Question From ( 101 To 150 )
101. A 24-years-old patient has chronic glomerulonephritis.Urine test reveals the following: the relative density is 1010, protein – 1,65 g/l, RBCs – 5-7 in the field of vision, WBCs – 2-3 in the field of vision. Blood creatinine – 0,350 millimole/l. Serum sodium – 148 millimole/l. What is the main reason for hyperazotemia in this patient?
A. Reduction of glomerular filtration rate
B. Reduction of tubular reabsorption rate
C. Increased proteinuria
D. Reduction of renal blood flow
E. Sodium retention in the organism
Answer: Reduction of glomerular filtration rate
Explanation
| Glomerulonephritis is a condition characterized by inflammation of the glomeruli, which are the tiny blood vessels in the kidneys that filter waste products from the blood. Chronic glomerulonephritis can lead to progressive damage to the glomeruli, resulting in a reduction in GFR and impaired kidney function. Hyperazotemia refers to an increased level of nitrogen-containing compounds, such as urea and creatinine, in the blood. In this patient, the blood creatinine level is elevated, which is indicative of impaired kidney function. The relative density of urine and presence of RBCs and WBCs in the urine suggest that there is also some degree of proteinuria and inflammation in the kidneys. Reduced GFR is the main reason for hyperazotemia in this patient because it impairs the kidneys’ ability to filter waste products from the blood, leading to the accumulation of nitrogen-containing compounds in the blood. This can result in a range of symptoms, including fatigue, weakness, and changes in urine output. While other factors, such as reduced tubular reabsorption rate, increased proteinuria, reduced renal blood flow, and sodium retention, can also contribute to hyperazotemia, reduced GFR is the most likely reason in this patient with chronic glomerulonephritis. |
102. After an accident a patient complains of pain in the hip joint. Objectively: the leg is in the position of flexion, adduction and internal rotation, significantly contracted. There is elastic resistance to passive adduction or abduction of the extremity. Major trochanter is located high above the Roser-Nelaton line. A significant lordosis is present. What is your provisional diagnosis?
A. Iliac dislocation of hip
B. Femoral neck fracture with a displacement
C. Cotyloid cavity fracture with a central dislocation of hip
D. Inferoposterior dislocation of hip
E. Pertrochanteric fracture of hip
Answer: Iliac dislocation of hip
Explanation
| The clinical presentation described in the question, including the leg being in a position of flexion, adduction, and internal rotation, along with significant contracture and elastic resistance to passive adduction or abduction of the extremity, are all characteristic of an iliac dislocation of the hip. In addition, the major trochanter being located high above the Roser-Nelaton line and the presence of significant lordosis further support this diagnosis. Femoral neck fracture with a displacement (option B) can also cause pain and limited mobility in the hip joint, but the presentation in this case is more consistent with an iliac dislocation. Cotyloid cavity fracture with a central dislocation of hip (option C) and inferoposterior dislocation of hip (option D) are less likely diagnoses based on the clinical presentation described in the question. Pertrochanteric fracture of hip (option E) is also a possible diagnosis in this case, but the description of elastic resistance to passive adduction or abduction of the extremity is more characteristic of an iliac dislocation rather than a pertrochanteric fracture. It is important to note that this is just a provisional diagnosis based on the information provided in the question, and a thorough physical examination and imaging studies would be necessary to confirm the diagnosis and determine the appropriate treatment. |
103. As a result of prolonged exposure to the sun a 20-year-old patient has developed low-grade fever, pain and swelling in the knee and ankle joints, erythema on her face and nose bridge, leukopenia and accelerated ESR. She has been provisionally diagnosed with systemic lupus erythematosus. What pathognomonic laboratory data may confirm this diagnosis?
A. Antinuclear factor
B. Accelerated ESR
C. C-reactive protein
D. Anaemia
E. Lymphocytosis
Answer: Antinuclear factor
Explanation
| SLE is an autoimmune disease that can affect multiple organs and tissues in the body, including the joints, skin, kidneys, and blood vessels. The symptoms described in the question, such as fever, joint pain and swelling, skin rash, and laboratory findings of leukopenia and accelerated erythrocyte sedimentation rate (ESR), are all consistent with SLE. The presence of antinuclear antibodies (ANA) is a hallmark laboratory finding in SLE, and it is often used as a screening test for the disease. ANA are antibodies that target the cell nucleus, and they can be detected in the blood using various laboratory tests, including indirect immunofluorescence or enzyme-linked immunosorbent assays (ELISAs). A positive ANA test does not necessarily confirm a diagnosis of SLE, as ANA can also be present in other autoimmune diseases and in some healthy individuals. However, a high titer of ANA, along with clinical and other laboratory features, can support a diagnosis of SLE. Accelerated ESR (option B), C-reactive protein (option C), anemia (option D), and lymphocytosis (option E) are not specific to SLE and can be seen in many other conditions. However, they can be supportive of a diagnosis of SLE when combined with other clinical and laboratory findings. |
104. Examination of the corpse of a man who died from hanging reveals: death spots disappear when pressed upon and restore after 50 seconds, rigor mortis is moderately expressed only in the masticatory muscles as well as neck and finger muscles, body temperature is of 31oC. The time of death:
A. 6-7 hours ago
B. 1-2 hours ago
C. 16-24 hours ago
D. 8-10 hours ago
E. 10-18 hours ago
Answer: 6-7 hours ago
Explanation
| The finding that the death spots disappear when pressed upon and restore after 50 seconds is consistent with a postmortem interval (PMI) of 4-8 hours. This is because death spots, also known as livor mortis or hypostasis, begin to appear in dependent areas of the body within 1-2 hours of death and reach their maximum intensity within 8-12 hours. After this time, the death spots become fixed and do not disappear when pressed upon. The moderate expression of rigor mortis only in the masticatory muscles, neck, and finger muscles is also consistent with a PMI of 4-8 hours. Rigor mortis is a postmortem change that results in the stiffening of the muscles of the body, and it begins to appear within 1-2 hours of death, starting in the eyelids and jaw muscles and spreading to the rest of the body over the next 6-12 hours. After 24-48 hours, rigor mortis begins to resolve, starting in the same areas where it first appeared. Finally, the body temperature of 31oC is also consistent with a PMI of 4-8 hours. This is because the body temperature drops at a rate of about 1.5oC per hour after death, until it reaches the temperature of the environment. Therefore, a body temperature of 31oC suggests a PMI of about 6-7 hours, assuming an initial body temperature of 37oC. |
105. After contusion of the right eye a patient complains of sudden loss of vision with remaining light perception. Objectively: the eye is not irritated. The cornea is transparent. Pupil reacts to light. The pupil area is black. The fundus reflex is absent. What is the most likely cause of vision loss?
