Question From ( 101 To 150 )
101. After supercooling a 38-yearold woman developed muscle pain, body temperature rise up to 39oC, headache, dysuria, positive Pasternatsky’s symptome. In the urine: leukocyturia, bacteriuria. In blood: Decrease in Hb rate down to 103 g/l, left shift leukocytosis, ESR acceleration up to 32 mm/h. Blood urea – 6,0 millimole/l. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Renal tuberclosis
C. Acute glomerulonephritis
D. Urolithiasis
E. Acute cystitis
Answer: Acute pyelonephritis
Explanation
| Based on the provided information, the most likely diagnosis for this patient is acute pyelonephritis: – The symptoms of high fever, chills, flank pain, headache and dysuria are classic for acute pyelonephritis. – The urinary findings of leukocytes and bacteria in the urine indicate a urinary tract infection that has ascended from the bladder to involve the kidneys (pyelonephritis). – The laboratory abnormalities of an elevated ESR, left shift leukocytosis and slight decrease in hemoglobin are consistent with an acute inflammatory process like pyelonephritis. – The normal blood urea level rules out more severe kidney involvement. Pyelonephritis is more likely than the other options given: B) Renal tuberculosis – No history or symptoms to suggest TB C) Acute glomerulonephritis – Laboratory tests not indicative of glomerulonephritis D) Urolithiasis – No mention of stones or other symptoms typical for this condition E) Acute cystitis – Cystitis does not typically cause high fevers or left shift leukocytosis In summary, the combination of typical symptoms, urinary and laboratory findings, and absence of features suggesting other diagnoses makes acute pyelonephritis the most likely diagnosis for this patient’s condition following her recent episode of being supercooled. Aggressive antibiotic treatment targeting common uropathogens is indicated. |
102. A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis – 13, 1 · 109/l, ESR – 28 mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
Answer: Chronic calculous cholecystitis
Explanation
| The most likely diagnosis given the provided information is chronic calculous cholecystitis: 1. The history of intermittent right upper quadrant pain that is exacerbated by fatty meals is classic for gallbladder disease, especially when gallstones are present. 2. The recent progression of symptoms with daily attacks that have become more severe point to an exacerbation or acute episode of the chronic condition. 3. The development of jaundice, pale stools and dark urine indicate obstruction of the common bile duct, likely by a gallstone that has migrated from the gallbladder. This is a common complication of chronic cholecystitis. 4. The laboratory abnormalities of leukocytosis and elevated ESR are nonspecific but consistent with an inflammatory process like acute cholecystitis. In contrast: B) Chronic pancreatitis – No history of typical pancreatic pain or other features to suggest this diagnosis. C) Fatty liver – Would not explain the presenting gallbladder symptoms and jaundice. D) Cholangitis – Would expect elevated bilirubin and liver enzymes to be more prominent. E) Hypertensive dyskinesia – Refers to gallbladder motility disorder; gallstones are not mentioned. So in summary, the classic history of intermittent biliary colic that has progressed to include obstructive jaundice, the normal age of onset, and lack of features pointing strongly to alternative diagnoses make chronic calculous cholecystitis with acute cholangitis the most likely diagnosis for this patient. Evaluation with imaging studies and liver function tests would be warranted. |
103. A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation. She was hospitalized with suspicion of placental presentation. Under what conditions is it rational to conduct the internal examination for the diagnosis specification?
A. In the operating room prepared for the operation
B. In the examination room of antenatal clinic
C. In the admission ward of maternity hospital
D. In the delivery room keeping to all the aseptics regulations
E. The examination is not to be conducted because of risk of profuse haemorrhage
Answer: In the operating room prepared for the operation
Explanation
| The most likely diagnosis given the provided information is chronic calculous cholecystitis: 1. The history of intermittent right upper quadrant pain that is exacerbated by fatty meals is classic for gallbladder disease, especially when gallstones are present. 2. The recent progression of symptoms with daily attacks that have become more severe point to an exacerbation or acute episode of the chronic condition. 3. The development of jaundice, pale stools and dark urine indicate obstruction of the common bile duct, likely by a gallstone that has migrated from the gallbladder. This is a common complication of chronic cholecystitis. 4. The laboratory abnormalities of leukocytosis and elevated ESR are nonspecific but consistent with an inflammatory process like acute cholecystitis. In contrast: B) Chronic pancreatitis – No history of typical pancreatic pain or other features to suggest this diagnosis. C) Fatty liver – Would not explain the presenting gallbladder symptoms and jaundice. D) Cholangitis – Would expect elevated bilirubin and liver enzymes to be more So in summary, the classic history of intermittent biliary colic that has progressed to include obstructive jaundice, the normal age of onset, and lack of features pointing strongly to alternative diagnoses make chronic calculous cholecystitis with acute cholangitis the most likely diagnosis for this patient. Evaluation with imaging studies and liver function tests would be warranted. |
104. 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 likely diagnosis?
A. Microbial eczema
B. Allergic dermatitis
C. Seborrheic eczema
D. Cutaneous tuberculosis
E. Streptococcal impetigo
Answer: Microbial eczema
Explanation
| The most likely diagnosis based on the symptoms described is microbial eczema, also known as infected eczema or secondary infected eczema. Microbial eczema is a type of eczema that occurs when a bacterial, viral, or fungal infection develops in the affected area. The symptoms described in this case are consistent with the clinical presentation of microbial eczema. The patient is experiencing itching in the left shin, which is an area that is commonly affected by eczema. The presence of a trophic ulcer suggests that the skin in that area is compromised, making it more susceptible to infection. The redness, edema, oozing lesions, and yellowish crusts are also consistent with the signs of an infected eczema. The other options listed are less likely based on the symptoms described. Allergic dermatitis usually presents as a red, itchy rash that is not well-defined. Seborrheic eczema typically affects the scalp, face, and chest, and is characterized by redness, scaling, and itching. Cutaneous tuberculosis typically presents as a painless, non-healing ulcer with raised borders. Streptococcal impetigo is a bacterial skin infection that usually affects children and is characterized by blisters that burst and form a honey-colored crust. In summary, based on the symptoms described, the most likely diagnosis is microbial eczema. |
105. A 30-year-old patient presented with body temperature rise up to 38, 5oC, pain in the small articulations of hands; face edemata and erythema. In blood: RBCs – 2, 6 · 1012/l; Hb- 98 г/л; WBCs – 2 · 109/l; ESR – 58 mm/h. In the urine: protein – 3,1 g/l; RBCs – 10-15 in the vision field. What disease can be suspected in this case?
A. Systemic lupus erythematosus
B. Sepsis C. Systemic scleroderma
D. Periarteritis nodosa
E. Acute glomerulonephritis
Answer: Systemic lupus erythematosus
Explanation
| Based on the symptoms and laboratory findings described, the most likely diagnosis is Systemic Lupus Erythematosus (SLE). SLE is a chronic autoimmune disease that can affect multiple organ systems, including the skin, joints, kidneys, and blood vessels. The patient is presenting with a low-grade fever, joint pain, and facial edema and erythema, which are all common symptoms of SLE. Additionally, the laboratory findings are consistent with SLE, including a low white blood cell count (WBCs), elevated erythrocyte sedimentation rate (ESR), and proteinuria with hematuria. The low WBC count is a common finding in SLE and is due to autoimmune destruction of white blood cells. The elevated ESR indicates inflammation, which is a hallmark of SLE. The proteinuria with hematuria suggests kidney involvement, which is also common in SLE. The other options listed are less likely based on the symptoms and laboratory findings. Sepsis typically presents with high fever and signs of systemic infection, such as elevated WBC count. Systemic scleroderma is characterized by skin thickening and fibrosis, which is not present in this case. Periarteritis nodosa is a rare autoimmune disease that affects the blood vessels, and typically presents with fever, weight loss, and joint pain. Acute glomerulonephritis usually presents with hematuria, proteinuria, and signs of kidney dysfunction, but is less likely in this case given the other symptoms and laboratory findings. In summary, based on the symptoms and laboratory findings described, the most likely diagnosis is Systemic Lupus Erythematosus (SLE). |
106. A 5-grade pupil complains about extensive skin rash accompanied by intensive itch, especially at night. Objectively: there are small red papules set mostly in pairs in the region of interdigital folds on both hands, on the flexor surface of radicarpal articulations, abdomen and buttock skin as well as internal surface of thighs. In the centre of some papules vesicles or serohaemorrhagic crusts can be seen. There are multiple excoriations. What is the most likely diagnosis?
