful for diagnosing subarachnoid hemorrhage. |
114. Immediately after delivery a woman had haemorrhage, blood loss exceeded postpartum haemorrhage rate and was progressing. There were no symptoms of placenta detachment. What tactics should be chosen?
A. Manual removal of placenta and afterbirth
B. Uterus tamponade
C. Instrumental revision of uterine cavity walls
D. Removal of afterbirth by Crede’s method
E. Intravenous injection of methylergometrine with glucose
Answer: Manual removal of placenta and afterbirth
Explanation
| Postpartum hemorrhage is a significant complication of childbirth and can result from a variety of causes, including retained placental tissue, uterine atony, or trauma to the birth canal. In this case, the fact that the patient is experiencing excessive bleeding and the symptoms of retained placental tissue are not present suggests that the placenta and afterbirth have not been fully delivered. Manual removal of the placenta and afterbirth is a procedure that involves manually separating the placenta and afterbirth from the uterine wall and removing them from the uterus. This can be performed under local or general anesthesia and is typically effective in stopping bleeding and preventing further complications. Uterus tamponade (Option B) is a procedure in which a balloon or other device is inserted into the uterus and inflated to compress the uterine walls and stop bleeding. It can be useful in cases of uterine atony or other causes of postpartum hemorrhage, but is less likely to be effective if the bleeding is due to retained placental tissue. Instrumental revision of uterine cavity walls (Option C) may be necessary if retained placental tissue is suspected, but is less likely to be effective if the placenta and afterbirth have not been fully delivered. Removal of afterbirth by Crede’s method (Option D) involves applying pressure to the uterus to help expel the placenta, but may be less effective in cases of excessive bleeding or retained placental tissue. Intravenous injection of methylergometrine with glucose (Option E) is a medication that can be used to help reduce bleeding after delivery, but may be less effective if the bleeding is due to retained placental tissue. Moreover, its use is contraindicated in patients with hypertension and other conditions. |
115. A 33 year old patient was delivered to the infectious diseases department on the 7-th day of disease. He complained about great weakness, high temperature, pain in the lumbar area and leg muscles, icteritiousness, dark colour of urine, headache. The acute disease started with chill, body temperature rise up to 40oC, headache, pain in the lumbar area and sural muscles. Icterus turned up on the 4th day, nasal and scleral haemorrhages came on the 5th day. Fever has lasted for 6 days. Diuresis – 200 ml. What is the most probable diagnosis?
A. Leptospirosis
B. Typhoid fever
C. Virus A hepatitis
D. Sepsis
E. Yersiniosis
Answer: Leptospirosis
Explanation
| Leptospirosis is a bacterial infection that is transmitted to humans through contact with the urine of infected animals, especially rats. The symptoms of leptospirosis can include fever, headache, muscle pain (especially in the legs and lower back), jaundice, and kidney damage. The presence of weakness, high temperature, pain in the lumbar area and leg muscles, icteric skin, dark urine, headache, and nasal and scleral hemorrhages are all consistent with the diagnosis of leptospirosis. The fact that the patient’s symptoms started with a chill, fever, and muscle pain is also consistent with leptospirosis, which often presents as a flu-like illness in the early stages. The decreased urine output seen in this case is also indicative of kidney damage, which can occur in severe cases of leptospirosis. Typhoid fever (Option B) is a bacterial infection that is transmitted through contaminated food or water, and typically presents with fever, abdominal pain, and other symptoms. Virus A hepatitis (Option C) is a viral infection that can cause fever, jaundice, and other symptoms, but is less likely in this case given the presence of muscle pain and hemorrhages. Sepsis (Option D) is a severe infection that can cause fever and other symptoms, but is less likely in this case given the presence of muscle pain, jaundice, and hemorrhages. Yersiniosis (Option E) is a bacterial infection that can cause fever, abdominal pain, and other symptoms, but is less likely in this case given the presence of muscle pain, jaundice, and hemorrhages. |
116. A 72 year old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most probable diagnosis?
A. Microbial eczema
B. Allergic dermatitis
C. Seborrheic eczema
D. Cutaneous tuberculosis
E. Streptococcal impetigo
Answer: Microbial eczema
Explanation
| Microbial eczema, also known as infected eczema or impetiginized eczema, is a type of eczema that becomes infected with bacteria, typically Staphylococcus aureus or Streptococcus pyogenes. It can cause itching, redness, edema, oozing lesions, and yellowish crusts, as seen in this patient. The fact that the focus of affection is well-defined, and the presence of a trophic ulcer suggest that the underlying cause of the eczema may be related to poor circulation or other vascular issues. Allergic dermatitis (Option B) is a type of eczema that is caused by exposure to allergens, such as poison ivy or nickel. It typically presents with itching, redness, and small fluid-filled blisters. Seborrheic eczema (Option C) is a type of eczema that affects oily areas of the skin, such as the scalp, face, and chest. It typically presents with redness, scaling, and itching. Cutaneous tuberculosis (Option D) is a rare form of tuberculosis that |
117. A 29 year old female patient complains about periodical right-sided headache that is usually provoked by strong smells or excitement. The patient’s mother suffers from the same disease. Objectively: examination of internal organs revealed no pathology. During the attack there are general hyperesthesia and nausea, at the end of the attack polyuria is observed. Palpation of the right temporal artery during the attack revealed tension and painfulness of the artery. Complete blood count and urine analysis reveale dno pecularities. What is the most probable diagnosis?
A. Migraine
B. Neuritis of the facial nerve
C. Neuralgia of trigeminus
D. Meniere’s syndrome
E. Epilepsy
Answer: Migraine
Explanation
| Migraine is a type of headache that is often characterized by moderate to severe pain on one side of the head, sensitivity to light and sound, and nausea. It can be triggered by a variety of factors, including strong smells, excitement, stress, and certain foods. The presence of periodical right-sided headache that is usually provoked by strong smells or excitement, general hyperesthesia, nausea, and polyuria at the end of the attack are all consistent with the diagnosis of migraine. The fact that the patient’s mother also suffers from the same disease suggests that there may be a genetic component to the patient’s condition. Palpation of the right temporal artery during the attack revealing tension and painfulness of the artery is also consistent with migraine, as this can be a characteristic feature of migraine headaches. Neuritis of the facial nerve (Option B) is a condition that can cause facial pain, but is less likely given the unilateral nature of the patient’s symptoms. Neuralgia of trigeminus (Option C) is a condition that can cause severe facial pain, but typically presents with episodes of intense, stabbing pain in the face, rather than headache. Meniere’s syndrome (Option D) is a condition that affects the inner ear and can cause symptoms such as vertigo, ringing in the ears, and hearing loss, but is less likely given the absence of these symptoms in the patient’s presentation. Epilepsy (Option E) is a neurological disorder that can cause seizures, but is less likely given the absence of seizure-like symptoms in the patient’s presentation. |
118. A 52 year old woman complains about face distortion. It turned up 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
| Facial neuritis is a condition that causes sudden, temporary weakness or paralysis of the muscles on one side of the face. It can be caused by a variety of factors, including viral infections, trauma, and exposure to cold. The presence of face distortion, asymmetry, flattened frontal folds, and a lowered mouth corner are all consistent with the diagnosis of facial neuritis. The fact that the symptoms appeared after supercooling also suggests that this may be the cause of the patient’s condition. The absence of other pathology on examination and the normal blood count and ESR further support the diagnosis of facial neuritis. Trigeminus neuralgia (Option B) is a condition that causes sudden, severe facial pain, but does not typically cause facial weakness or paralysis. Hemicrania or migraine (Option C) is a type of headache that can cause facial pain and other symptoms, but is less likely given the absence of headache and the presence of facial weakness. Ischemic stroke (Option D) is a serious condition that can cause sudden onset of facial weakness or paralysis, but is less likely given the absence of other neurological symptoms and the fact that the patient’s symptoms appeared after exposure to cold. Brain tumor (Option E) can also cause facial weakness or paralysis, but is less likely in this case given the sudden onset of symptoms and the absence of other neurological symptoms. |
119. A 10 year old boy suffers from chronic viral hepatitis type B with maximal activity. What laboratory test can give the most precise characteristic of cytolysis degree?