A. Hemophthalmia
B. Retinal detachment
C. Traumatic cataract
D. Acute occlusion of retinal vessels
E. Optic nerve avulsion
Answer: Hemophthalmia
Explanation
| Hemophthalmia is a condition in which blood accumulates in the vitreous humor, the gel-like substance that fills the inside of the eye. It can occur as a result of trauma to the eye, such as a contusion or penetrating injury. The sudden loss of vision with remaining light perception, along with the absence of the fundus reflex and a black pupil area, are all consistent with hemophthalmia. Retinal detachment (option B) is another possible cause of vision loss after eye trauma, but it typically presents with symptoms such as flashes of light, floaters, and a curtain-like shadow in the visual field, which are not described in the question. Traumatic cataract (option C) can also occur after eye trauma, but it typically presents with a cloudy or opaque lens, which is not mentioned in the question. Acute occlusion of retinal vessels (option D) can cause sudden vision loss, but it is typically associated with other symptoms such as pain, headache, and a pale optic disc, which are not described in the question. Optic nerve avulsion (option E) is a rare but serious complication of eye trauma that can cause permanent vision loss, but it typically presents with other signs such as afferent pupillary defect, optic disc swelling, and loss of light perception, which are not described in the question. |
106. 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
| Breast cancer is a malignant tumor that can present as a painless lump or mass in the breast tissue. The description of a neoplasm in the upper internal quadrant of the left breast, up to 2.5 cm in diameter, dense, and uneven, is consistent with the characteristics of a breast cancer. In addition, the fact that the neoplasm is painless on palpation is also suggestive of a cancerous growth. The absence of enlarged regional lymph nodes does not rule out the possibility of breast cancer, as lymph node involvement may not be apparent until later stages of the disease. Cyst (option B) and fibroadenoma (option C) are benign breast tumors that can also present as a palpable lump in the breast, but they are typically painless and have a smooth, round, and well-defined shape. Mastopathy (option D) is a non-specific term that refers to any benign breast disorder, and it is not a specific diagnosis. Lipoma (option E) is a benign tumor composed of fatty tissue, and it is typically soft, mobile, and painless. |
107. A 65-year-old patient complains of 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). The rate of 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 che
Answer: Computer tomography of pelvis
Explanation
| Prostate cancer is a common malignancy in men, and the staging of the disease is essential for determining the appropriate treatment and prognosis. The TNM staging system is used for prostate cancer, which takes into account the size and extent of the primary tumor (T), the presence and extent of regional lymph node involvement (N), and the presence and extent of distant metastasis (M). A CT scan of the pelvis can provide detailed information about the size and location of the prostate tumor and its invasion into adjacent tissues, such as the seminal vesicles, bladder, and rectum. It can also detect the presence of regional lymph node involvement and distant metastasis, such as to the bones or other organs. Roentgenography of the lumbar spine (option B) and excretory urography (option C) are not likely to provide information about the stage of the neoplastic process in this patient. Bone scintigraphy (option D) is a useful imaging modality for detecting bone metastases in prostate cancer, which is a common site of spread for this malignancy. However, it is not the most appropriate method for determining the stage of the disease in this patient. Roentgenography of the chest (option E) is not likely to provide relevant information about the stage of prostate cancer, as lung metastases are relatively uncommon in this malignancy. |
108. While staying in a stuffy room a 19- year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are cold. AP – 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological signs. What is the most likely diagnosis?