A. Scabies
B. Dermatitis
C. Ringworm of body
D. Toxicoderma
E. Eczema
Answer: Scabies
Explanation
| The most likely diagnosis based on the symptoms described is scabies. Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei and is characterized by intense itching, especially at night, and a rash with small red papules that often appear in pairs. The distribution of the rash in this case, with involvement of the interdigital folds, flexor surfaces of the wrists, abdomen, buttocks, and thighs, is also consistent with scabies. The presence of vesicles or serohaemorrhagic crusts in the center of some papules, as well as multiple excoriations, are also typical findings in scabies. The other options listed are less likely based on the symptoms described. Dermatitis is a general term for skin inflammation and can have various causes, but the pattern of distribution in this case is more suggestive of scabies. Ringworm of body is a fungal infection that usually presents as a circular rash with a raised border and central clearing, which is not consistent with the rash described in this case. Toxicoderma is a generalized term for skin reactions to drugs or other substances, which may not present with the typical distribution and morphology of scabies. Eczema is a non-contagious skin condition characterized by dry, itchy, and inflamed skin, and is less likely in this case given the distribution of the rash and the presence of excoriations. In summary, based on the symptoms described, the most likely diagnosis is scabies. |
107. A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38oC. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?
A. Erysipelas
B. Microbial eczema
C. Contact dermatitis
D. Toxicoderma
E. Haemorrhagic vasculitis
Answer: Erysipelas
Explanation
| Based on the symptoms described, the most likely provisional diagnosis is erysipelas. Erysipelas is a bacterial skin infection that affects the upper dermis and superficial lymphatics, and it is usually caused by Streptococcus pyogenes. The patient is presenting with an acute onset of symptoms, including a red, hot, and well-defined spot on the skin of the right leg, with edema and isolated vesicles in the affected area. These symptoms are consistent with the clinical presentation of erysipelas. The other options listed are less likely based on the symptoms described. Microbial eczema, contact dermatitis, and toxicoderma are all more likely to present with a more generalized rash, rather than a well-defined area of redness with vesicles. Haemorrhagic vasculitis is a rare condition that can cause skin lesions, but it typically presents with palpable purpura and is not consistent with the symptoms described in this case. In summary, based on the symptoms described, the most likely provisional diagnosis is erysipelas. |
108. 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
| The main provision for successful prevention of gaseous gangrene is the removal of necrotic tissues and timely surgical processing of the wound. Gaseous gangrene is a serious and potentially life-threatening bacterial infection that can occur in soft tissue, particularly in the presence of anaerobic bacteria. The bacteria produce toxins that cause tissue destruction and gas formation, which can lead to tissue necrosis and sepsis. The most effective way to prevent or treat gaseous gangrene is to remove all necrotic tissues and perform timely surgical debridement of the wound. This involves removing any dead or damaged tissue, cleaning the wound thoroughly, and applying appropriate wound dressings. Antibiotics may also be administered to prevent or treat bacterial infections, but they are not sufficient on their own to prevent gaseous gangrene. The other options listed are less effective or not appropriate for preventing gaseous gangrene. Injection of specific serum (either 3,000 U or 30,000 U) is not commonly used for treating or preventing gaseous gangrene. Infiltration of soft tissues around the wound with antibiotic solution may be helpful, but it is not as effective as surgical debridement. Wound lavage with 6% solution of hydrogen peroxide can be useful for cleaning the wound, but it is not sufficient on its own to prevent gaseous gangrene. In summary, the main provision for successful prevention of gaseous gangrene is the removal of necrotic tissues and timely surgical processing of the wound. |
109. A 35-year-old patient was admitted to the in-patient psychiatric facility for the first time. He was diagnosed with paranoid schizophrenia. What is the most rational treatment method?
A. Neuroleptic therapy
B. Vitamin therapy
C. Physiotherapy
D. Psychotherapy
E. Reflex therapy
Answer: Neuroleptic therapy
Explanation
| The most rational treatment method for a patient with paranoid schizophrenia is neuroleptic therapy. Neuroleptics, also known as antipsychotics, are medications that are effective in treating the positive symptoms of schizophrenia, such as delusions and hallucinations. They work by blocking dopamine receptors in the brain, which reduces the activity of dopamine and helps to alleviate symptoms. There are two main types of neuroleptics: typical and atypical. Typical neuroleptics are older medications that are effective in treating positive symptoms but can cause side effects such as movement disorders. Atypical neuroleptics are newer medications that are also effective in treating positive symptoms but have fewer side effects. The choice of neuroleptic medication and dosage will depend on the individual patient’s symptoms, medical history, and other factors. The goal of treatment is to achieve symptom relief while minimizing side effects. Other treatment methods, such as vitamin therapy, physiotherapy, psychotherapy, and reflex therapy, may be used in conjunction with neuroleptic therapy as part of a comprehensive treatment plan. However, neuroleptic therapy is the most rational and effective treatment method for the positive symptoms of paranoid schizophrenia. |
110. A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progressing under conditions of weak general peripheric resistance and decreased 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
| In the case of acute macrofocal myocardial infarction complicated by cardiogenic shock, the first-line antihypotensive drug that should be administered is dopamine. Dopamine is a vasopressor medication that acts on both alpha and beta adrenergic receptors. It increases blood pressure by causing vasoconstriction and also increases cardiac output by increasing heart rate and contractility. In patients with cardiogenic shock, dopamine can improve blood flow to vital organs such as the brain, kidneys, and heart. Noradrenaline and adrenaline are also vasopressor medications that can be used to treat hypotension in cardiogenic shock. However, they have a stronger effect on vasoconstriction and may increase the workload on the heart, which can be detrimental in some cases. Mesatonum is a medication that acts on alpha adrenergic receptors and can also be used to treat hypotension. However, it has a more limited effect on cardiac output and may not be as effective in treating cardiogenic shock. Prednisolone is a steroid medication that has anti-inflammatory and immunosuppressive effects, but it is not typically used as an antihypotensive drug in the setting of cardiogenic shock. In summary, in the case of acute macrofocal myocardial infarction complicated by cardiogenic shock, the first-line antihypotensive drug that should be administered is dopamine. |
111. A patient came to the traumatology centre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of glass. 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
| Based on the symptoms described, the nerve that is most likely damaged is the ulnar nerve. The ulnar nerve is a peripheral nerve that runs down the arm and supplies the IV and V fingers, as well as the interior dorsal and palmar surface of the hand. A cut on a piece of glass on the lower third of the volar forearm surface could potentially injure the ulnar nerve and result in impaired flexion of the IV and V fingers, as well as reduced sensitivity in the affected areas. The other nerves listed are less likely to be damaged based on the symptoms described. The radial nerve supplies the extensor muscles of the forearm and hand, and injury to this nerve would result in weakness or paralysis of these muscles, rather than impaired flexion of the IV and V fingers. The median nerve supplies the muscles of the forearm and hand that allow for wrist and finger flexion, but injury to this nerve would also affect the thumb and middle and index fingers, rather than just the IV and V fingers. The musculoskeletal and axillary nerves are not typically involved in hand and finger movements and are less likely to be affected by a cut on the volar forearm surface. In summary, based on the symptoms described, the nerve that is most likely damaged is the ulnar nerve. |
112. A patient was delivered to the admission ward 40 minutes after a minor trauma with complaints of pain in the thoracic spine. He has a history of pulmonary tuberculosis. Roentgenography results: suspected compression fracture of the VIII and IX thoracic vertebrae. What pathological process in spine might have stimulated pathological fracture of vertebral bodies?
A. Tuberculous spondylitis
B. Syphilis
C. Malignant tumour metastasis
D. Osteomyelitis
E. Traumatic fracture
Answer: Tuberculous spondylitis
Explanation
| The pathological process in the spine that might have stimulated a pathological fracture of the vertebral bodies in this patient with a history of pulmonary tuberculosis is tuberculous spondylitis, also known as Pott disease. Tuberculous spondylitis is a form of tuberculosis that affects the spine and can cause destruction of the vertebral bodies, leading to spinal deformity, paralysis, and pathological fractures. The disease is caused by Mycobacterium tuberculosis, which can spread from the lungs to the spine through the bloodstream or lymphatic system. In patients with tuberculous spondylitis, the vertebral bodies become weakened and may collapse under normal stress, such as from minor trauma. This can result in compression fractures and other spinal abnormalities. The other options listed are less likely to cause a pathological fracture of the vertebral bodies in a patient with a history of pulmonary tuberculosis. Syphilis can affect the spine, but it typically causes destructive changes in the cervical spine rather than the thoracic spine. Malignant tumor metastasis can cause pathological fractures, but this is less likely in a patient with a history of pulmonary tuberculosis. Osteomyelitis can cause vertebral destruction, but it is less common than tuberculous spondylitis and typically affects the lumbar spine. Traumatic fracture is also less likely in this case, given the minor nature of the trauma and the presence of a suspected compression fracture involving multiple vertebral bodies. In summary, in a patient with a history of pulmonary tuberculosis and a suspected compression fracture involving multiple thoracic vertebral bodies, the most likely pathological process in the spine that might have stimulated the fracture is tuberculous spondylitis. |
113. On the next day after esophagoscopy and biopsy a 44-year-old female patient developed emphysema of both supraclavicular regions, deglutition pain and pain behind the breastbone, cyanosis. Body temperature – 39oC. In blood: WBCs – 16 · 109/l, left shift in the neutrophils. Xray picture shows a limited shadow of the posterior mediastinum at a level with trachea bifurcation. The patient was diagnosed with esophagus rupture. What treatment tactics would be the most rational?