A. Transaminase test
B. Weltman’s coagulation test
C. Takata-Ara test
D. Prothrombin test
E. Test for whole protein
Answer: Transaminase test
Explanation
| Transaminases are enzymes that are normally found inside liver cells and are released into the bloodstream when liver cells are damaged. In cases of chronic viral hepatitis type B with maximal activity, liver cells are continuously being damaged, leading to increased levels of transaminases in the blood. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are the two transaminases that are most commonly measured in the blood to assess liver function. Elevated levels of these enzymes are indicative of liver damage and can be used to monitor the degree of cytolysis in chronic viral hepatitis type B. Weltman’s coagulation test (Option B), Takata-Ara test (Option C), and prothrombin test (Option D) are all tests that can be used to assess liver function in cases of chronic viral hepatitis, but are less specific for assessing the degree of cytolysis. The test for whole protein (Option E) is a general test that measures the total amount of protein in the blood, and is not specific to liver function or the degree of cytolysis. |
120. Examination of a 12 year old child revealed diffuse thyroid enlargement of the II degree. Heart auscultation revealed dullness of heart sounds, heart rate was 64/min. The child has frequent constipations, anemia. Concentration of thyreoglobulin antibodies is increased. What disease might have caused such symptoms?
A. Autoimmune thyroiditis
B. Diffuse toxic goiter
C. Thyroid carcinoma
D. Thyroid hyperplasia
E. Endemic goiter
Answer: Autoimmune thyroiditis
Explanation
| Autoimmune thyroiditis is a condition in which the immune system attacks the thyroid gland, leading to inflammation and damage to the gland. This can result in diffuse thyroid enlargement, or goiter, which may be accompanied by other symptoms such as constipation and anemia. In this case, the presence of diffuse thyroid enlargement of the II degree, increased concentration of thyroglobulin antibodies, frequent constipations, and anemia are all consistent with the diagnosis of autoimmune thyroiditis. The dullness of heart sounds and heart rate of 64/min may also be indicative of hypothyroidism, which can occur in cases of autoimmune thyroiditis. Diffuse toxic goiter (Option B) is a condition in which the thyroid gland produces too much thyroid hormone, resulting in hyperthyroidism. This is less likely in this case given the presence of hypothyroidism symptoms such as constipation and anemia. Thyroid carcinoma (Option C) is a type of thyroid cancer that can cause thyroid enlargement, but is less likely given the diffuse nature of the enlargement and the presence of other symptoms such as constipation and anemia. Thyroid hyperplasia (Option D) is a noncancerous enlargement of the thyroid gland that can occur in response to various factors, but is less likely given the presence of increased concentration of thyroglobulin antibodies and other symptoms such as constipation and anemia. Endemic goiter (Option E) is a type of goiter that is caused by iodine deficiency, and is less likely in this case given the presence of increased concentration of thyroglobulin antibodies and other symptoms such as constipation and anemia. |
121. A 13 year old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32 micromole/l, in urine – 6%, acetone +. What treatment should be administered?
A. Short-acting insulin
B. Long-acting insulin
C. Biguanides
D. Sulfonylurea
E. Diet
Answer: Short-acting insulin
Explanation
| The symptoms of thirst, polyuria, and weakness, along with the presence of glucose in the urine and acetone in the breath, suggest that the patient is experiencing diabetic ketoacidosis (DKA), which is a potentially life-threatening complication of diabetes. In DKA, the body produces high levels of ketones in response to a lack of insulin, which can lead to acidosis and other serious complications. Treatment with insulin is necessary to lower blood glucose levels and prevent further ketone production. In this case, the low glucose concentration in blood on an empty stomach and the presence of acetone in the urine suggest that the patient may be experiencing a severe insulin deficiency. Short-acting insulin would be the most appropriate treatment in this case, as it acts quickly to bring blood glucose levels down and prevent further ketone production. Long-acting insulin (Option B), biguanides (Option C), and sulfonylurea (Option D) are not appropriate treatments for DKA, as they do not act quickly enough to lower blood glucose levels and prevent further ketone production. Diet (Option E) is important for the management of diabetes, but is not sufficient as the sole treatment for DKA. Insulin therapy is necessary to prevent the potentially life-threatening complications of DKA. |
122. Surgical department admitted a 37 year old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?
A. Removal of necrotic tissues and timely surgical processing of the wound
B. Injection of specific serum 3 000 U
C. Injection of specific serum 30 000 U
D. Infiltration of soft tissues around the wound with antibiotic solution
E. Wound lavage with 6% solution of hydrogen peroxide
Answer: Removal of necrotic tissues and timely surgical processing of the wound
Explanation
| Gaseous gangrene is a serious and potentially life-threatening bacterial infection that can occur in wounds that are contaminated with certain types of bacteria, such as Clostridium perfringens. The bacteria produce toxins that can cause tissue destruction and gas formation within the affected tissues. The most effective way to prevent gaseous gangrene is to remove all necrotic tissues and to surgically clean and debride the wound as soon as possible after injury. This will help to remove any bacteria that may be present and prevent the spread of infection. Injection of specific serum (Options B and C) may be used as an adjunct to surgical treatment in severe cases of gaseous gangrene, but is not the main provision for prevention. Infiltration of soft tissues around the wound with antibiotic solution (Option D) may be used as a prophylactic measure in some cases, but is not sufficient as the sole treatment for gaseous gangrene. Wound lavage with 6% solution of hydrogen peroxide (Option E) is not recommended, as it can be damaging to healthy tissues and may not effectively remove all bacteria from the wound. Other solutions, such as saline or povidone-iodine, may be used for wound irrigation. |
123. A 40 year old patient was bitten by a stray dog for about an hour ago. The bite can be seen on the patient’s left shin in form of a wound 4х2х0,5 cm large. What kind of aid would be recommended in this case?