A. Syncope
B. Vegetovascular paroxysm
C. Epileptic attack
D. Hysterical neurosis
E. Transient ischemic attack
Answer: Syncope
Explanation
| Syncope, also known as fainting, is a sudden and temporary loss of consciousness caused by a temporary decrease in blood flow to the brain. It can be triggered by various factors, such as emotional stress, dehydration, or prolonged standing in a stuffy room, as described in the question. The symptoms of severe weakness, dizziness, blackout, nausea, and loss of consciousness without convulsions are all consistent with the diagnosis of syncope. The pale skin, cold extremities, shallow breathing, and low blood pressure are all typical signs of reduced blood flow to the brain during a syncopal episode. The presence of pupillary and tendon reflexes without any pathological signs suggests that there is no underlying neurological or structural problem causing the symptoms. Vegetovascular paroxysm (option B) is a non-specific term that refers to a sudden onset of symptoms related to the autonomic nervous system, such as sweating, palpitations, and nausea. However, it is not a specific diagnosis and does not explain the loss of consciousness. Epileptic attack (option C) typically presents with convulsions and other neurological signs, which are not described in the question. Hysterical neurosis (option D) is a non-specific term that refers to a group of psychological disorders characterized by emotional or physical symptoms that are not explained by a medical condition. However, it is not a specific diagnosis and does not explain the loss of consciousness. Transient ischemic attack (option E) is a temporary episode of neurological dysfunction caused by a temporary disruption of blood flow to the brain, but it typically presents with focal neurological signs, such as weakness or numbness in one part of the body, which are not described in the question. |
109. The air of a foundry worker’s working zone contains condensation aerosol with dust particles sized 2 nm (90%), 2-5 nm (2%), over 5 nm(6%), below 2 nm (about 2%). Characterize the dust dispersivity:
A. Fine-dispersed
B. Median-dispersed
C. Coarsely dispersed
D. Ultrafine-dispersed
E. Mist
Answer: Fine-dispersed
Explanation
| The majority of the dust particles in the air are sized 2 nm, which is considered to be a small particle size. In addition, the percentage of particles sized 2-5 nm is only 2%, while the percentage of particles over 5 nm is 6%. This indicates that the majority of the dust particles are small and fine, rather than coarse or large. The term “fine-dispersed” is used to describe a type of dust that consists of small particles that can remain suspended in the air for a long time and can easily penetrate deep into the respiratory system when inhaled. This type of dust is commonly found in industries such as mining, construction, and manufacturing. The term “median-dispersed” (option B) is not a commonly used term to describe dust dispersivity, and it is unclear what it would refer to in this context. The term “coarsely dispersed” (option C) is used to describe a type of dust that consists of large or heavy particles that tend to settle quickly and do not remain suspended in the air for long periods of time. This type of dust is commonly found in industries such as agriculture and woodworking. The term “ultrafine-dispersed” (option D) is used to describe a type of dust that consists of very small particles, typically less than 100 nanometers in size. This type of dust is commonly found in industries such as electronics and nanotechnology. The term “mist” (option E) is used to describe a type of aerosol that consists of liquid droplets suspended in the air, rather than solid particles. Mist is commonly found in industries such as metalworking and agriculture. |
110. A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes – cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP- 180/100 mm Hg. Blood potassium – 1,8 millimole/l, sodium – 4,8 millimole/l. In urine: alkaline reaction, the relative density – 1012, protein and sugar are not found, WBCs – 3-4 in the field of vision, RBCs – 1- 2 in the field of vision. Conn’s syndrome is suspected. Which drug should be chosen for the treatment of arterial hypertension?
A. Spironolactone
B. Propanolol
C. Enalapril
D. Hydrochlorothiazide
E. Clonidine
Answer: Spironolactone
Explanation
| Conn’s syndrome, also known as primary hyperaldosteronism, is a condition characterized by the overproduction of the hormone aldosterone by the adrenal glands. This leads to an excess of sodium and water retention and a loss of potassium, which can result in hypertension and electrolyte imbalances. In this patient, the low blood potassium level (1.8 millimoles/liter) is consistent with hyperaldosteronism, and the absence of protein and sugar in the urine suggests that the hypertension is not due to kidney disease. Therefore, the most appropriate treatment for the hypertension would be a medication that blocks the effects of aldosterone, such as spironolactone. Propanolol (option B) is a beta-blocker that is commonly used for the treatment of hypertension, but it does not specifically target the underlying cause of hypertension in Conn’s syndrome. Enalapril (option C) is an angiotensin-converting enzyme (ACE) inhibitor that is commonly used for the treatment of hypertension, but it may not be as effective in Conn’s syndrome because it does not directly target the effects of aldosterone. Hydrochlorothiazide (option D) is a diuretic that can be used for the treatment of hypertension, but it may worsen the hypokalemia (low potassium) that is common in Conn’s syndrome, and it does not directly target the effects of aldosterone. Clonidine (option E) is an alpha-2 agonist that can be used for the treatment of hypertension, but it does not specifically target the underlying cause of hypertension in Conn’s syndrome. |
111. A patient is 30 years old, works as a carpenter. Six months ago there appeared some behavioural changes: he got interested in philosophy, began writing a treatise on the purpose of his human existence, quitted his job, stopped caring about his children, went out carelessly dressed, heard “voices in his head”that guided his behaviour. The patient claimed sure that he was an Ambassador of God on Earth and was constantly feeling His influence. He is not critical about his disease. What diagnosis can be assumed?