A. Surgical: mediastinum drainage, gastric fistula establishment
B. Surveillance
C. Conservative antibacterial treatment
D. Radical surgical treatment with esophagus suturing
E. Surgical: gastric fistula establishment
Answer: Surgical: mediastinum drainage, gastric fistula establishment
Explanation
| In a patient with esophagus rupture, the most rational treatment tactic would be surgical intervention, specifically mediastinum drainage and gastric fistula establishment. Esophagus rupture is a serious condition that requires immediate medical attention. It can be caused by a variety of factors, including trauma, foreign body ingestion, and medical procedures such as esophagoscopy. The symptoms of esophagus rupture include pain on swallowing, chest pain, cyanosis, fever, and signs of mediastinal emphysema. Surgical intervention is the most effective treatment for esophagus rupture. The goal of surgery is to drain the mediastinum and establish a gastric fistula, which allows air and fluid to escape from the stomach and prevents further contamination of the mediastinum. In some cases, the esophagus may also need to be repaired or resected. Conservative antibacterial treatment alone is not sufficient to treat esophagus rupture, as it does not address the underlying mechanical problem. Surveillance is also not appropriate, as the condition requires immediate intervention. Radical surgical treatment with esophagus suturing may be necessary in some cases, but the first priority is to establish drainage and prevent further contamination of the mediastinum. In summary, in a patient with esophagus rupture, the most rational treatment tactic would be surgical intervention, specifically mediastinum drainage and gastric fistula establishment. |
114. A 30-year-old woman with a long history of chronic pyelonephritis complains about considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP- 200/120 mm Hg. In blood: creatinine – 0,62 millimole/l, hypoproteinemia, albumines – 32 g/l, potassium – 6,8 millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?
A. Haemodialysis
B. Antibacterial therapy
C. Enterosorption
D. Haemosorption
E. Blood transfusion
Answer: Haemodialysis
Explanation
| In a patient with chronic pyelonephritis and symptoms of weakness, sleepiness, decreased diuresis, and severe hypertension, along with laboratory findings of hypoproteinemia, hyperkalemia, and hypochromic anemia, the first step in the treatment tactics would be haemodialysis. Haemodialysis is a medical treatment that involves the removal of waste products and excess fluid from the blood by passing it through a dialysis machine. It is used in patients with acute or chronic renal failure to improve their kidney function and manage their symptoms. In this case, the patient’s symptoms and laboratory findings suggest that she is experiencing acute kidney injury, which can be a complication of chronic pyelonephritis. Antibacterial therapy may also be necessary to treat the underlying chronic pyelonephritis, but the first priority is to address the acute complications of kidney injury and severe hypertension. Enterosorption, haemosorption, and blood transfusion are not appropriate treatments for this patient’s condition. In summary, in a patient with chronic pyelonephritis and symptoms of acute kidney injury, the first step in the treatment tactics would be haemodialysis to manage her symptoms and improve her kidney function. Antibacterial therapy may also be necessary to treat the underlying chronic pyelonephritis. |
115. A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?
A. Blood glucose analysis on an empty stomach
B. Glucose in urine test on the base of daily diuresis
C. Acetone in urine test
D. Glucose tolerance test
E. Glucosuric profile
Answer: Blood glucose analysis on an empty stomach
Explanation
| In a 10-year-old girl presenting with symptoms of thirst, frequent urination, and weight loss, the laboratory analysis that should be carried out in the first place is a blood glucose analysis on an empty stomach. These symptoms are indicative of hyperglycemia, which is often associated with diabetes mellitus. A blood glucose analysis on an empty stomach can help diagnose or exclude diabetes mellitus as the underlying cause of the symptoms. The other tests listed may also be useful in the diagnosis and management of diabetes mellitus, but they are typically carried out after a diagnosis has been made. For example, glucose in urine test and acetone in urine test can be used to monitor blood glucose levels and assess the severity of the condition. Glucose tolerance test and glucosuric profile are also used to diagnose diabetes mellitus, but they are more invasive and time-consuming than a simple blood glucose analysis on an empty stomach. In summary, in a 10-year-old girl presenting with symptoms of hyperglycemia, the laboratory analysis that should be carried out in the first place is a blood glucose analysis on an empty stomach to diagnose or exclude diabetes mellitus as the underlying cause of the symptoms. |
116. A 19-year-old patient complains about skin rash that appeared 2 days ago after eating smoked fish. The rash disappears after 4-6 hours but then turns up again. It is accompanied by itch. Objectively: trunk and upper limbs are covered with multiple pink blisters as big as a pea or a bean. What is the most likely diagnosis?
A. Acute urticaria
B. Allergic dermatitis
C. Quincke’s edema
D. Toxicodermia
E. Purigo
Answer: Acute urticaria
Explanation
| The most likely diagnosis for a 19-year-old patient with a skin rash that appeared 2 days ago after eating smoked fish, accompanied by itching and multiple pink blisters on the trunk and upper limbs that disappear after 4-6 hours but then reappear, is acute urticaria. Acute urticaria is a common skin condition characterized by the sudden appearance of itchy, raised, pink or red welts or hives, which can vary in size and shape. It is often caused by an allergic reaction to a food, medication, insect bite, or other environmental trigger. In this case, the symptoms developed after eating smoked fish, suggesting a possible allergic reaction. The fact that the rash disappears and then reappears after a few hours is characteristic of urticaria, which is known for its transient nature. Other symptoms of acute urticaria can include swelling of the lips, tongue, or face, as well as difficulty breathing in severe cases. Allergic contact dermatitis, toxicodermia, and purigo are less likely diagnoses in this case, as they are typically characterized by different types of skin lesions and do not have the transient nature of urticaria. Quincke’s edema is a severe form of allergic reaction that can cause swelling of the face, lips, tongue, and throat, and can be life-threatening if not treated promptly. While it is possible that the patient may develop Quincke’s edema as a complication of acute urticaria, the symptoms described do not suggest this diagnosis at this time. In summary, based on the symptoms described, the most likely diagnosis for a 19-year-old patient with a skin rash after eating smoked fish is acute urticaria. |
117. A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?
A. Cancer
B. Cyst
C. Fibroadenoma
D. Mastopathy
E. Lipoma
Answer: Cancer
Explanation
| In a 68-year-old patient with a tumour in her left breast that is dense, uneven, and painless on palpation, the most likely diagnosis is cancer. Breast cancer is a malignant tumor that can occur in the breast tissue. It is more common in women over the age of 50, and the most common symptom is the presence of a lump or mass in the breast. Other symptoms can include changes in the size or shape of the breast, skin dimpling, nipple inversion, or discharge from the nipple. In this case, the description of a dense, uneven, painless mass in the breast is highly suggestive of breast cancer. The absence of enlarged regional lymph nodes does not rule out the possibility of cancer, as lymph node involvement can occur later in the course of the disease. Cysts, fibroadenomas, mastopathy, and lipomas are benign breast conditions that can also present as palpable masses in the breast. However, they are typically described as smooth, round, and mobile, and may be tender or painful on palpation. The dense, uneven, and painless nature of the mass described in this case makes cancer a more likely diagnosis. In summary, in a 68-year-old patient with a dense, uneven, painless mass in the breast, the most likely diagnosis is cancer. A biopsy and further imaging studies would be necessary to confirm the diagnosis and determine the stage and treatment options. |
118. A 40-year-old female patient has been observing profuse menses 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 likely diagnosis?
A. Nascent submucous fibromatous node
B. Abortion in progress
C. Cervical carcinoma
D. Cervical myoma
E. Algodismenorrhea
Answer: Nascent submucous fibromatous node
Explanation
| In a 40-year-old female patient presenting with profuse menses accompanied by spasmodic pain in the lower abdomen for a year, along with a dense formation up to 5 cm in diameter in the cervical canal and an enlarged, painful uterus of normal consistency, the most likely diagnosis is a nascent submucous fibromatous node. Submucous fibroids or fibromatous nodes are benign tumors that grow beneath the lining of the uterus and can cause heavy menstrual bleeding and pelvic pain. They are more common in women over the age of 40 and can range in size from small nodules to large masses that distort the uterus. The presence of a dense formation in the cervical canal is highly suggestive of a submucous fibromatous node. Cervical carcinoma is less likely as the symptoms and examination findings are not typical for this condition. Abortion in progress is also less likely as the patient has been experiencing these symptoms for a year and no evidence of products of conception or miscarriage has been mentioned. Cervical myoma is also a possible diagnosis, but the presence of a dense formation in the cervical canal suggests a submucous fibromatous node. Algodismenorrhea is not a diagnosis, but rather a term used to describe painful periods, which may or may not be related to an underlying condition. In summary, in a 40-year-old female patient with profuse menses, a dense formation in the cervical canal, and an enlarged, painful uterus of normal consistency, the most likely diagnosis is a nascent submucous fibromatous node. Further evaluation with imaging studies and a biopsy may be necessary to confirm the diagnosis and determine the appropriate treatment. |
119. A 65-year-old patient complains about pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). Prostatespecific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?