A. Wound lavage with soapsuds, retension sutures
B. Aseptic bandage
C. Salve bandage
D. Blind suture
E. Retension sutures
Answer: Wound lavage with soapsuds, retension sutures
Explanation
| Washing the wound with soapsuds helps to remove any dirt and bacteria that may be present, which can help to prevent infection. Retension sutures are used to bring the edges of the wound together, which can help to promote healing and reduce scarring. Aseptic bandage (Option B) and salve bandage (Option C) may be used after the wound has been cleaned and sutured, but are not recommended as the sole treatment for a dog bite wound. Blind suture (Option D) is not recommended for dog bite wounds, as it can trap bacteria inside the wound and increase the risk of infection. Retension sutures (Option E) are recommended for wound closure, but should be used in combination with wound lavage and other appropriate treatments. It is important to note that in addition to first aid, patients who have been bitten by a stray dog should seek medical attention as soon as possible. They may require further treatment, such as antibiotics or rabies vaccination, depending on the severity of the wound and the risk of infection. |
124. A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progresing under conditions of weak general peripheric resistance and lowered cardiac output. What antihypotensive drug should be injected to the patient in the first place?
A. Dopamine
B. Noradrenaline
C. Adrenaline
D. Mesatonum
E. Prednisolone
Answer: Dopamine
Explanation
| Cardiogenic shock is a condition in which the heart is unable to pump enough blood to meet the body’s needs, leading to a decrease in blood pressure and organ perfusion. In this case, the patient’s weak general peripheral resistance and decreased cardiac output suggest that the patient is in a state of shock. Dopamine is a medication that can help to increase blood pressure and cardiac output by stimulating the heart and blood vessels. It can be used to treat hypotension and shock in patients with acute myocardial infarction. Noradrenaline (Option B) and adrenaline (Option C) are also medications that can be used to increase blood pressure and cardiac output, but are generally reserved for cases in which dopamine is ineffective. Mesatonum (Option D) is a medication that can be used to treat hypotension, but is less commonly used in the treatment of cardiogenic shock. Prednisolone (Option E) is a steroid medication that is used to treat a variety of inflammatory conditions, but is not indicated for the treatment of hypotension or shock. |
125. A patient applied to the traumatology cenre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of galss. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?
A. Ulnar
B. Radial
C. Median
D. Musculoskeletal
E. Axillary
Answer: Ulnar
Explanation
| The ulnar nerve is a nerve that runs from the neck down to the hand, and provides sensation to the little finger and half of the ring finger, as well as motor function to the muscles that control these fingers. It also provides sensation to the interior dorsal and palmar surface of the hand. In this case, the impaired flexion of the IV and V fingers, along with the reduced sensitivity of the interior dorsal and palmar surface of the hand as well as of the IV finger, are all consistent with damage to the ulnar nerve. The radial nerve (Option B) provides sensation to the back of the hand and controls the muscles that extend the wrist and fingers. It is less likely to be affected in this case given the symptoms described. The median nerve (Option C) provides sensation to the thumb, index finger, middle finger, and half of the ring finger, as well as motor function to the muscles that control these fingers. It is less likely to be affected in this case given the distribution of the symptoms. The musculocutaneous nerve (Option D) provides sensation to the skin on the lateral forearm and controls the muscles that flex the elbow. It is not likely to be affected in this case given the location of the injury. The axillary nerve (Option E) provides sensation to the skin over the deltoid muscle and controls the muscles that abduct the arm. It is not likely to be affected in this case given the location of the injury. |
126. It was noticed that a 7 year old pupil had been innattentive several times during the lessons. The teacher also noticed that the child had been smacking his lips and had vacant look. There were no falls and convulsions. During such short periods of absence the child didn’t react to calling his name. His mother notic such phenomena before but didn’t pay much attention to them thinking that the child was deep in thought. What type of epileptic attack (according to the standard classification) is it?
A. Absentia
B. Generalized tonoclonic epilepsy
C. Simple partial epilepsy
D. Complex partial epilepsy
E. Jacksonian partial epilepsy
Answer: Absentia
Explanation
| Absence seizures are characterized by a sudden onset of brief periods of unconsciousness or “absences,” during which the person may appear to be staring into space and not responding to stimuli. The seizures are typically brief, lasting only a few seconds, and are often accompanied by subtle movements such as lip-smacking or blinking. In this case, the child’s symptoms of inattention, vacant look, and unresponsiveness to calling his name during short periods of absence suggest that he may be experiencing absence seizures. Generalized tonic-clonic epilepsy (Option B) is a type of generalized convulsive epilepsy that is characterized by sudden, violent muscle contractions (tonic phase) followed by rhythmic jerking (clonic phase) and loss of consciousness. This type of seizure is not consistent with the symptoms described in this case. Simple partial epilepsy (Option C) and Jacksonian partial epilepsy (Option E) are types of partial (focal) epilepsy that involve seizures that begin in a specific area of the brain and may or may not spread to other parts of the brain. These types of seizures typically involve more localized symptoms, such as tingling, twitching, or numbness in a specific part of the body, and are not consistent with the symptoms described in this case. Complex partial epilepsy (Option D) is a type of partial epilepsy that involves seizures that begin in a specific area of the brain and may spread to other parts of the brain. This type of seizure is typically associated with a loss of consciousness and may involve complex movements or behaviors, such as lip-smacking, picking at clothes, or wandering aimlessly. While some of these symptoms are similar to those described in this case, absence seizures are a more likely explanation given the brief duration of the episodes and lack of convulsive movements. |
127. A 41 year old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC9, 8 · 109/l, RBC- 3, 0 · 1012/l, ESR – 52 mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfosalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Answer: Sulfosalasine
Explanation
| Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum, and is characterized by symptoms such as abdominal pain, diarrhea, and rectal bleeding. Sulfasalazine is a medication that is commonly used to treat ulcerative colitis, as it helps to reduce inflammation in the colon and improve symptoms. Sulfasalazine is a combination of two drugs: sulfapyridine and 5-aminosalicylic acid (5-ASA). 5-ASA is the active ingredient that helps to reduce inflammation in the colon. Sulfasalazine works by delivering 5-ASA to the colon, where it is most needed. Motilium (Option B) is a medication that is used to treat nausea and vomiting, and is not indicated for the treatment of ulcerative colitis. Vikasol (Option C) is a medication that is used to treat bleeding disorders, and is not indicated for the treatment of ulcerative colitis. Linex (Option D) is a probiotic medication that contains beneficial bacteria that can help to restore the natural balance of bacteria in the gut. While it may be used as an adjunct to treatment for ulcerative colitis, it is not a pathogenetic treatment for the condition. Kreon (Option E) is a medication that contains pancreatic enzymes, and is used to treat conditions such as pancreatic insufficiency. It is not indicated for the treatment of ulcerative colitis. |
128. A 38 year old female patient complains about body stiffness in the morning, especially in the articulations of her upper and lower limbs, that disappears 30-60 minutes later after active movements. She has also arthritis of metacarpophalangeal and proximal phalangeal articulations, subfebrile temperature. ESR- 45 mm/h. Roentgenography revealed osteoporosis and erosion of articular surface of small hand and foot articulations. What is the most probable diagnosis?