A. Schizophrenia
B. Alcocholic psychosis
C. Reactive psychosis
D. Somatogenic psychosis
E. Organic psychosis
Answer: Schizophrenia
Explanation
| Schizophrenia is a severe mental disorder characterized by a range of symptoms, including hallucinations, delusions, disordered thinking and speech, and behavioral changes. The patient’s symptoms of behavioral changes, delusions of grandeur, hearing “voices in his head,” and lack of insight into his illness are all consistent with a diagnosis of schizophrenia. The onset of symptoms in this patient, which occurred six months ago, is consistent with the typical age of onset for schizophrenia, which is late adolescence or early adulthood. The patient’s sudden interest in philosophy, writing a treatise on the purpose of his human existence, and belief in being an ambassador of God on Earth are all indicative of a break from reality, which is a hallmark feature of schizophrenia. Alcoholic psychosis (option B) is a condition that can occur in individuals with a history of chronic alcoholism, characterized by hallucinations, delusions, and disordered thinking. However, the patient’s symptoms do not suggest a history of chronic alcoholism, and the sudden onset of symptoms is not typical of alcoholic psychosis. Reactive psychosis (option C) is a term used to describe a brief period of psychosis that occurs in response to a stressful life event. However, the patient’s symptoms have been present for six months, which is longer than the typical duration of reactive psychosis. Somatogenic psychosis (option D) is a term used to describe a group of psychotic disorders that are caused by a physical illness or injury. However, the patient’s symptoms do not suggest a physical cause for his psychosis. Organic psychosis (option E) is a term used to describe a group of psychotic disorders that are caused by a specific organic factor, such as a brain injury or infection. However, the patient’s symptoms do not suggest a specific organic cause for his psychosis. |
112. A 27-year-old patient complains of nasal haemorrhages, multiple bruises on the anterior surface of the trunk and extremities, sudden weakness. In blood: Hb- 74 g/l, reticulocytes – 16%, RBCs – 2, 5 · 1012/l, platelets – 30 · 109/l, ESR- 25 mm/h. What is the most effective measure for the treatment of thrombocytopenia?
A. Splenectomy
B. Iron preparations
C. Hemotransfusion
D. Cytostatics
E. Vitamin B12
Answer: Splenectomy
Explanation
| Thrombocytopenia is a condition characterized by a low platelet count, which can lead to bleeding and bruising. The patient’s symptoms of nasal hemorrhages, multiple bruises, and sudden weakness are all consistent with thrombocytopenia. Splenectomy, or surgical removal of the spleen, is a treatment option for thrombocytopenia in cases where the spleen is responsible for the destruction of platelets. In this patient, the low platelet count and high reticulocyte count suggest that the bone marrow is producing enough platelets, but they are being destroyed by the spleen. Therefore, removing the spleen would be an effective treatment for the thrombocytopenia. Iron preparations (option B) are used to treat iron deficiency anemia, which can cause low hemoglobin levels. However, iron deficiency anemia is not the cause of thrombocytopenia in this patient. Hemotransfusion (option C) involves the transfusion of blood products, such as platelets or red blood cells, to replace the deficient or damaged blood components. While hemotransfusion may be necessary in some cases of thrombocytopenia, it is not the most effective measure for the treatment of thrombocytopenia in this patient, as the cause of the thrombocytopenia is related to the spleen. Cytostatics (option D) are drugs that are used to treat various types of cancer and autoimmune diseases by suppressing the immune system. While cytostatics may be used to treat some cases of thrombocytopenia, they are not the most effective measure for the treatment of thrombocytopenia in this patient. Vitamin B12 (option E) is used to treat vitamin B12 deficiency anemia, which can cause low hemoglobin levels. However, vitamin B12 deficiency anemia is not the cause of thrombocytopenia in this patient. |
113. 2 days ago a patient presented with acute pain in the left half of chest, general 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
| Herpes zoster, also known as shingles, is a viral infection caused by the reactivation of the varicella-zoster virus, which causes chickenpox. The virus remains dormant in the dorsal root ganglia of the spinal cord after the initial infection, and reactivation can occur later in life, typically in individuals over the age of 50 or those with weakened immune systems. The symptoms of herpes zoster include acute pain, fever, headache, and a rash consisting of clusters of fluid-filled blisters that are typically localized to one side of the body. In this patient, the erythematous skin and multiple groups of vesicles on the left side of the chest are consistent with a diagnosis of herpes zoster. Pemphigus (option B) is a group of autoimmune skin disorders that cause blistering of the skin and mucous membranes. However, the symptoms described in this patient are not consistent with pemphigus. Herpes simplex (option C) is a viral infection caused by the herpes simplex virus, which typically presents as cold sores or genital herpes. The symptoms described in this patient are not consistent with herpes simplex. Streptococcal impetigo (option D) is a bacterial skin infection characterized by the presence of red, crusted lesions. However, the symptoms described in this patient are not consistent with streptococcal impetigo. Herpetiform Duhring’s dermatosis (option E) is a rare autoimmune skin disorder that causes blistering of the skin and mucous membranes. However, the symptoms described in this patient are not consistent with herpetiform Duhring’s dermatosis. |
114. After lifting a load a patient felt undurable pain in the loin. He was diagnosed with acute lumbosacral radiculitis. Which of the following is contraindicated for this patient?
A. Warming procedures
B. Dehydrating drugs
C. Analgetics
D. Vitamins of B group
E. Intravenous injection of aminophylline
Answer: Warming procedures
Explanation
| Acute lumbosacral radiculitis, also known as sciatica, is a condition characterized by pain, tingling, and numbness in the lower back and leg, often caused by compression or irritation of the sciatic nerve. Treatment for acute lumbosacral radiculitis typically involves pain management and physical therapy. Warming procedures, such as hot packs or heating pads, are commonly used for the treatment of various musculoskeletal conditions, but they are contraindicated for acute lumbosacral radiculitis. This is because warming procedures can increase inflammation and swelling, which can exacerbate the symptoms of acute lumbosacral radiculitis. Dehydrating drugs (option B) are not typically used for the treatment of acute lumbosacral radiculitis and are not contraindicated for this condition. Analgesics (option C), such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, are commonly used for the treatment of pain associated with acute lumbosacral radiculitis and are not contraindicated for this condition. Vitamins of B group (option D), such as vitamin B12, are sometimes used for the treatment of neuropathic pain, including that associated with acute lumbosacral radiculitis, and are not contraindicated for this condition. Intravenous injection of aminophylline (option E) is a medication that is used to treat bronchospasm and is not typically used for the treatment of acute lumbosacral radiculitis. However, it is not contraindicated for this condition. |
115. The institutions which take part in carrying out medical examinations can be prevention and treatment facilities, medical board of Ministry of Defense, medical board of Ministry of Home Affairs, medico-social expert commissions, forensic medical boards etc. What institutions are responsible for temporary disability examination?