A. Computer tomography of pelvis
B. Roentgenography of lumbar spine
C. Excretory urography
D. Bone scintigraphy
E. Roentgenography of chest
Answer: Computer tomography of pelvis
Explanation
| In a 65-year-old patient with pain in the lumbar spine, moderate disuria, and a diagnosis of adenocarcinoma of the prostate with hypoechogenic nodes in both lobes and capsule invasion, the most appropriate supplemental examination method to determine the stage of the neoplastic process is computer tomography (CT) of the pelvis. CT of the pelvis is a useful imaging modality for evaluating the extent of the prostate cancer, including the involvement of adjacent structures such as the bladder, rectum, and pelvic lymph nodes. This information is important for determining the stage of the disease and guiding treatment decisions. Roentgenography of the lumbar spine and excretory urography may be useful for evaluating the lumbar spine and urinary tract, respectively, but they are less likely to provide information about the extent of the prostate cancer. Bone scintigraphy may be useful for detecting the spread of the cancer to the bones, but it is less useful for evaluating the local extent of the disease. Roentgenography of the chest may be useful for detecting metastases to the lungs, but it is less likely to be relevant in this case. In summary, in a 65-year-old patient with adenocarcinoma of the prostate, the most appropriate supplemental examination method to determine the stage of the neoplastic process is CT of the pelvis. |
120. A 44-year-old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times higher 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
| In a 44-year-old man who has been working in the coke industry for 16 years with a high dust concentration at his workplace and radiographic evidence of pneumoconiosis, the most probable type of pneumoconiosis is anthracosis. Anthracosis, also known as coal dust pneumoconiosis, is a type of pneumoconiosis caused by the inhalation of coal dust. It is a common occupational disease in coal miners and workers in related industries, such as coke production. The dust concentration in this patient’s workplace is 5-10 times higher than the maximum permissible concentration, which increases the risk of developing anthracosis. Anthracosilicosis, also known as mixed dust pneumoconiosis, is a similar condition caused by the inhalation of a mixture of coal and silica dust. Silicatosis is a type of pneumoconiosis caused by the inhalation of silica dust, which is commonly seen in workers in industries such as mining, sandblasting, and construction. Asbestosis is a type of pneumoconiosis caused by the inhalation of asbestos fibers, which can lead to the development of lung cancer and mesothelioma. Siderosis is a type of pneumoconiosis caused by the inhalation of iron dust, which is seen in workers in industries such as welding and steel production. In summary, in a 44-year-old man with a history of working in the coke industry for 16 years and radiographic evidence of pneumoconiosis, the most probable type of pneumoconiosis is anthracosis, caused by the inhalation of coal dust. |
121. 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
| The statistic method that allows to eliminate the influence of age structure on morbidity indices in different administrative districts is standardization. Standardization is a statistical method that adjusts for differences in the age structure of two or more populations being compared. This method involves calculating age-specific rates for each population and then applying a standard age distribution, such as the World Health Organization (WHO) standard population, to calculate age-adjusted rates for each population. Age-adjusted rates allow for a valid comparison of morbidity rates between populations with different age structures. In the case described, standardization would allow for a comparison of morbidity rates between different administrative districts with different age structures, by adjusting for the effect of age on the morbidity rates. This would provide a more accurate measure of the differences in morbidity rates between the districts, and help to identify any underlying factors that may be contributing to the differences. Wilcoxon’s t-criterion, correlative regressive analysis, analysis of dynamic series, and calculation of average values are statistical methods that are not specifically designed to adjust for differences in age structure and would not be appropriate for this purpose. In summary, standardization is the most appropriate statistical method for eliminating the influence of age structure on morbidity indices when comparing different administrative districts. |
122. A driver had been fixing a car in a closed garage and afterwards complained about headache, dizziness, nausea, muscle asthenia, sleepiness. Objectively: pulse and respiratory rate elevation, excitement, hypertension, delirium of persecution. What is the most likely diagnosis?
A. Intoxication with carbon oxide
B. Intoxication with ethyl gasoline
C. Posttraumatic encephalopathy
D. Hypertensive crisis
E. Asthenovegetative syndrome
Answer: Intoxication with carbon oxide
Explanation
| In a driver who had been fixing a car in a closed garage and subsequently complained of headache, dizziness, nausea, muscle asthenia, sleepiness, along with physical examination findings of pulse and respiratory rate elevation, excitement, hypertension, and delirium of persecution, the most likely diagnosis is intoxication with carbon monoxide. Carbon monoxide (CO) is a colorless, odorless gas that is produced by incomplete combustion of carbon-containing materials, such as gasoline or propane. It can be lethal in high concentrations, and even at lower levels, it can cause a range of symptoms, including headache, dizziness, nausea, weakness, confusion, and loss of consciousness. The symptoms and examination findings described in this case are highly suggestive of CO poisoning. Intoxication with ethyl gasoline is less likely, as gasoline contains a variety of chemicals, but ethyl gasoline is not one of the major components. Posttraumatic encephalopathy may cause symptoms such as headache and confusion, but it is not associated with exposure to CO. Hypertensive crisis may cause elevated blood pressure, but it is not associated with the other symptoms described in this case. Asthenovegetative syndrome is a non-specific term that is not a diagnosis, but rather a collection of symptoms related to fatigue and autonomic dysfunction. In summary, in a driver who had been fixing a car in a closed garage and subsequently developed symptoms of headache, dizziness, nausea, muscle asthenia, sleepiness, along with physical examination findings of pulse and respiratory rate elevation, excitement, hypertension, and delirium of persecution, the most likely diagnosis is intoxication with carbon monoxide. Immediate removal from the source of exposure and administration of oxygen therapy are critical for the management of this condition. |
123. A worker who undergoes regular medical check-up for duodenal ulcer received a subsidized 24-day sanatorium voucher from his plant. The term of annual leave of a worker is 24 calender days, it will take 4 days more to get to the sanatorium and back home. What is the procedure of obtaining a 4-day sick-leave?
A. Medical Expert Commission issues a 4-day sick list
B. Medical Expert Commission issues a 28-day sick list
C. The doctor in charge issues a 4-day sick list
D. The doctor in charge issues a health certificate and sanatorium patient’s file for 28 days
E. Medical Expert Commission issues a 4-day health certificate
Answer: Medical Expert Commission issues a 4-day sick list
Explanation
| To obtain a 4-day sick leave, the worker needs to go through the Medical Expert Commission, which will issue a 4-day sick list. The worker is scheduled to receive a 24-day sanatorium voucher, but his annual leave is only 24 calendar days, which means he will need an additional 4 days to travel to the sanatorium and return home. During this time, he will not be able to work, and therefore, he will need a sick leave to cover these 4 days. The procedure for obtaining a sick leave in this case is to go to the Medical Expert Commission, which is responsible for assessing the worker’s health and ability to work. The Commission will evaluate the worker’s medical condition and issue a sick leave for the required 4 days. Option B, which suggests a 28-day sick leave, is not appropriate in this case, as the worker only needs a sick leave for 4 days, not 28 days. Option C, which suggests that the doctor in charge can issue a sick leave, may be appropriate in some cases, but in this case, the Medical Expert Commission is the appropriate authority to issue a sick leave. Option D suggests issuing a health certificate and sanatorium patient’s file for 28 days, which is not necessary in this case, as the worker only needs a sick leave for 4 days. Option E, which suggests issuing a 4-day health certificate, is not appropriate, as a health certificate is not the same as a sick leave, and it does not provide the worker with the necessary coverage for time off work. In summary, to obtain a 4-day sick leave in this case, the worker needs to go through the Medical Expert Commission, which will assess his medical condition and issue a sick leave for the required 4 days. |
124. The total area of a ward at the therapeutical department is 28 m2. What is the maximum number of beds that can be exploited in this ward?
A. 4
B. 1
C. 2
D. 3
E. 5
Answer: 4
Explanation
| The maximum number of beds that can be accommodated in a ward depends on the size of the beds and the available floor space. Assuming a standard bed size of 2 meters by 1 meter, the maximum number of beds that can be accommodated in a ward of 28 m² can be calculated as follows: – Calculate the total floor area required for one bed: 2 meters x 1 meter = 2 m² – Divide the total floor area of the ward by the floor area required for one bed: 28 m² ÷ 2 m² = 14 – Round down to the nearest whole number to account for space required for aisles, furniture, and equipment: 14 beds rounded down to the nearest whole number gives 4 beds Therefore, the maximum number of beds that can be accommodated in a ward of 28 m² is 4 beds. |
125. 2 days ago a patient presented with acute pain in the left half of chest, gneral weakness, fever and headache. Objectively: between the 4 and 5 rib on the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm in diameter filled with transparent liquid. What diease are these symptoms typical for?
A. Herpes zoster
B. Pemphigus
C. Herpes simplex
D. Streptococcal impetigo
E. Herpetiform Duhring’s dermatosis
Answer: Herpes zoster
Explanation
| The symptoms described in the question are typical for herpes zoster, also known as shingles. Herpes zoster is a viral infection caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. The initial symptoms of herpes zoster include pain, fever, and headache, which may be followed by the appearance of a characteristic rash. The rash typically appears as a band or stripe of red, blistered skin that wraps around one side of the chest, abdomen, or face, and is usually accompanied by itching or burning sensations. In the case described, the patient has acute pain in the left half of the chest, general weakness, fever, and headache, which are consistent with the initial symptoms of herpes zoster. The presence of erythematous skin and multiple groups of vesicles filled with transparent liquid between the 4th and 5th rib on the left side is also typical of herpes zoster. Pemphigus is an autoimmune disorder characterized by the formation of blisters on the skin and mucous membranes, but the description of the lesions in the question is not consistent with pemphigus. Herpes simplex is a viral infection that causes cold sores or genital herpes, but it does not typically cause a band or stripe of blisters on one side of the body. Streptococcal impetigo is a bacterial skin infection that causes red, itchy sores, but it does not typically produce a band or stripe of blisters. Herpetiform Duhring’s dermatosis is a rare autoimmune disorder that causes blisters and itching, but it does not produce a band or stripe of blisters. In summary, the symptoms described in the question are typical for herpes zoster, a viral infection caused by the reactivation of the varicella-zoster virus. |
126. A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the firstaid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?