A. Rheumatoid arthritis
B. Psoriatic arthropathy
C. Osteoarthrosis deformans
D. Systemic lupus erythematosus
E. Reactive polyarthritis
Answer: Rheumatoid arthritis
Explanation
| Rheumatoid arthritis is a chronic autoimmune disorder that primarily affects the joints, causing inflammation and destruction of the joint tissues. The characteristic symptoms of rheumatoid arthritis include morning stiffness, joint pain, and swelling, which can be accompanied by fatigue, fever, and weight loss. In this case, the patient’s complaints of morning stiffness, arthritis of the metacarpophalangeal and proximal phalangeal articulations, and erosions seen on X-ray are all consistent with a diagnosis of rheumatoid arthritis. The subfebrile temperature and elevated ESR level are also common findings in patients with this condition. Psoriatic arthropathy (Option B) is a type of arthritis that can occur in patients with psoriasis, and is characterized by joint pain, swelling, and stiffness. However, the presence of erosions on X-ray is more suggestive of rheumatoid arthritis. Osteoarthrosis deformans (Option C) is a degenerative joint disease that is characterized by the breakdown of cartilage in the joints. While this condition can cause joint pain and stiffness, it typically does not cause erosions on X-ray. Systemic lupus erythematosus (Option D) is an autoimmune disorder that can affect multiple organs and systems, including the joints. However, the joint involvement in lupus is typically less severe than in rheumatoid arthritis, and erosions on X-ray are less common. Reactive polyarthritis (Option E) is a type of arthritis that can occur in response to an infection or other trigger. While this condition can cause joint pain and swelling, it is typically acute and self-limited, and does not cause erosions on X-ray. |
129. A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?
A. Aerophagia
B. Pylorostenosis
C. Pylorospasm
D. Acute gastroenteritis
E. Esophageal atresia
Answer: Aerophagia
Explanation
| Aerophagia, or swallowing of air, is a common cause of regurgitation in infants. It can occur during feeding, especially if the baby is not latched on properly or is feeding too quickly. Swallowing of air can also occur during crying or other activities that involve rapid breathing. Pyloric stenosis (Option B) is a condition in which the muscle at the lower end of the stomach (pylorus) becomes thickened, leading to narrowing of the opening into the small intestine. This can cause vomiting, but typically occurs after the first few weeks of life and is associated with poor weight gain. Pylorospasm (Option C) is a condition in which the muscle of the pylorus goes into spasm, leading to obstruction of the opening into the small intestine. This can cause vomiting, but typically occurs after the first few weeks of life and is associated with poor weight gain. Acute gastroenteritis (Option D) is a condition in which the digestive system becomes inflamed, typically due to infection with a virus or bacteria. It can cause vomiting, diarrhea, and other symptoms, but is less likely to be the cause of regurgitation in this case given the child’s age and overall development. Esophageal atresia (Option E) is a rare condition in which the esophagus (the tube that connects the mouth to the stomach) does not develop properly. It typically causes feeding difficulties and vomiting in the first few days of life. |
130. Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
A. Chronic tonsillitis
B. Chronic pharyngitis
C. Acute lacunar tonsillitis
D. Paratonsillitis
E. Tonsillar tumour
Answer: Chronic tonsillitis
Explanation
| Chronic tonsillitis is a persistent inflammation of the tonsils, which can lead to recurrent episodes of acute tonsillitis. The symptoms of chronic tonsillitis can include enlargement of the tonsils, purulent discharge from the tonsillar crypts, and a feeling of general malaise. In this case, the patient’s symptoms of weakness, inertness, subfebrile temperature, and enlarged retromaxillary lymph nodes, along with the presence of purulent plugs in the tonsillar crypts, are all consistent with a diagnosis of chronic tonsillitis. The fact that the patient had acute angina three weeks prior also suggests that this may be a recurrent or chronic condition. Chronic pharyngitis (Option B) is a persistent inflammation of the pharynx, which can cause symptoms such as sore throat, difficulty swallowing, and a feeling of a lump in the throat. While chronic pharyngitis can coexist with chronic tonsillitis, the presence of purulent plugs in the tonsillar crypts points more towards tonsillitis as the primary diagnosis. Acute lacunar tonsillitis (Option C) is a type of acute tonsillitis that is characterized by the formation of pus-filled pockets (lacunae) within the tonsils. While this condition can cause similar symptoms to chronic tonsillitis, the fact that the patient’s symptoms have persisted for three weeks suggests a more chronic process. Paratonsillitis (Option D) is a rare condition in which the tissue surrounding the tonsils becomes inflamed and infected. While this condition can cause symptoms such as fever, sore throat, and difficulty swallowing, it is less likely than chronic tonsillitis given the patient’s specific symptoms. Tonsillar tumor (Option E) is a rare but serious condition that can cause symptoms such as persistent sore throat, difficulty swallowing, and a feeling of a lump in the throat. However, this is less likely than chronic tonsillitis given the patient’s history of acute angina and the presence of purulent plugs in the tonsillar crypts. |
131. A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin di-seases before. What is the most probable diagnosis?
A. Hydradenitis
B. Furuncle
C. Mycosis
D. Herpes zoster
E. Streptococcal impetigo
Answer: Hydradenitis
Explanation
| Hydradenitis is a chronic inflammation of the sweat glands and hair follicles, which can lead to the formation of painful nodules or abscesses in areas such as the axillae, groin, and buttocks. These nodules can burst and discharge pus, and new nodules can form in the surrounding area. In this case, the patient’s symptoms of a painful induration in the axillary crease that later burst and discharged pus, followed by the appearance of new infiltrations around the affected area, are all consistent with a diagnosis of hydradenitis. The fact that the patient has never suffered from skin diseases before also supports this diagnosis. Furuncle (Option B) is a localized skin infection that typically affects a single hair follicle and surrounding tissue. While furuncles can cause symptoms such as pain, redness, and swelling, they are typically self-limited and do not lead to the formation of multiple nodules or abscesses. Mycosis (Option C) is a fungal infection of the skin, which can cause symptoms such as itching, redness, and scaling. While mycosis can affect the axillae, it typically does not cause the formation of painful nodules or abscesses. Herpes zoster (Option D) is a viral infection that can cause a painful rash, typically in a single dermatome (an area of skin supplied by a single nerve). While herpes zoster can affect the axillae, it typically presents with a characteristic rash, which is not described in this case. Streptococcal impetigo (Option E) is a bacterial skin infection that typically causes small blisters or sores on the face, arms, or legs. It is less likely than hydradenitis given the location of the patient’s symptoms in the axillary crease. |
132. A 28 year old woman has bursting pain in the lower abdomen during menstruation; chocolate-like discharges from vagina. It is known from the anamnesis that the patient suffers from chronic adnexitis. Bimanual examination revealed a tumour-like formation of heterogenous consistency 7х7 cm large to the left from the uterus. The formation is restrictedly movable, painful when moved. What is the most probable diagnosis?