A. Prevention and treatment facilities
B. Sanitary-and-prophylactic institutions
C. Medico-social expert commissions
D. Medical boards of Ministry of Defense
E. Medical boards of Ministry of Home Affairs
Answer: Prevention and treatment facilities
Explanation
| Temporary disability examination is a medical assessment carried out to determine the extent of an individual’s temporary incapacity to work due to illness or injury. Prevention and treatment facilities, such as hospitals, clinics, and medical centers, are responsible for conducting temporary disability examinations and issuing medical certificates for temporary disability. Sanitary-and-prophylactic institutions (option B) are responsible for promoting and maintaining public health, such as through vaccination campaigns and disease prevention programs, and are not typically involved in temporary disability examination. Medico-social expert commissions (option C) are responsible for assessing an individual’s ability to work and determining eligibility for disability benefits. While medico-social expert commissions may be involved in assessing permanent disability, they are not typically involved in temporary disability examination. Medical boards of Ministry of Defense (option D) and medical boards of Ministry of Home Affairs (option E) are responsible for conducting medical examinations and assessments of military personnel and government officials, respectively, but are not typically involved in temporary disability examination for the general population. |
116. 10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large. Discharges from the genital tracts were profuse and bloody. Uterus tonus was low, fundus of uterus was located below the navel. Examination of genital tracts revealed that the uterine cervix, vaginal walls, perineum were intact. There was uterine bleeding with following blood coagulation. Your actions to stop the bleeding:
A. To make manual examination of uterine cavity
B. To apply hemostatic forceps upon the uterine cervix
C. To introduce an ether-soaked tampon into the posterior fornix
D. To put an ice pack on the lower abdomen
E. To administer uterotonics
Answer: To make manual examination of uterine cavity
Explanation
| The patient’s symptoms are consistent with postpartum hemorrhage, which is a potentially life-threatening complication that can occur after delivery. The presence of a tissue defect in the placenta and profuse, bloody discharges from the genital tract suggest that there is active bleeding from the uterus. The low uterine tonus and fundus of uterus located below the navel suggest that the uterus is not contracting effectively to stop the bleeding. Therefore, the most appropriate action to stop the bleeding in this patient would be to make a manual examination of the uterine cavity to identify the source of the bleeding and manually compress the bleeding vessels. Applying hemostatic forceps upon the uterine cervix (option B) or introducing an ether-soaked tampon into the posterior fornix (option C) may be used in some cases of postpartum hemorrhage, but they are not the most appropriate actions for this patient with a tissue defect in the placenta and low uterine tonus. Putting an ice pack on the lower abdomen (option D) may help to decrease swelling and pain, but it is not effective for stopping bleeding. Administering uterotonics (option E), such as oxytocin or misoprostol, can help to stimulate uterine contractions and stop bleeding in postpartum hemorrhage. However, in this patient with a tissue defect in the placenta and low uterine tonus, a manual examination of the uterine cavity to identify and manually compress bleeding vessels is the most appropriate initial action. |
117. While lifting a heavy load a 39- year-old patient suddenly felt a severe headache, pain in the interscapular region,and started vomiting. Objectively: the pulse is rhythmic, 60/min., AP – 180/100 mm Hg. The patient is agitated. He presents with photophobia, hyperacusis. There are positive Kernig’s and Brudzinski’s signs on both sides. In blood: WBCs – 10 · 109/l. CSF is bloody, cytosis is 240/3. What is the most likely diagnosis?
A. Subarachnoid haemorrhage
B. Sympathoadrenal crisis
C. Acute hypertonic encephalopathy
D. Meningococcal meningitis
E. Ischemic stroke
Answer: Subarachnoid haemorrhage
Explanation
| Subarachnoid hemorrhage (SAH) is a medical emergency that occurs when there is bleeding in the subarachnoid space, which is the space between the arachnoid mater and pia mater layers of the meninges that cover the brain. SAH typically presents with a sudden onset severe headache, often described as the worst headache of the patient’s life. Other symptoms may include nausea, vomiting, photophobia, hyperacusis, and signs of meningeal irritation such as positive Kernig’s and Brudzinski’s signs. The patient’s age and the sudden onset of symptoms following a physical exertion, as well as the high blood pressure and agitation, are all consistent with a diagnosis of subarachnoid hemorrhage. The bloody cerebrospinal fluid (CSF) with high white blood cell (WBC) count also supports this diagnosis. Sympathoadrenal crisis (option B) is a condition that occurs due to an acute stress response, which can cause symptoms such as anxiety, sweating, and palpitations. However, the sudden onset of severe headache and positive Kernig’s and Brudzinski’s signs are not consistent with this diagnosis. Acute hypertonic encephalopathy (option C) is a condition characterized by neurological symptoms such as convulsions, coma, and edema of the brain, often caused by rapid correction of hyponatremia. The patient’s symptoms are not consistent with acute hypertonic encephalopathy. Meningococcal meningitis (option D) is a bacterial infection caused by Neisseria meningitidis that can cause symptoms such as headache, fever, and neck stiffness. However, the sudden onset of severe headache and positive Kernig’s and Brudzinski’s signs, as well as the bloody CSF with high WBC count, are more consistent with subarachnoid hemorrhage. Ischemic stroke (option E) is a condition caused by a blockage in a blood vessel supplying the brain, which can cause symptoms such as sudden onset weakness or numbness on one side of the body, difficulty speaking, and loss of vision. The patient’s symptoms, including severe headache and photophobia, are not consistent with ischemic stroke. |