A. Dressing ward
B. Admission-and-sorting tent
C. Isolation ward
D. Evacuation
E. In the manner of self-help
Answer: Dressing ward
Explanation
| The patient’s condition described in the question indicates a severe abdominal injury with signs of internal bleeding and peritoneal irritation. Therefore, the appropriate department of the regimental aid post to provide medical care is the dressing ward. The dressing ward is responsible for providing emergency medical care to patients with injuries and wounds, including the initial stabilization and management of severe bleeding and shock. In this case, the patient has a severe abdominal injury with signs of internal bleeding, and therefore, the dressing ward is the appropriate department to provide immediate medical care. The patient’s condition is grave, with signs of shock such as pale skin, tachycardia, and low blood pressure. The abdominal bandage is soaked with blood, and the abdomen is tense, with dullness in flat parts that changes its location with the change of body position. These findings suggest the need for immediate medical attention to prevent further deterioration of the patient’s condition. The admission-and-sorting tent is responsible for triaging patients based on the severity of their condition, and the isolation ward is responsible for managing patients with infectious diseases. The evacuation department is responsible for transporting patients to higher-level medical facilities. In the manner of self-help is not an appropriate option, as the patient requires urgent medical attention. In summary, given the patient’s severe abdominal injury with signs of internal bleeding and peritoneal irritation, the appropriate department of the regimental aid post to provide medical care is the dressing ward. |
127. A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps- 120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:
A. With ambulance vehicle in the 1st turn
B. With a passing vehicle in the 1st turn
C. With ambulance vehicle in the 2nd turn
D. With a passing vehicle in the 2nd turn
E. With a passing vehicle in the 3rd turn
Answer: With ambulance vehicle in the 1st turn
Explanation
| Based on the patient’s condition described in the question, the appropriate mode of transport and turn for evacuation to the collecting battalion is with an ambulance vehicle in the 1st turn. The patient has a severe injury with a shell splinter in the left subcostal region, and he has been bandaged by his fellow soldiers with an individual field dressing. The patient’s condition is grave, with symptoms of dizziness, weakness, thirst, and abdominal pain, along with pale skin and a heart rate of 120 bpm. The abdomen is painful, but soft on palpation, and the dressing is slightly soaked with blood. Given the patient’s severe condition and potential for further deterioration, an ambulance vehicle is the appropriate mode of transport for evacuation to the collecting battalion. An ambulance vehicle is equipped with medical equipment and staffed by trained medical professionals who can provide emergency medical care during transport. The use of a passing vehicle is not appropriate in this case, as it does not provide the necessary medical care and monitoring during transport. In addition, given the severity of the patient’s condition, he should be evacuated in the 1st turn, which is the highest priority for evacuation. Patients in the 1st turn require urgent medical attention and should be evacuated as soon as possible to a higher-level medical facility for further treatment. In summary, given the patient’s severe condition with a shell splinter injury and symptoms of dizziness, weakness, thirst, and abdominal pain, the appropriate mode of transport and turn for evacuation to the collecting battalion is with an ambulance vehicle in the 1st turn. |
128. On the 5th day after labor body temperature of a 24-year-old 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 fingers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR – 30 mm/h. What is the most likely diagnosis?
A. Endometritis
B. Parametritis
C. Pelviperitonitis
D. Metrophlebitis
E. Lochiometra
Answer: Endometritis
Explanation
| The symptoms and findings described in the question are consistent with the diagnosis of endometritis. Endometritis is an infection of the inner lining of the uterus that occurs after childbirth. The infection is typically caused by bacteria that enter the uterus during labor or delivery. The symptoms of endometritis include fever, weakness, headache, abdominal pain, and irritability, which are consistent with the symptoms described in the question. In addition, the patient has an enlarged uterus that is slightly painful on palpation, along with moderate, turbid vaginal discharge with a foul smell. Bimanual examination revealed that the cervical canal lets in 2 transverse fingers. These findings are all consistent with the diagnosis of endometritis. Parametritis, pelviperitonitis, and metrophlebitis are other possible complications of childbirth that can cause fever and abdominal pain, but they typically present with different symptoms and findings. Lochiometra is a condition in which the uterine cavity fills with lochia due to an obstruction in the cervical canal, but it does not typically cause fever or other signs of infection. In summary, based on the symptoms and findings described in the question, the most likely diagnosis is endometritis, an infection of the inner lining of the uterus that occurs after childbirth. |
129. An 11-yearold girl was taken by an acute disease: she got pain in the lumbar region, nausea, vomiting, frequent urination, body temperature 39oC. Objectively: the abdomen is soft, painful on palpation in the lumbar region. Common urine analysis revealed considerable leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Acute appendicitis
C. Chronic glomerulonephritis
D. Acute vulvovaginitis
E. Acute glomerulonephritis
Answer: Acute pyelonephritis
Explanation
| The symptoms and findings described in the question are consistent with the diagnosis of acute pyelonephritis. Acute pyelonephritis is a bacterial infection of the kidneys and upper urinary tract that typically presents with symptoms such as pain in the lumbar region, nausea, vomiting, frequent urination, and fever. The patient in the question has all of these symptoms, along with a body temperature of 39°C. The abdomen is soft but painful on palpation in the lumbar region, which is consistent with the location of the kidneys. The common urine analysis revealed leukocyturia and bacteriuria, indicating the presence of white blood cells and bacteria in the urine. The urine also contained colibacilli, which are commonly associated with urinary tract infections. Acute appendicitis is a condition that typically presents with pain in the lower right abdomen, and it is unlikely to cause symptoms such as nausea, vomiting, and frequent urination. Chronic glomerulonephritis is a long-term inflammatory condition of the kidneys that typically presents with symptoms such as high blood pressure and proteinuria, which are not described in the question. Acute vulvovaginitis is an infection of the vulva and vagina that typically presents with symptoms such as itching, burning, and discharge, which are not described in the question. Acute glomerulonephritis is an acute inflammatory condition of the kidneys that typically presents with symptoms such as hematuria and edema, which are not described in the question. In summary, based on the symptoms and findings described in the question, the most likely diagnosis is acute pyelonephritis, a bacterial infection of the kidneys and upper urinary tract. |
130. A patient is active, lively, fussy. He opposes the examination. His speech is fast and loud, his statements are spontaneous and inconsequent. Specify the psychopathological state of this patient:
A. Psychomotor agitation
B. Catatonic agitation
C. Delirium
D. Behavioral disorder
E. Paranoid syndrome
Answer: Psychomotor agitation
Explanation
| The psychopathological state of the patient described in the question is psychomotor agitation. Psychomotor agitation is a state of increased physical and mental activity, restlessness, and fidgeting. Patients with psychomotor agitation may have rapid and loud speech, spontaneous and inconsequent statements, and may oppose examination. The patient in the question is described as active, lively, and fussy, with fast and loud speech and inconsequent statements, which are all consistent with psychomotor agitation. Catatonic agitation, on the other hand, is a state of increased motor activity that is characterized by repetitive and purposeless movements, such as pacing or rocking. Patients with catatonic agitation may also exhibit rigidity or posturing. Delirium is a state of confusion and disorientation, with impaired attention and memory, and is typically caused by medical conditions such as infections or medication side effects. Behavioral disorder is a broad term that can refer to any abnormal behavior or conduct. Paranoid syndrome is a mental disorder characterized by the presence of paranoid delusions, which are fixed false beliefs that are not based in reality. In summary, based on the description provided in the question, the psychopathological state of the patient is psychomotor agitation, which is characterized by increased physical and mental activity, restlessness, and fidgeting. |
131. A surgeon examined a 42-year-old patient and diagnosed him with right forearm furuncle, purulo-necrotic stage. The furuncle was lanced. At the hydration stage the wound dressing should enclose the following medication:
A. Hypertonic solution
B. Vishnevsky ointment
C. Ichthyol ointment
D. Chloramine
E. Dimexide
Answer: Hypertonic solution
Explanation
| At the hydration stage of wound healing following a furuncle lancing, the wound dressing should enclose a hypertonic solution. A hypertonic solution is a solution with a higher concentration of solutes than the surrounding tissue, which helps to draw out excess fluid and promote wound healing. In the case of a purulo-necrotic stage furuncle that has been lanced, the wound needs to be kept clean and moist to promote healing and prevent infection. Vishnevsky ointment and ichthyol ointment are topical treatments that may be used in the healing process of a furuncle, but they are not typically used during the hydration stage of wound healing. Chloramine and dimexide are disinfectants that can be used to prevent infection, but they are not typically used during the hydration stage of wound healing either. In summary, for the hydration stage of wound healing following a furuncle lancing, the wound dressing should enclose a hypertonic solution to promote healing and prevent infection. |
132. A 37-year-old patient was delivered to a hospital in unconscious state. He got a closed abdominal injury. He is suspected to have internal haemorrhage, intraabdominal injury. He is being prepared an emergency operation. By means of standard sera a physician determined his blood group and got the following results: 0(I) – no agglutination, А(II) – no agglutination, В(III) – no agglutination. What is the patient’s blood group?