A. Endometrioid cyst of the left ovary
B. Follicular cyst of the left ovary
C. Fibromatous node
D. Exacerbation of chronic adnexitis
E. Tumour of sigmoid colon
Answer: Endometrioid cyst of the left ovary
Explanation
133. As a result of prophylactic medical examination a 35 year old woman was diagnosed with alimentary and constitutive obesity of the III degree. It is known from her anamnesis that the patient doesn’t observe rules of rational nutrition: she often overeats, the last food intake is usually 10-15 minutes before going to bed, prefers fattening and rich in carbohydrates food. What is the main alimentary risk factor of obesity development?
A. Energetic unprofitableness of nutrition
B. Excess of carbohydrates
C. Excess of fats
D. Lack of cellulose
E. Violation of dietary pattern
Answer: Energetic unprofitableness of nutrition
Explanation
| Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside of the uterus, such as on the ovaries. Endometrioid cysts, also known as chocolate cysts, are a type of ovarian cyst that can form when endometrial tissue grows within the ovary and fills with blood. In this case, the patient’s symptoms of bursting pain in the lower abdomen during menstruation and chocolate-like discharges from the vagina are consistent with endometriosis. The presence of a tumor-like formation of heterogeneous consistency that is restrictedly movable and painful when moved also suggests an ovarian cyst. Chronic adnexitis, or inflammation of the ovaries and fallopian tubes, can increase the risk of developing ovarian cysts. Follicular cysts of the ovary (Option B) are a common type of ovarian cyst that form when a follicle in the ovary fails to rupture and release an egg. These cysts are typically benign and regress on their own, but can cause pain or other symptoms if they become large or rupture. Fibromatous nodes (Option C) are benign tumors of the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure. However, the location of the tumor in this case suggests an ovarian rather than uterine origin. Exacerbation of chronic adnexitis (Option D) can cause symptoms such as pelvic pain, vaginal discharge, and fever, but would not typically present as a tumor-like formation. A tumor of the sigmoid colon (Option E) would not typically cause symptoms such as menstrual pain or vaginal discharge, and would not be located in the left adnexal area. |
134. A 40 year old female patient has been observing excessive menstruation accompanied by spasmodic pain in the lower abdomen for a year. Bimanual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpable. Bloody discharges are profuse. What is the most probable diagnosis?
A. Nascent submucous fibromatous node
B. Abortion in progress
C. Cervical carcinoma
D. Cervical myoma
E. Algodismenorrhea
Answer: Nascent submucous fibromatous node
Explanation
| Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside of the uterus, such as on the ovaries. Endometrioid cysts, also known as chocolate cysts, are a type of ovarian cyst that can form when endometrial tissue grows within the ovary and fills with blood. In this case, the patient’s symptoms of bursting pain in the lower abdomen during menstruation and chocolate-like discharges from the vagina are consistent with endometriosis. The presence of a tumor-like formation of heterogeneous consistency that is restrictedly movable and painful when moved also suggests an ovarian cyst. Chronic adnexitis, or inflammation of the ovaries and fallopian tubes, can increase the risk of developing ovarian cysts. Follicular cysts of the ovary (Option B) are a common type of ovarian cyst that form when a follicle in the ovary fails to rupture and release an egg. These cysts are typically benign and regress on their own, but can cause pain or other symptoms if they become large or rupture. Fibromatous nodes (Option C) are benign tumors of the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure. However, the location of the tumor in this case suggests an ovarian rather than uterine origin. Exacerbation of chronic adnexitis (Option D) can cause symptoms such as pelvic pain, vaginal discharge, and fever, but would not typically present as a tumor-like formation. A tumor of the sigmoid colon (Option E) would not typically cause symptoms such as menstrual pain or vaginal discharge, and would not be located in the left adnexal area. |
135. A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in the arm is absent. “Scarf”symptom is positive. What is the most probable diagnosis?
A. Total right-sided obstetric paralysis
B. Proximal right-sided obstetric paralysis
C. Distal right-sided obstetric paralysis
D. Hemiparesis
E. Tetraparesis
Answer: Total right-sided obstetric paralysis
Explanation
| Endometriosis is a condition in which the tissue that normally lines the inside of the uterus (endometrium) grows outside of the uterus, such as on the ovaries. Endometrioid cysts, also known as chocolate cysts, are a type of ovarian cyst that can form when endometrial tissue grows within the ovary and fills with blood. In this case, the patient’s symptoms of bursting pain in the lower abdomen during menstruation and chocolate-like discharges from the vagina are consistent with endometriosis. The presence of a tumor-like formation of heterogeneous consistency that is restrictedly movable and painful when moved also suggests an ovarian cyst. Chronic adnexitis, or inflammation of the ovaries and fallopian tubes, can increase the risk of developing ovarian cysts. Follicular cysts of the ovary (Option B) are a common type of ovarian cyst that form when a follicle in the ovary fails to rupture and release an egg. These cysts are typically benign and regress on their own, but can cause pain or other symptoms if they become large or rupture. Fibromatous nodes (Option C) are benign tumors of the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure. However, the location of the tumor in this case suggests an ovarian rather than uterine origin. Exacerbation of chronic adnexitis (Option D) can cause symptoms such as pelvic pain, vaginal discharge, and fever, but would not typically present as a tumor-like formation. A tumor of the sigmoid colon (Option E) would not typically cause symptoms such as menstrual pain or vaginal discharge, and would not be located in the left adnexal area. |
136. A 42 year old man applied to a hospital 10 minutes after he got stung by a bee and complained about face edema and difficult respiration. Objectively: Ps- 98 bpm, AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of 1% dimedrol solution intramuscularly and recommended to apply to his local therapeutist on the next day. What tactics of treatment should be chosen for this patient?