118. A surgeon examined a 42-yearold patient and diagnosed him with right forearm furuncle at the purulonecrotic 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
| A furuncle is a skin infection that occurs when a hair follicle becomes infected with bacteria, typically Staphylococcus aureus. The furuncle typically goes through several stages, including the purulonecrotic stage, in which a pus-filled lesion develops, and the hydration stage, in which the lesion begins to drain and heal. At the hydration stage, the wound dressing should be designed to promote healing and prevent infection. A hypertonic solution, such as saline or sodium chloride solution, can be used to help remove excess fluid from the wound and promote healing. It can also help to reduce swelling and inflammation. Vishnevsky ointment (option B) and Ichthyol ointment (option C) are both commonly used for the treatment of skin infections and can be effective in promoting healing. However, they are not the most appropriate medications for a furuncle at the hydration stage. Chloramine (option D) is a disinfectant that is effective against a wide range of bacteria and viruses. However, it is not typically used in wound dressings for furuncles. Dimexide (option E) is a medication that can be used for the treatment of skin infections, among other uses. However, it is not typically used in wound dressings for furuncles. |
119. After a 10-year-old child had been bitten by a bee, he was delivered to a hospital. There were lip, face and neck edemata. The patient felt hot and short of breath. Objectively: breathing was laboured and noisy. There were foamy discharges from the mouth, cough. The skin was pale and cold. There was bradypnoea. Heart sounds were muffled and arrhythmic. Thready pulse was present. What diagnosis was made by the expert in resuscitation?
A. Anaphylactic shock
B. Quincke’s edema
C. Bronchial asthma
D. Acute cardiovascular collapse
E. Cerebral coma
Answer: Anaphylactic shock
Explanation
| Anaphylactic shock is a severe and potentially life-threatening allergic reaction that occurs when the body’s immune system overreacts to an allergen, such as a bee sting. Symptoms of anaphylactic shock can include lip, face, and neck edema, difficulty breathing, labored and noisy breathing, foamy discharges from the mouth, coughing, pale and cold skin, bradypnea, muffled and arrhythmic heart sounds, and thready pulse. The rapid onset of symptoms following a bee sting, including lip, face, and neck edema and difficulty breathing, strongly suggest anaphylactic shock as the diagnosis. The foamy discharges from the mouth, coughing, and muffled and arrhythmic heart sounds are also consistent with anaphylactic shock. Quincke’s edema (option B) is a condition that causes swelling of the deeper layers of the skin and mucous membranes, typically in the face, lips, tongue, and throat. However, the difficulty breathing and other symptoms described are more consistent with anaphylactic shock. Bronchial asthma (option C) is a chronic respiratory condition that causes inflammation and narrowing of the airways, leading to wheezing, coughing, and shortness of breath. While asthma can be triggered by allergens, the rapid onset of symptoms following a bee sting and the presence of other symptoms such as lip, face, and neck edema suggest anaphylactic shock as the diagnosis. Acute cardiovascular collapse (option D) is a condition in which the heart suddenly stops working effectively, leading to a decrease in blood pressure and organ failure. While the patient has symptoms of cardiovascular compromise, such as muffled and arrhythmic heart sounds and thready pulse, the rapid onset of symptoms following a bee sting and the presence of other symptoms such as lip, face, and neck edema suggest anaphylactic shock as the diagnosis. Cerebral coma (option E) is a condition characterized by a loss of consciousness and decreased brain function. While the patient may be agitated or confused due to the anaphylactic shock, the other symptoms described are not consistent with cerebral coma. |
120. Half an hour after a 30-year-old woman had had some custard cake, she experienced lancinating abdominal pain, nausea, vomiting. Objectively: body temperature – 36, 0oC, pale skin, breathing rate – 20/min, Ps- 100/min. AP- 95/65 mm Hg, loud cardiac sounds. Dry tongue. Abdomen was painful in its epigastrial part, there were no signs of peritoneum irritation. What is the first measure to be taken?
A. Gastric lavage
B. Administration of an enterosorbent
C. Injection of Cerucal
D. Intravenous rehydratation
E. Antibiotic therapy
Answer: Gastric lavage
Explanation
| Gastric lavage is a procedure in which the stomach is washed out with a solution to remove any remaining food or toxins. This procedure can be effective in removing the ingested food or toxins that may be causing the symptoms. The symptoms of lancinating abdominal pain, nausea, and vomiting, along with the physical findings of pale skin, tachycardia, hypotension, loud cardiac sounds, and dry tongue, suggest that the patient may have ingested a toxic substance or is suffering from food poisoning. Therefore, gastric lavage is the most appropriate first measure to be taken to remove any remaining toxins or ingested food from the stomach. Administration of an enterosorbent (option B) or injection of Cerucal (option C) may be appropriate treatments for certain types of food poisoning or stomach disorders. However, gastric lavage is the most appropriate first measure in this case. Intravenous rehydration (option D) may be necessary if the patient is dehydrated due to vomiting and nausea. However, gastric lavage should be performed first to remove any remaining toxins or ingested food. Antibiotic therapy (option E) is not indicated in this case as the cause of the symptoms is not clear and the patient’s physical findings do not suggest a bacterial infection. |
121. A 45-year-old patient, a sailor, was hospitalized on the 2nd day of the disease. A week ago he returned from India. Complains of body temperature of 41oC, severe headache, dyspnea, cough with frothy rusty sputum. Objectively: the patient is pale, mucous membranes are cyanotic, breathing rate – 24/min, tachycardia is present. In lungs: diminished breath sounds, moist rales over both lungs, crepitation. What is the most likely diagnosis?