A. 0(I)
B. А(II)
C. В(III)
D. АВ(IV)
E. –
Answer: 0(I)
Explanation
| Based on the results of the standard sera test, the patient’s blood group is most likely 0(I). The standard sera test is used to determine a person’s blood type by mixing their blood with anti-A and anti-B antibodies. If the blood agglutinates (clumps) in the presence of anti-A antibodies, the person has type A blood; if it agglutinates in the presence of anti-B antibodies, they have type B blood; if it agglutinates in the presence of both antibodies, they have type AB blood; and if it does not agglutinate in the presence of either antibody, they have type O blood. In the case of the patient described in the question, the standard sera test showed no agglutination with anti-A, anti-B, or both antibodies, which means that the patient’s blood does not contain A or B antigens on the surface of the red blood cells. This is consistent with blood group 0(I), which is also known as blood group O negative. Blood group O is the most common blood group in the world, and people with O negative blood are considered “universal donors” because their blood can be transfused to people with any blood type. In summary, based on the results of the standard sera test, the patient’s blood group is most likely 0(I), which is also known as blood group O negative. |
133. 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
| The complication described in the question, mediastinal displacement with respiratory insufficiency and cardiac abnormalities, is most likely caused by valvular pneumothorax. Valvular pneumothorax is a type of tension pneumothorax in which air enters the pleural space through a one-way valve, causing pressure to build up in the pleural cavity. As pressure builds up, it can cause compression of the lungs, heart, and other mediastinal structures, leading to respiratory and cardiac abnormalities. Clinical and radiological investigations that reveal mediastinal displacement are consistent with this diagnosis. Open pneumothorax is a type of pneumothorax in which air enters the pleural space through an open wound, and closed pneumothorax is a type of pneumothorax in which air enters the pleural space through a closed injury, such as a rib fracture. Neither of these types of pneumothorax typically causes mediastinal displacement or significant respiratory or cardiac abnormalities. Subcutaneous emphysema is a condition in which air gets trapped under the skin, typically in the chest or neck, and causes a crackling sensation when touched. It is not typically associated with mediastinal displacement or significant respiratory or cardiac abnormalities. Mediastinitis is a condition in which the mediastinum, the area between the lungs that contains the heart, major blood vessels, and other structures, becomes inflamed or infected. It is typically caused by an infection that spreads from the lungs or other nearby organs, and it is not typically associated with pneumothorax or displacement of mediastinal structures. In summary, based on the symptoms and findings described in the question, the most likely cause of the complication is valvular pneumothorax, a type of tension pneumothorax that can cause mediastinal displacement, respiratory insufficiency, and cardiac abnormalities. |
134. An 18-year-old primigravida in her 27-28 week of gestation 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
| The postoperative measures that need to be taken for the prevention of pregnancy complications in the case of an 18-year-old primigravida who underwent an operation for acute phlegmonous appendicitis in her 27-28 week of gestation are to prevent noncarrying of pregnancy. Noncarrying of pregnancy, also known as miscarriage, is the loss of pregnancy before the 20th week of gestation. In the case of the patient described in the question, the surgery for acute phlegmonous appendicitis may have led to adhesions or scarring within the pelvic area, which can increase the risk of noncarrying of pregnancy. Therefore, measures need to be taken to prevent this complication. Intestinal obstruction, fetus hypotrophy, premature placenta detachment, and late gestosis are all potential pregnancy complications, but they are not specifically associated with a history of appendectomy. Intestinal obstruction can occur due to adhesions, but this is more common after multiple abdominal surgeries. Fetus hypotrophy can occur due to a variety of factors such as poor nutrition or placental insufficiency. Premature placenta detachment and late gestosis are more commonly associated with conditions such as hypertension or preeclampsia. In summary, the postoperative measures that need to be taken for the prevention of pregnancy complications in the case of an 18-year-old primigravida who underwent an operation for acute phlegmonous appendicitis in her 27-28 week of gestation are to prevent noncarrying of pregnancy, which can occur due to adhesions or scarring within the pelvic area. |
135. A 30-year-old patient presents with sudden loss of consciousness, tonoclonic spasms, AP- 150/100 mm Hg, heart rate – 100/min. Before the attack he felt dizziness, sense of irreality, inexplicable fear. After the attack the patient failed to remember it. What is the most likely diagnosis?
A. Epilepsy
B. Morgagni-Adams-Stokes syndrome
C. Vestibular syncope
D. Transitory ischemic attack
E. Hyperventilation ischemic attack
Answer: Epilepsy
Explanation
| The most likely diagnosis for the patient based on the symptoms described in the question is epilepsy. Epilepsy is a neurological disorder characterized by recurrent seizures, which can manifest as sudden loss of consciousness, tonic-clonic spasms, and changes in blood pressure and heart rate. The patient in the question has experienced sudden loss of consciousness, tonic-clonic spasms, and elevated blood pressure and heart rate, which are all consistent with an epileptic seizure. The patient also reported symptoms such as dizziness, sense of irreality, and fear before the seizure, which are common in some people with epilepsy and may be indicative of an aura, a warning sign that precedes a seizure. Morgagni-Adams-Stokes syndrome is a condition characterized by episodes of transient loss of consciousness due to a disruption in the heart’s electrical conduction system. Vestibular syncope is a type of fainting spell that occurs as a result of a problem in the inner ear. Transient ischemic attack is a temporary episode of neurological dysfunction caused by a lack of blood flow to the brain, which can mimic the symptoms of a stroke. Hyperventilation ischemic attack is a condition in which hyperventilation causes a decrease in blood flow to the brain, leading to neurological symptoms. In summary, based on the symptoms described in the question, the most likely diagnosis for the patient is epilepsy, a neurological disorder characterized by recurrent seizures that can manifest as sudden loss of consciousness, tonic-clonic spasms, and changes in blood pressure and heart rate. |
136. A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: t o- 37, 3oC, respiration rate – 19/min, heart rate=Ps – 92/min; AP- 120/80 mm Hg. Vesicular respiration. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and can be still heard after cough. ECG showed no pathological changes. What is the most likely giagnosis?
A. Acute pleuritis
B. Intercostal neuralgia
C. Subcutaneous emphysema
D. Spontaneous pneumothorax
E. Pericarditis sicca
Answer: Acute pleuritis
Explanation
| The most likely diagnosis for the patient based on the symptoms and findings described in the question is acute pleuritis. Acute pleuritis is an inflammation of the pleura, the thin membrane that lines the lungs and chest cavity. It is typically characterized by piercing chest pain that is worsened by breathing, coughing, or sneezing, as well as dyspnea (shortness of breath) and a dry cough. On physical examination, there may be a pleural friction rub, which is a creaking or grating sound heard on auscultation that is caused by the inflamed pleural surfaces rubbing against each other. The patient in the question has piercing pain during breathing, cough, and dyspnea, which are all consistent with acute pleuritis. The noise heard on auscultation that gets stronger with phonendoscope pressing and is still heard after cough is also consistent with a pleural friction rub. Intercostal neuralgia is a condition characterized by pain along the intercostal nerves, which run between the ribs. It can cause sharp pain that is worsened by movement or breathing, but it typically does not cause a pleural friction rub or dyspnea. Subcutaneous emphysema is a condition in which air gets trapped under the skin, typically in the chest or neck, and causes a crackling sensation when touched. It can be caused by a puncture of the lung or chest wall, but it typically does not cause a pleural friction rub or dyspnea. Spontaneous pneumothorax is a condition in which air gets trapped in the pleural space, causing the lung to collapse. It can cause sudden chest pain and dyspnea, but it typically does not cause a pleural friction rub and the vesicular respiration heard on auscultation would be absent or decreased on the affected side. Pericarditis sicca is a type of pericarditis in which there is inflammation of the pericardium, the sac that surrounds the heart, but without the accumulation of fluid. It can cause chest pain that is worsened by breathing or lying down, but it typically does not cause a pleural friction rub or dyspnea. In summary, based on the symptoms and findings described in the question, the most likely diagnosis for the patient is acute pleuritis, an inflammation of the pleura that causes piercing chest pain, dyspnea, and a pleural friction rub on auscultation. |
137. HIV displays the highest tropism towards the following blood cells:
A. T-helpers
B. T-suppressors
C. T-killers
D. Thrombocytes
E. Erythrocytes
Answer: T-helpers
Explanation
| HIV displays the highest tropism towards T-helpers, also known as CD4+ T cells. T-helpers are a type of immune cell that play a key role in the adaptive immune response by recognizing antigens presented on the surface of antigen-presenting cells and then releasing cytokines that activate other immune cells. HIV specifically targets and infects T-helpers by binding to the CD4 receptor on their surface, which allows the virus to enter the cell and replicate. As HIV replicates within T-helpers, it gradually destroys these cells, leading to a progressive decline in immune function and the development of acquired immunodeficiency syndrome (AIDS). The loss of T-helpers also impairs the ability of the immune system to mount an effective response against other infections and diseases, leading to opportunistic infections and other complications. In summary, HIV displays the highest tropism towards T-helpers, a type of immune cell that plays a critical role in the adaptive immune response. By infecting and destroying T-helpers, HIV leads to a progressive decline in immune function and the development of AIDS. |
138. In terms of megacalorie (1000 kcal = 4184 kJ) the ration of an adult includes 30 g of proteins, 37 g of fats, 137 g of carbohydrates, 15 mg of vitamin C, 0,6 mg of thiamine (vitamin B1). The ration is UNBALANCED as to the contents of:
A. Vitamin C
B. Proteins
C. Fats
D. Carbohydrates
E. Thiamine
Answer: Vitamin C
Explanation
| To determine which nutrient the ration is unbalanced in terms of, we need to compare the recommended daily intake (RDI) of each nutrient to the amount provided in the given ration. The RDI for vitamin C is 90 mg for adult men and 75 mg for adult women. The ration provides only 15 mg of vitamin C, which is significantly below the RDI for both men and women. Therefore, the ration is unbalanced as to the content of vitamin C. The RDI for protein is 56 grams per day for adult men and 46 grams per day for adult women. The ration provides 30 grams of protein, which is within the range of the RDI for both men and women. The RDI for fat is 20-35% of daily energy intake, or approximately 44-77 grams of fat per day for a 2000 calorie diet. The ration provides 37 grams of fat, which is within the range of the RDI. The RDI for carbohydrates is 130 grams per day. The ration provides 137 grams of carbohydrates, which is slightly above the RDI. The RDI for thiamine (vitamin B1) is 1.2 mg for adult men and 1.1 mg for adult women. The ration provides 0.6 mg of thiamine, which is below the RDI for both men and women, but not as significantly as the vitamin C content. In summary, the ration is unbalanced as to the content of vitamin C, with only 15 mg provided compared to the RDI of 90 mg for adult men and 75 mg for adult women. The other nutrients (protein, fat, carbohydrates, and thiamine) are within the range of the RDI or slightly below, but not as significantly as the vitamin C content. |
139. A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC – 11 · 109/l, stab neutrophils – 6%, segmented neutrophils – 70%, lymphocytes – 8%, ESR – 42 mm/h. What is the ethiological factor pneumonia?