A. Intravenous introduction of prednisolone and hospitalization
B. Intravenous introduction of calcium chloride
C. The patient needs no further medical aid
D. Hospitalization for observation
E. Intravenous introduction of calcium chloride and hospitalization
Answer: Intravenous introduction of prednisolone and hospitalization
Explanation
| The patient is showing signs of an anaphylactic reaction to the bee sting, including facial edema and difficulty breathing. These symptoms can rapidly progress and become life-threatening, so prompt treatment is necessary. The injection of dimedrol (diphenhydramine), an antihistamine, can help to alleviate some of the symptoms of the reaction, but it is not sufficient to fully treat anaphylaxis. Intravenous introduction of corticosteroids, such as prednisolone, is recommended for the treatment of anaphylaxis. Additionally, hospitalization is necessary for observation and further treatment, as the patient’s condition can worsen rapidly and require additional interventions, such as epinephrine or bronchodilators. Intravenous introduction of calcium chloride (Option B or E) is not indicated in the treatment of anaphylaxis. The patient should not be discharged without further medical aid (Option C), as anaphylaxis can be life-threatening if left untreated. Hospitalization for observation (Option D) is also not sufficient, as prompt treatment with corticosteroids is necessary to prevent the progression of the reaction. |
137. A 44 year old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times more than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?
A. Anthracosis
B. Anthracosilicosis
C. Silicatosis
D. Asbestosis
E. Siderosis
Answer: Anthracosis
Explanation
| Anthracosis, also known as coal worker’s pneumoconiosis, is a type of lung disease caused by the inhalation of coal dust. It is commonly seen in individuals who work in coal mines or in the coke industry. Symptoms of anthracosis can include cough, shortness of breath, and chest pain. In this case, the patient has a history of working in the coke industry for 16 years, with a significant exposure to coal dust. The roentgenography of his lungs revealed changes that are typical for pneumoconiosis, which further supports a diagnosis of anthracosis. Anthracosilicosis (Option B) is a type of pneumoconiosis caused by the inhalation of both coal dust and silica particles. While silica exposure may also occur in the coke industry, the dust concentration described in this case is primarily coal dust, suggesting a higher likelihood of anthracosis rather than anthracosilicosis. Silicatosis (Option C) is a type of pneumoconiosis caused by the inhalation of silica dust, which can occur in industries such as mining, construction, and sandblasting. While silica exposure may also occur in the coke industry, the dust concentration described in this case is primarily coal dust, suggesting a higher likelihood of anthracosis rather than silicatosis. Asbestosis (Option D) is a type of pneumoconiosis caused by the inhalation of asbestos fibers, which can occur in industries such as construction, shipbuilding, and manufacturing. Asbestos exposure is not typically associated with the coke industry, making this diagnosis less likely. Siderosis (Option E) is a type of pneumoconiosis caused by the inhalation of iron particles, which can occur in industries such as welding and metalworking. This diagnosis is less likely than anthracosis given the patient’s occupation in the coke industry. |
138. Study of morbidity rate in a city N revealed that population of different administrative districts differed in age structure. What statistic method allows to eliminate influence of this factor upon morbidity indices?
A. Standardization
B. Wilcoxon’s t-criterion
C. Correlative regressive analysis
D. Analysis of dynamic series
E. Calculation of average values
Answer: Standardization
Explanation
| Standardization is a statistical method that adjusts for differences in the age structure of populations when comparing morbidity rates between different populations or geographic areas. This is important because morbidity rates can vary based on the age distribution of the population, with certain diseases being more common in older or younger age groups. By standardizing the morbidity rates, the comparison becomes more meaningful because it eliminates the confounding effect of age structure. This allows for a more accurate comparison of morbidity rates between different populations or geographic areas. Wilcoxon’s t-criterion (Option B) is a statistical test used to compare two independent samples to determine if they come from populations with the same distribution. It is not relevant for adjusting for the influence of age structure on morbidity rates. Correlative regressive analysis (Option C) is a statistical method used to determine the relationship between two variables, such as morbidity rates and demographic factors. While this method can be useful for identifying correlations between variables, it does not adjust for the influence of age structure on morbidity rates. Analysis of dynamic series (Option D) is a statistical method used to analyze trends over time. While this method can be useful for identifying trends in morbidity rates over time, it does not adjust for the influence of age structure on morbidity rates. Calculation of average values (Option E) is a basic statistical method used to summarize data. While this method can be useful for describing the central tendency of morbidity rates, it does not adjust for the influence of age structure on morbidity rates. |
139. An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?
A. Tinned food
B. Potatoes
C. Pasteurized milk
D. Boiled meat
E. Cabbage
Answer: Tinned food
Explanation
| Botulism is a serious form of food poisoning caused by the bacterium Clostridium botulinum, which produces a neurotoxin that can cause paralysis and potentially be fatal. Canned or tinned food that has been improperly processed or stored can provide an environment where the bacteria can grow and produce the toxin. Therefore, in an outbreak of food poisoning suspected to be caused by botulism, tinned food should be chosen for analysis in the first place to confirm the diagnosis. This can involve testing the food for the presence of the bacteria or the toxin, as well as examining the conditions under which the food was processed and stored. Potatoes (Option B), pasteurized milk (Option C), boiled meat (Option D), and cabbage (Option E) are not typically associated with the transmission of botulism. However, it is important to investigate all potential sources of food contamination in an outbreak of food poisoning and to consider other potential causes of illness, such as other bacterial or viral infections. |
140. A 72 year old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0,01, the eye is dense but painful on palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?
A. Acute attack of primary glaucoma of the left eye
B. Acute iridocyclitis of the left eye
C. Secondary glaucoma of the left eye
D. Acute keratitis of the left eye
E. Degeneration of the left eye cornea
Answer: Acute attack of primary glaucoma of the left eye
Explanation
| Glaucoma is a group of eye diseases that result in damage to the optic nerve, often due to increased pressure within the eye. Primary glaucoma is the most common form and is typically caused by a blockage of the eye’s drainage system, leading to increased intraocular pressure. In this case, the patient experienced acute pain in her left eye and abrupt vision impairment after receiving an injection of atropine, a medication commonly used to dilate the pupils during eye exams or surgeries. Atropine can cause the pupil to dilate and increase intraocular pressure, which can trigger an acute attack of glaucoma in patients who are susceptible. The patient’s symptoms of dense and painful left eye on palpation, opaque cornea, and cyanotic induration of eyeball vessels are consistent with an acute attack of primary glaucoma. Reduced visual acuity is also a common symptom of glaucoma. Acute iridocyclitis (Option B) is an inflammation of the iris and ciliary body of the eye, which can cause pain, redness, and light sensitivity. However, the patient’s symptoms are more consistent with a diagnosis of acute glaucoma. Secondary glaucoma (Option C) can occur as a result of another eye condition or medication, but the patient’s history and symptoms suggest a diagnosis of primary glaucoma. Degeneration of the cornea (Option E) can cause vision impairment, but it would not typically present with the other symptoms described in this case. |
141. Administration of a plant producing red lead paint intends to form a group of medical specialists for periodical medical examinations. What specialist must be obligatory included into this group?