A. Pneumonic plaque
B. Miliary tuberculosis
C. Influenza
D. Ornithosis
E. Sepsis
Answer: Pneumonic plaque
Explanation
| Pneumonic plague is a severe form of the bacterial infection caused by the bacterium Yersinia pestis, which can be transmitted through the air from person to person. Symptoms of pneumonic plague can include high fever, severe headache, dyspnea, cough with frothy rusty sputum, pale skin, cyanotic mucous membranes, tachycardia, and pulmonary symptoms such as diminished breath sounds, moist rales, and crepitation. The patient’s recent travel history to India and the rapid onset of severe symptoms, including high fever, severe headache, dyspnea, and cough with frothy rusty sputum, strongly suggest pneumonic plague as the diagnosis. The physical findings of pale skin, cyanotic mucous membranes, tachycardia, and pulmonary symptoms such as diminished breath sounds, moist rales, and crepitation are also consistent with pneumonic plague. Miliary tuberculosis (option B) is a form of tuberculosis in which the bacteria spread through the bloodstream and affect multiple organs, including the lungs. However, the rapid onset of severe symptoms and the recent travel history to India suggest pneumonic plague as the diagnosis. Influenza (option C) is a viral infection that can cause symptoms such as high fever, headache, and respiratory symptoms such as cough and dyspnea. However, the frothy rusty sputum and physical findings such as diminished breath sounds, moist rales, and crepitation are not typically associated with influenza. Ornithosis (option D) is a bacterial infection caused by the bacterium Chlamydia psittaci, which can be transmitted from birds to humans. Symptoms can include fever, headache, and respiratory symptoms such as cough and dyspnea. However, the recent travel history to India and the frothy rusty sputum suggest pneumonic plague as the diagnosis. Sepsis (option E) is a serious medical condition caused by an overwhelming immune response to infection. While the patient may be at risk for sepsis due to the bacterial infection, the specific symptoms and physical findings described are more consistent with pneumonic plague. |
122. 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
| T-helper cells, also known as CD4+ T cells, are a type of white blood cell that play a critical role in the immune system by coordinating the response to infections. HIV specifically targets and infects T-helper cells, leading to a progressive decline in the number of these cells and a weakening of the immune system. T-suppressor cells (option B) and T-killer cells (option C) are also types of T cells that play important roles in the immune system, but they are not the primary target of HIV. Thrombocytes (option D), also known as platelets, are a type of blood cell that are involved in blood clotting. HIV does not infect thrombocytes. Erythrocytes (option E), also known as red blood cells, are responsible for carrying oxygen throughout the body. HIV does not infect erythrocytes. |
123. Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of hygienic norms?
A. Indirect light fittings
B. Direct light fittings
C. Semi-reflected light fittings
D. Ambient light fittings
E. Combined light fittings
Answer: Indirect light fittings
Explanation
| Indirect light fittings, also known as up-lighters, direct light towards the ceiling or walls, which then reflects back into the room. This type of lighting creates a diffuse and soft illumination that reduces the contrast between bright and dark areas, minimizing the risk of glare and visual fatigue. Indirect lighting also helps to reduce the amount of direct light that falls onto surfaces, which can reduce the accumulation of dust and other particles. In educational settings, it is important to maintain a high level of hygiene to prevent the spread of infectious diseases. Indirect lighting is more hygienic than other types of lighting because it reduces the accumulation of dust and other particles that can harbor bacteria and other microorganisms. Indirect lighting also makes it easier to clean and maintain the lighting fittings, as there are no exposed surfaces to collect dust and other debris. Direct light fittings (option B) and semi-reflected light fittings (option C) can create a more focused and intense illumination, which can increase the risk of glare and visual fatigue. These types of fittings can also create exposed surfaces that can collect dust and other debris. Ambient light fittings (option D) and combined light fittings (option E) are broad categories that can include indirect, direct, and semi-reflected light fittings, depending on the specific design and installation. While these types of fittings may be appropriate in certain settings, indirect light fittings are generally the most appropriate in respect of hygienic norms when illuminating educational rooms. |
124. A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents with nausea, vomiting, dry mouth and body temperature 36, 6oC. She has a right ovarian cyst in history. Bimanual examination reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren’t palpable, the right fornix is contracted. There is a painful formation on the right of uterus. It’s round, elastic and mobile. It is 7х8 cm large. In blood: leukocytosis with the left shit. What is the most likely diagnosis?
A. Ovarian cyst with pedicle torsion
B. Right-sided pyosalpinx
C. Subserous fibromyoma of uterus
D. Acute metritis
E. Extrauterine pregnancy
Answer: Ovarian cyst with pedicle torsion
Explanation
| The symptoms of acute pain in the lower abdomen, nausea, vomiting, and low-grade fever are consistent with this diagnosis. The bimanual examination findings of a painful, round, elastic, and mobile formation on the right side of the uterus, along with a contracted right fornix and absence of palpable uterine appendages, also suggest an ovarian cyst. The leukocytosis with a left shift seen in the blood work indicates an acute inflammatory process, which is consistent with the diagnosis of ovarian cyst torsion. The other options, including right-sided pyosalpinx (infection and pus in the fallopian tube), subserous fibromyoma of the uterus (a benign uterine tumor), acute metritis (infection of the uterus), and extrauterine pregnancy (pregnancy outside of the uterus), do not fit with the clinical presentation and examination findings described in this case. |
125. A 39-year-old patient complains of a tumour on the anterior surface of her neck. The tumour has been observed for 2 years. It is nonmobile and has enlarged recently. The patient has a changed tone of voice, a sense of pressure. Objectively: in the left lobe of the thyroid gland a 3 cm node is palpable; it is very dense, tuberous, painless. Cervical lymph nodes are enlarged. Functional status of the thyroid gland is unchanged. What is the most likely diagnosis?