A. Legionella
B. Mycoplasm
C. Streptococcus
D. Staphylococcus
E. Pneumococcus
Answer: Legionella
Explanation
| The etiologicalfactor for the pneumonia in this patient is most likely Legionella. Legionella is a type of bacteria that can cause a severe form of pneumonia known as Legionnaires’ disease. The symptoms of Legionnaires’ disease can include fever, dyspnea (shortness of breath), dry cough, pleural pain, myalgia (muscle pain), and arthralgia (joint pain). On physical examination, there may be moist rales and a pleural friction rub, and X-ray may show infiltrates in the lungs. The laboratory findings in the patient support the diagnosis of bacterial pneumonia, with an elevated white blood cell count and an increased percentage of segmented neutrophils. The elevated erythrocyte sedimentation rate (ESR) is also indicative of an inflammatory process. Mycoplasma pneumonia is another common cause of community-acquired pneumonia in young adults, but it typically presents with a milder form of the disease and may not cause pleural pain or a pleural friction rub. Streptococcus pneumoniae (pneumococcus) is another common cause of bacterial pneumonia, but it typically presents with a more rapid onset of symptoms and may not cause pleural pain or a pleural friction rub. Staphylococcus aureus is a less common cause of pneumonia and is often associated with risk factors such as underlying lung disease or immunosuppression. In summary, based on the symptoms, physical examination, and laboratory findings, the most likely etiological factor for the pneumonia in this patient is Legionella, a type of bacteria that can cause severe pneumonia with symptoms such as fever, dyspnea, dry cough, pleural pain, and myalgia. |
140. A 47-year-old patient complains about cough with purulent sputum, pain in the lower part of the left chest, periodical body temperature rise. She has been suffering from these presentations for about 10 years. Objectively: “drumstick”distal phalanges. What examination would be the most informative for making a diagnosis?
A. Bronchography
B. Bronchoscopy
C. Survey radiograph of lungs
D. Pleural puncture
E. Bacteriological analysis of sputum
Answer: Bronchography
Explanation
| The most informative examination for making a diagnosis in this patient would be bronchography. Bronchography is a diagnostic imaging technique that involves the injection of a contrast agent into the bronchial tree, followed by imaging to visualize the airways. It can be used to identify structural abnormalities, such as bronchiectasis, which is a condition characterized by permanent dilation of the bronchi and can cause cough with purulent sputum and recurrent infections. The patient in the question has been suffering from cough with purulent sputum and chest pain for about 10 years, which suggests a chronic respiratory condition. The presence of “drumstick” distal phalanges also raises suspicion for a chronic respiratory condition such as bronchiectasis, which can be associated with clubbing of the fingers. Other diagnostic tests, such as bronchoscopy, survey radiograph of lungs, pleural puncture, and bacteriological analysis of sputum, may also be useful in evaluating this patient’s condition, but bronchography is the most informative for identifying structural abnormalities of the airways, such as bronchiectasis. Bronchoscopy is a procedure that involves the insertion of a flexible tube with a camera into the airways to visualize the bronchi and obtain tissue samples for analysis. Survey radiograph of lungs can provide information about the overall structure of the lungs but may not be as sensitive or specific as bronchography for identifying bronchiectasis. Pleural puncture and bacteriological analysis of sputum may be useful for identifying the cause of infections but may not be as informative for identifying structural abnormalities. |
141. A heat station working on solid fuel is located in a residential district. On cloudy foggy days in december there was an increase in diseases with upper airway affection and signs of general intoxication. There were also mortal cases among the elderly people. What is the most likely factor that provoked toxic effect?
A. Suspended materials
B. High air humidity
C. Calm
D. Low air temperature
E. Temperature gradient
Answer: Suspended materials
Explanation
| The most likely factor that provoked the toxic effect in this scenario is suspended materials. The heat station working on solid fuel is likely emitting air pollutants, such as particulate matter, sulfur dioxide, and nitrogen oxides. These pollutants can become suspended in the air and be inhaled by individuals living in the surrounding residential district. Exposure to high levels of suspended particulate matter can cause irritation and inflammation of the upper airways, leading to symptoms such as cough, sore throat, and difficulty breathing. Long-term exposure to high levels of particulate matter has also been associated with an increased risk of respiratory and cardiovascular diseases. In addition to respiratory effects, exposure to air pollutants can also cause general intoxication and other systemic effects. Elderly individuals may be particularly susceptible to the toxic effects of air pollution, as they may have underlying health conditions that make them more vulnerable. Factors such as high air humidity, calm weather, low air temperature, and temperature gradient may also contribute to the severity of the toxic effect by affecting the dispersion and concentration of the suspended materials in the air. However, the primary factor that is likely causing the toxic effect in this scenario is the suspended materials emitted by the heat station. |
142. A 32-year-old female patient consulted a doctor about a skin affection of her body, face and extremities which turned up after peroral intake of biseptol. The patient was diagnosed with drug toxicoderma. What treatment methods would be the most effective for this patient?
A. Extracorporal therapy
B. Anti-inflammatory therapy
C. Antihistamine therapy
D. Disintoxication therapy
E. Immunotherapy
Answer: Extracorporal therapy
Explanation
| The most effective treatment method for drug toxicoderma in this patient would be extracorporeal therapy. Drug toxicoderma is a type of drug-induced skin reaction that can occur as a result of an allergic or hypersensitivity reaction to a medication. Biseptol is a commonly used antibiotic that can cause skin reactions in some individuals. Extracorporeal therapy, such as plasmapheresis or hemodialysis, can be effective in removing the drug or its metabolites from the bloodstream and reducing the severity of the skin reaction. Plasmapheresis involves the removal of plasma from the blood, which contains the drug and its metabolites, and replacing it with a substitute solution. Hemodialysis involves the use of a machine to filter the blood and remove the drug and its metabolites. Anti-inflammatory therapy, such as topical or systemic corticosteroids, can be useful in reducing inflammation and itching associated with drug toxicoderma. Antihistamine therapy can also be helpful in relieving itching and other symptoms. Disintoxication therapy, which involves the use of various agents to enhance the elimination of toxins from the body, may also be useful in some cases of drug toxicoderma. Immunotherapy, such as the use of intravenous immunoglobulin (IVIG), has been used in some cases of severe drug-induced skin reactions, but its effectiveness is not well established and it is not typically considered a first-line treatment. In summary, extracorporeal therapy, such as plasmapheresis or hemodialysis, would be the most effective treatment method for drug toxicoderma in this patient, as it can remove the drug or its metabolites from the bloodstream and reduce the severity of the skin reaction. Other treatment options, such as anti-inflammatory therapy, antihistamine therapy, disintoxication therapy, and immunotherapy, may also be useful in managing symptoms and promoting recovery. |
143. A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
A. Uterine endometriosis
B. Uterine carcinoma
C. Subserous uterine fibromyoma
D. Endomyometritis
E. Adnexal endmetriosis
Answer: Uterine endometriosis
Explanation
| Uterine 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, fallopian tubes, or other pelvic structures. This can cause symptoms such as hyperpolymenorrhea (excessive bleeding during menstruation) and algodismenorrhea (painful menstruation), as well as other symptoms such as pelvic pain, painful intercourse, and infertility. In the case of this patient, the moderate, chocolate-colored discharge and slightly enlarged and painful uterus are suggestive of uterine endometriosis. The deep and painless fornices suggest that the adnexa (ovaries and fallopian tubes) are not involved, which would make adnexal endometriosis less likely. Uterine carcinoma is an unlikely diagnosis in this patient, as there are no changes to the uterine cervix and the symptoms are more consistent with a benign gynecological condition. Subserous uterine fibromyoma is a type of benign tumor that grows on the outside of the uterus, but it typically does not cause abnormal menstrual bleeding or pain during menstruation. Endomyometritis is an inflammation of the endometrium and the muscular layers of the uterus, but it usually presents with symptoms such as fever, lower abdominal pain, and abnormal vaginal discharge. In summary, based on the patient’s symptoms and gynecological examination findings, the most likely diagnosis is uterine endometriosis, a condition in which endometrial tissue grows outside of the uterus and can cause symptoms such as hyperpolymenorrhea and algodismenorrhea. |
144. On the tenth day after discharge from the maternity house a 2-year-old patient consulted a doctor about body temperature rise up to 39oC, pain in the right breast. Objectively: the mammary gland is enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful. What is the most likely diagnosis?