A. Neuropathologist
B. Gynaecologist
C. Psychiatrist
D. Dermatologist
E. Otolaryngologyst
Answer: Neuropathologist
Explanation
| The specialist who must be obligatorily included in the group of medical specialists for periodical medical examinations in a plant producing red lead paint is a neuropathologist (Option A). Red lead paint is a type of lead-based paint that can pose a significant health risk to individuals who are exposed to it. Lead exposure can cause a range of health problems, including neurological damage, developmental delays, anemia, and kidney damage. As such, it is important to include a neuropathologist in the group of medical specialists responsible for conducting periodical medical examinations at the plant. Neuropathologists specialize in diagnosing and treating diseases of the nervous system, including those that may be caused by lead exposure. While gynecologists (Option B), psychiatrists (Option C), dermatologists (Option D), and otolaryngologists (Option E) may be important specialists for certain aspects of employee health, they are not directly relevant for the diagnosis and treatment of neurological damage caused by lead exposure. |
142. A 42 year old man works in a boiler room. He complains about girdle headache and recurring vomiting. There was also short-term consciousness loss. Objectively: increase of tendon reflexes, spontaneous myofibrillations. AP is 150/80 mm Hg, Ps- 104 bpm. Visible mucous membranes and cutaneous surfaces have crimson colouring. What is the most probable diagnosis?
A. Poisoning with carbon monooxide
B. Poisoning with hydrocyanic acid
C. Poisoning with anilin colouring agents
D. Poisoning with methane
E. Poisoning with benzine
Answer: Poisoning with carbon monooxide
Explanation
| Carbon monoxide (CO) is a colorless, odorless gas that is produced by incomplete combustion of fuels such as natural gas, propane, gasoline, and wood. CO poisoning occurs when high levels of CO are inhaled, preventing oxygen from being delivered to the body’s tissues and organs. In this case, the patient works in a boiler room, which is a setting where CO exposure can occur. The patient’s symptoms of girdle headache, recurring vomiting, and short-term consciousness loss are consistent with CO poisoning, as CO can cause headache, nausea, and confusion. The patient’s objective findings of increased tendon reflexes and spontaneous myofibrillations are also consistent with CO poisoning, as CO can cause neurological damage. The patient’s high blood pressure (AP is 150/80 mm Hg), rapid heart rate (Ps- 104 bpm), and crimson coloration of the mucous membranes and cutaneous surfaces are also consistent with CO poisoning. Hydrocyanic acid (Option B) is a toxic gas that can cause symptoms such as headache, dizziness, and confusion, but it is not typically associated with the patient’s occupation or symptoms. Anilin colouring agents (Option C) are chemicals used in the production of dyes and plastics, and can cause symptoms such as headache, dizziness, and nausea, but they are not typically associated with the patient’s occupation or symptoms. Methane (Option D) is a flammable gas that is not toxic, and poisoning with methane would not cause the patient’s symptoms. Benzene (Option E) is a toxic chemical commonly found in industrial settings, and exposure to high levels of benzene can cause symptoms such as headache, dizziness, and confusion. However, the patient’s occupation and symptoms are more consistent with CO poisoning. |
143. The amount of ultraviolet radiation dose was measured in minutes. What device was applied for measurement of the biodose?
A. Gorbachev’s biodosimeter
B. UV-meter
C. Actinometer
D. Radiometer
E. Catathermometer
Answer: Gorbachev’s biodosimeter
Explanation
| The most commonly used device for measuring ultraviolet radiation dose in minutes is a UV meter or UV dosimeter. UV meters are portable devices that use sensors to measure the intensity of ultraviolet radiation in a given location and provide a quantitative measure of the amount of UV radiation that has been received. So, option B is the correct answer. An actinometer is a device used to measure the strength of radiation by measuring the rate of chemical reaction induced by the radiation. Radiometer is an instrument used for measuring the intensity of electromagnetic radiation. Catathermometer is a thermometer used for measuring high temperatures. |
144. A 63 year old patient complained about pain in the lumbar area. He underwent a course of physiological treatment on account of radiculitis but this led to no improvement of his condition. R-graphy of spinal column and pelvic bones revealed osteoporosis and serious bone defects. Blood analysis revealed moderate normochromic anaemia, urine analysis revealed proteinuria. Whole blood protein made up 10,7 g/l. What disease should be suspected?
A. Myelomatosis
B. Urolithiasis
C. Acute radiculitis
D. Metastases in bones
E. Systemic osteoporosis
Answer: Myelomatosis
Explanation
| The patient is a 63-year-old who complains of pain in the lumbar area, which makes it necessary to evaluate the condition of the bones. The radiography of the spinal column and pelvic bones revealed osteoporosis and serious bone defects. In addition, the blood analysis revealed moderate normochromic anemia, urine analysis revealed proteinuria, and the whole blood protein made up 10.7 g/L. These findings suggest a diagnosis of myelomatosis, also known as multiple myeloma. Myeloma is a type of blood cancer that affects the plasma cells, which are responsible for producing antibodies to fight infections. In myeloma, plasma cells become abnormal and multiply uncontrollably, leading to the production of abnormal antibodies that can cause damage to bones and other organs. The pain in the lumbar area and serious bone defects seen in the radiography are common symptoms of myeloma, which can cause bone loss and fractures. The presence of anemia and proteinuria are also common findings in myeloma, as the abnormal plasma cells can interfere with the production of normal blood cells and cause kidney damage. In conclusion, the combination of symptoms and findings in this patient suggest a diagnosis of myelomatosis. Further testing, such as bone marrow biopsy and serum protein electrophoresis, may be necessary to confirm the diagnosis. |
145. A sergeant was injured by a shell splinter in the left subcostal area. He was bandaged with a first-aid pack on a battlefield. The patient was delivered to the regiment medical aid station. He complains about dizziness, weakness, thirst, abdominal pain. General condition is grave, the patient is pale. Ps is 120 bpm. Abdomen is soft, painful on palpation. The bandage is well fixed but a little bit soaked with blood. The patient should be evacuated to the medical battalion with the following transport and in the following turn:
A. With medical vehicle in the first turn
B. With a passing car in the first turn
C. With medical vehicle in the second turn
D. With a passing car in the second turn
E. With a passing car in the third turn
Answer: With medical vehicle in the first turn
Explanation
| The patient has suffered a penetrating injury to the left subcostal area, and is showing signs of shock with dizziness, weakness, thirst, and a high heart rate of 120 bpm. These symptoms suggest that the patient may be experiencing hemorrhagic shock, which can be a life-threatening condition. The bandage is well fixed but soaked with blood, indicating ongoing bleeding from the wound. The fact that the patient is pale and in a grave condition further supports the possibility of ongoing bleeding and shock. Given the severity of the patient’s condition and the need for urgent medical attention, the patient should be transported to the medical battalion with a medical vehicle in the second turn. A medical vehicle would be better equipped to provide emergency medical care and monitor the patient’s condition during transport. A passing car may not have the necessary medical equipment or personnel to provide adequate care and may not be able to monitor the patient’s condition during transport. In summary, the patient should be evacuated to the medical battalion with a medical vehicle in the second turn, as this would provide the best chance for the patient to receive proper medical care and monitoring during transport. |
146. On the 5th day after labor body temperature of a parturient suddenly rose up to 38, 7oC. She complains about weakness, headache, abdominal pain, irritability. Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, t o- 38, 7oC. Bimanual examination revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal lets in 2 transverse fi- ngers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR- 30 mm/h. What is the most probable diagnosis?