A. Lactational mastitis
B. Abscess
C. Erysipelas
D. Dermatitis
E. Tumour
Answer: Lactational mastitis
Explanation
| The most likely diagnosis in this 2-year-old patient is lactational mastitis. Lactational mastitis is an inflammation of the breast tissue that can occur in breastfeeding women, typically within the first few weeks after delivery. However, in rare cases, it can also occur in infants and young children who are still breastfeeding. Symptoms of lactational mastitis can include breast pain, redness, swelling, and fever. In this case, the patient is presenting with fever and pain in the right breast, as well as an enlarged mammary gland with a hyperemized area and an ill-defined induration in the upper external quadrant. These findings are consistent with lactational mastitis. Fluctuation, which is indicative of an abscess, is absent. Enlarged and painful lymph nodes in the right axillary region are also suggestive of an inflammatory process in the breast, such as lactational mastitis. Erysipelas is a bacterial skin infection that can cause fever and redness and swelling of the affected area. However, it typically presents with a well-defined border and is not associated with breast enlargement or induration. Dermatitis is a condition characterized by inflammation of the skin and can cause itching, redness, and swelling, but it is not typically associated with fever or breast enlargement. Tumor is an unlikely diagnosis in this case, as lactational mastitis is a much more common cause of breast inflammation in breastfeeding infants and young children. In summary, based on the patient’s symptoms and physical examination findings, the most likely diagnosis is lactational mastitis, an inflammation of the breast tissue that can occur in breastfeeding infants and young children and can cause symptoms such as breast pain, redness, swelling, and fever. |
145. A 47-year-old male patient got a flame burn of trunk and upper extremities and was delivered to the hospital. The patient is in grave condition, confused mental state, with fever. AP- 80/50 mm Hg, Ps- 118 bpm. It was locally stated that the patient got III B degree burns with total area of 20%. What medical actions should be taken?
A. Injection of narcotic analgetics and powdered blood substitutes
B. Initial surgical d-bridement
C. Administration of detoxicating blood substitutes
D. Necrotomy of burn surface, haemotransfusion
E. Antibacterial and detoxicating therapy
Answer: Injection of narcotic analgetics and powdered blood substitutes
Explanation
| The initial medical actions that should be taken in this patient with III B degree burns and grave condition are to provide pain relief and fluid resuscitation. Therefore, the most appropriate option from the given choices would be A: injection of narcotic analgesics and powdered blood substitutes. Narcotic analgesics such as morphine can help to control pain, which can be severe in patients with extensive burns. Powdered blood substitutes, such as polygeline or dextran, can be given to help maintain blood volume and prevent shock. Initial surgical debridement (B), which involves removing dead tissue and debris from the burn wound, may be necessary in the future, but it is not typically performed in the immediate aftermath of a burn injury. Administration of detoxicating blood substitutes (C) and necrotomy of the burn surface with hemotransfusion (D) are not indicated in the initial management of this patient. Antibacterial and detoxicating therapy (E) may be needed later if signs of infection or systemic toxicity develop, but it is not the first line of treatment and should not be considered until the patient’s fluid and pain management are stabilized. In summary, the most appropriate initial medical actions for this patient with III B degree burns and grave condition are to provide pain relief with narcotic analgesics and maintain blood volume with powdered blood substitutes. |
146. A 54-year-old female patient was admitted to the hospital with evident acrocyanosis, swollen cervical veins, enlarged liver, ascites. Cardiac borders are dilated. Heart sounds cannot be auscultated, apical beat is undetectable. AP is 100/50 mm Hg. X-ray picture of chest shows enlarged heart shadow in form of a trapezium. What pathology might have caused these symptoms?
A. Cardiac tamponade
B. Exudative pleuritis
C. Complex heart defect
D. Acute cardiac insufficiency
E. Hiatal hernia
Answer: Cardiac tamponade
Explanation
| Cardiac tamponade is a medical emergency that occurs when there is excessive fluid accumulation within the pericardial sac, leading to compression of the heart and impairment of its ability to pump blood effectively. The symptoms that the patient is presenting with, such as acrocyanosis, swollen cervical veins, enlarged liver, and ascites, are all consistent with the development of congestive heart failure due to decreased cardiac output. The dilation of cardiac borders and the enlarged heart shadow seen on X-ray are also consistent with the diagnosis of cardiac tamponade. In addition, the absence of audible heart sounds and the undetectable apical beat can be explained by the compression of the heart by the fluid in the pericardial sac, which prevents proper filling and contraction of the heart chambers. Exudative pleuritis, complex heart defect, acute cardiac insufficiency, and hiatal hernia are all possible differential diagnoses for this patient’s symptoms, but they are less likely to cause the specific combination of findings seen in this case. |
147. A 16-year-old female patient underwent an operation on account of diffuse toxic goiter of the III-IV degree 12 years ago. Now she has recurrence of thyrotoxicosis. The patient was offered operative intervention, but it is necessary first to localize the functioning gland tissue. What method should be applied for this purpose?
A. Gland scanning
B. USI
C. Puncture aspiration biopsy
D. Roentgenography of neck
E. Roentgenography of esophagus
Answer: Gland scanning
Explanation
| In cases of recurrence of thyrotoxicosis, it is important to determine the location and extent of the functioning thyroid tissue before considering any further treatment options. One of the most effective ways to do this is through gland scanning, also known as thyroid scanning or scintigraphy. Gland scanning involves the use of radioactive iodine (I-131) or technetium-99m pertechnetate, which is taken up by the functioning thyroid tissue. A special camera is then used to detect the radiation emitted by the radioactive material, producing an image of the thyroid gland. This allows for the identification of the location and extent of the functioning thyroid tissue, which can be useful in planning further treatment options. USI (ultrasound imaging) can also be used to visualize the thyroid gland, but it may not be as effective in identifying functioning thyroid tissue. Puncture aspiration biopsy and roentgenography of the neck and esophagus are not typically used for localizing functioning thyroid tissue. |
148. A 26-year-old woman complains of having bloody discharges from the genitals for the last 14 days, abdominal pain, general fatiguability, weakness, weight loss, body temperature rise, chest pain, obstructed respiration. 5 weeks ago she underwent induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarges up to 8-9 weeks of gestation. In blood: Hb- 72 g/l. Urine test for chorionic gonadotropin gave the positive result. What is the most likely diagnosis?
A. Chorioepithelioma
B. Metroendometritis
C. Uterus perforation
D. Uterine fibromyoma
E. Uterine carcinoma
Answer: Chorioepithelioma
Explanation
| The symptoms and findings described are consistent with choriocarcinoma, a malignant form of gestational trophoblastic disease that can occur after an incomplete abortion, molar pregnancy, or normal pregnancy. The patient’s history of induced abortion and positive urine test for chorionic gonadotropin are both suggestive of a recent pregnancy, which increases the suspicion for choriocarcinoma. Bloody discharges, abdominal pain, weight loss, and fever are common symptoms of choriocarcinoma, and the presence of an enlarged uterus on bimanual examination supports the diagnosis. A low hemoglobin level (Hb-72 g/L) is also consistent with anemia caused by excessive bleeding. Metroendometritis and uterus perforation are less likely to be the cause of these symptoms, as both are typically associated with acute pain and fever shortly after the abortion. Uterine fibromyoma and uterine carcinoma are also less likely, as they usually present with different symptoms and do not have a clear association with recent pregnancy. |
149. A 1,5-year-old child was taken by an acute disease: body temperature up to 39oC, frequent vomiting up to 5 times. Nervous system tests revealed positive Kernig’s and Brudzinski’s signs. The given symptoms relate to:
A. Meningeal signs
B. Discoordination syndrome
C. Motor disorder syndrome
D. Encephalic syndrome
E. Infectious toxicosis signs
Answer: Meningeal signs
Explanation
| The symptoms described, including high fever, vomiting, and positive Kernig’s and Brudzinski’s signs, are suggestive of meningitis, an inflammation of the protective membranes that surround the brain and spinal cord. Kernig’s sign is a test for resistance to extension of the knee when the hip is flexed, while Brudzinski’s sign is a test for neck stiffness that produces involuntary flexion of the hips and knees. These tests are used to evaluate for meningeal irritation, which can be caused by a variety of infectious agents, including bacteria, viruses, and fungi. Other common symptoms of meningitis include headache, neck stiffness, photophobia, and altered mental status. Discoordination syndrome, motor disorder syndrome, and encephalic syndrome are not specific diagnoses and do not describe the constellation of symptoms seen in this case. Infectious toxicosis signs may be present in meningitis, but they are not a specific indicator of the condition. |
150. A pediatrician had a conversation with a mother of a 7-month-old breast-fed boy and found out that the child was fed 7 times a day. How many times should the child of such age be fed?
A. 5 times
B. 3 times
C. 4 times
D. 6 times
E. 7 times
Answer: 5 times
Explanation
| According to the American Academy of Pediatrics, infants who are exclusively breastfed should be fed on demand, which can range from 8 to 12 times per day in the first few weeks of life. By 7 months of age, most infants can go longer between feedings and typically require between 4 to 6 feedings per day. Therefore, the pediatrician may recommend that the mother decrease the frequency of feedings to around 5 times per day at this age, depending on the individual needs of the infant. It is important to note that every infant is different, and feeding frequency can vary based on factors such as growth rate, appetite, and activity level. |