A. Endometritis
B. Parametritis
C. Pelviperitonitis
D. Metrophlebitis
E. Lochiometra
Answer: Endometritis
Explanation
| Endometritis is an inflammation of the inner lining of the uterus, which can occur after delivery. The symptoms include fever, weakness, headache, abdominal pain, and irritability, which are all present in this case. The patient’s body temperature is elevated at 38.7oC, which is indicative of an infection. The bimanual examination revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation, and the cervical canal was open. The presence of moderate, turbid discharges with a foul smell is also indicative of endometritis. The laboratory findings of skeocytosis (an increased number of white blood cells), lymphopenia (a decreased number of lymphocytes), and an elevated ESR (erythrocyte sedimentation rate) are also consistent with an inflammatory process such as endometritis. Parametritis, pelviperitonitis, metrophlebitis, and lochiometra are all possible complications after delivery, but they have different clinical manifestations and laboratory findings. Parametritis and pelviperitonitis typically present with severe abdominal pain, fever, and signs of peritoneal irritation. Metrophlebitis is characterized by fever, chills, and pain in the lower abdomen or pelvis. Lochiometra is the accumulation of lochia (postpartum vaginal discharge) within the uterus, which can cause pain and fever, but it usually occurs within the first few days after delivery. In conclusion, based on the clinical presentation and laboratory findings, the most probable diagnosis in this case is endometritis. |
147. A 19 year old boy was admitted to a hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can specify the patient’s blood group and rhesus compatibility?
A. A doctor of any speciality
B. A laboratory physician
C. A surgeon
D. A traumatologist
E. An anaesthesilogist
Answer: A doctor of any speciality
Explanation
| In a case of closed abdominal trauma where multiple ruptures of the spleen and small intestine have been revealed, and the patient’s blood pressure is rapidly dropping, it is necessary to perform hemotransfusion. Before performing the transfusion, it is important to determine the patient’s blood group and rhesus compatibility to ensure that the transfused blood is compatible with the patient’s own blood. Determining a patient’s blood group and rhesus compatibility requires laboratory testing, which is typically performed by a laboratory physician or a trained laboratory technician. These individuals are trained in blood banking and transfusion medicine and have the expertise to accurately determine a patient’s blood type and rhesus factor. While doctors of any specialty can order the laboratory testing, they may not have the training or expertise to accurately interpret the results or ensure that the transfusion is performed safely. Therefore, it is important to involve a laboratory physician or technician in the process to ensure that the transfusion is performed safely and effectively. In summary, the laboratory physician or technician is the most appropriate person to specify the patient’s blood group and rhesus compatibility in this case, as they have the necessary expertise and training to accurately perform the testing and ensure safe transfusion of blood products. |
148. A 36 year old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
A. Valvular pneumothorax
B. Open pneumothorax
C. Closed pneumothorax
D. Subcutaneous emphysema
E. Mediastinitis
Answer: Valvular pneumothorax
Explanation
| Valvular pneumothorax is a type of closed pneumothorax in which air enters the pleural space through a one-way valve and is unable to escape. This causes the pressure within the pleural space to increase, leading to mediastinal displacement and compression of the heart and lungs. In this case, the patient was delivered to the surgical department an hour after a road accident and is experiencing respiratory insufficiency and cardiac abnormalities. Clinical and radiological investigations revealed mediastinal displacement, which is consistent with valvular pneumothorax. Open pneumothorax occurs when air enters the pleural space through an open wound in the chest, leading to a loss of negative pressure and collapse of the lung. Closed pneumothorax occurs when air enters the pleural space through an injury to the lung or chest wall, but the wound is sealed and negative pressure is maintained. Subcutaneous emphysema occurs when air enters the tissues beneath the skin, causing swelling and crepitus. Mediastinitis is a rare but serious condition that involves inflammation or infection of the mediastinum, the space in the middle of the chest between the lungs. In summary, valvular pneumothorax is the most likely cause of mediastinal displacement in this case, based on the clinical and radiological findings. |
149. An 18 year old primigravida in her 27-28 week of pregnancy underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:
A. Noncarrying of pregnancy
B. Intestinal obstruction
C. Fetus hypotrophy
D. Premature placenta detachment
E. Late gestosis
Answer: Noncarrying of pregnancy
Explanation
| Acute appendicitis is a common surgical emergency in pregnancy and requires prompt surgical intervention. However, the surgery itself can pose certain risks and increase the likelihood of pregnancy complications, including noncarrying of pregnancy. Noncarrying of pregnancy, also known as miscarriage, is a common complication of surgery during pregnancy. The risk of noncarrying of pregnancy is highest in the first trimester, but it can occur at any stage of pregnancy. Surgery during pregnancy can increase the risk of noncarrying of pregnancy due to a variety of factors, including anesthesia, surgical trauma, and infection. To prevent noncarrying of pregnancy in the postoperative period, it is important to closely monitor the patient’s condition and provide appropriate care. This may include measures to prevent infection, pain management, and close monitoring of fetal well-being. In some cases, bed rest or other restrictions may be necessary to reduce the risk of complications. Intestinal obstruction, fetus hypotrophy, premature placenta detachment, and late gestosis are also potential complications of surgery during pregnancy, but they are less likely to occur in the context of an appendectomy in the second trimester. Nevertheless, it is important to monitor the patient closely and provide appropriate care to minimize the risk of any complications. |
150. It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?
A. Bathroom unit
B. Manipulation room
C. Doctor’s consulting room
D. Patient’s examination room
E. Nursing room
Answer: Bathroom unit
Explanation
| Complete isolation boxes, also known as negative pressure rooms, are designed to prevent the spread of airborne infectious diseases in healthcare settings. They consist of a tambour, a ward, and a lock chamber, and are typically used for patients with highly contagious respiratory infections, such as tuberculosis or COVID-19. In addition to these three components, a complete isolation box should also include a bathroom unit. The bathroom unit is important because it allows patients to maintain proper hygiene and sanitation while they are in isolation. It also helps to minimize the risk of contamination and spread of infection by providing a separate space for patients to use the bathroom facilities. Manipulation rooms, doctor’s consulting rooms, patient examination rooms, and nursing rooms are all important components of a healthcare facility, but they are not essential components of a complete isolation box. These rooms may be located outside of the isolation box and used as needed for patient care. In summary, a bathroom unit is an essential component of a complete isolation box, as it helps to maintain proper hygiene and sanitation and minimize the risk of contamination and spread of airborne infectious diseases in healthcare settings. |