A. Thyroid gland cancer
B. Nodular euthyroid goiter
C. Nodular hyperthyroid goiter
D. Chronic lymphomatous Hashimoto’s thyroiditis
E. Chronic fibrous Riedel’s thyroiditis
Answer: Thyroid gland cancer
Explanation
| The fact that the tumor has been observed for 2 years and has recently enlarged is also suggestive of malignancy. The enlargement of cervical lymph nodes is another concerning feature, as it suggests spread of the cancer to nearby lymph nodes. The functional status of the thyroid gland being unchanged does not rule out malignancy. Nodular euthyroid goiter (B) and nodular hyperthyroid goiter (C) are benign conditions that can also present with thyroid nodules, but they are unlikely given the clinical presentation and examination findings described in this case. Chronic lymphomatous Hashimoto’s thyroiditis (D) and chronic fibrous Riedel’s thyroiditis (E) are both rare chronic inflammatory conditions of the thyroid gland, but they are unlikely to present with a 3 cm nodule that is very dense and tuberous, as described in this case. |
126. 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 of pneumonia?
A. Legionella
B. Mycoplasm
C. Streptococcus
D. Staphylococcus
E. Pneumococcus
Answer: Legionella
Explanation
| The patient is a clerk who works in a conditioned room, which suggests that he may have been exposed to a contaminated air conditioning system, as Legionella can grow in such systems. The symptoms of fever, dyspnea, dry cough, pleural pain, myalgia, and arthralgia, along with moist rales and pleural friction rub on examination, are consistent with Legionella pneumonia. The laboratory findings of elevated WBC count, with an increase in both segments and stab neutrophils, and an elevated ESR, are also consistent with bacterial pneumonia. However, Legionella pneumonia is known to cause a relative lymphopenia, which is seen in this case with only 8% lymphocytes. Mycoplasma pneumonia (B) can also cause similar symptoms, but it typically presents in younger patients and is associated with a milder course of illness. Streptococcus pneumoniae (E) and Staphylococcus aureus (D) are common causes of bacterial pneumonia, but they typically present with a more acute onset of illness and are associated with a higher fever and more pronounced systemic symptoms. |
127. A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since childhood. The patient’s father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps – 220 bpm, AP – 80/60 mm Hg. ECG: heart rate – 215/min, widening and deformation of QRS complex accompanied by atrioventricular dissociation; positive P wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of P wave and QRST complex. Which of the following will be the most effective treatment?
A. Implantation of the artificial pacemaker
B. β-adrenoreceptor blocking agents
C. Cholinolytics
D. Calcium antagonists
E. Cardiac glycosides
Answer: Implantation of the artificial pacemaker
Explanation
| The ECG findings of a heart rate of 215/min, widening and deformation of the QRS complex, and atrioventricular dissociation with positive P wave, followed by complete dissociation of P wave and QRST complex, further support the diagnosis of a heart conduction disorder. Implantation of an artificial pacemaker is the most effective treatment for patients with symptomatic bradycardia or heart block, as it can help regulate the heart rate and prevent further arrhythmias. β-adrenoreceptor blocking agents (B), cholinolytics (C), calcium antagonists (D), and cardiac glycosides (E) are not indicated as first-line treatments for heart conduction disorders and would not be effective in this case |
128. 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 patient’s symptoms of cough with purulent sputum, chest pain, and periodical body temperature rise, along with the presence of “drumstick” distal phalanges, suggest a chronic lung disease, such as bronchiectasis, which is a condition where the airways become widened and scarred, leading to recurrent infections and cough with purulent sputum. Bronchography is a diagnostic imaging test that involves the injection of contrast material into the bronchial tree, followed by X-ray imaging, to visualize the airways and detect any abnormalities, such as bronchial dilation or other structural changes. This test can help confirm the diagnosis of bronchiectasis and determine the extent and location of the disease. While other tests, such as bronchoscopy (B), survey radiograph of lungs (C), pleural puncture (D), and bacteriological analysis of sputum (E), may also provide useful diagnostic information, they are less likely to be as informative as bronchography in this particular case. Bronchoscopy can be useful for visualizing the airways and collecting samples for analysis, but it may not be able to detect all cases of bronchiectasis. Survey radiograph of lungs may show changes consistent with bronchiectasis, but it may not be able to provide as detailed information as bronchography. Pleural puncture is unlikely to be informative in this case, as the patient’s symptoms and examination findings suggest a primary lung pathology. Bacteriological analysis of sputum can help identify the causative organism of the infection, but it is not specific for bronchiectasis. |
129. A 49-year-old patient complains of dyspnea, cough. There are no sputum discharges. He has repeatedly used salbutamol and intal but with no effect. Objectively: he is only able to sit while leaning on the table. Cyanosis of face, acrocyanosis are present. Breathing is shallow, laboured, in some parts it cannot be auscultated; there are diffuse rales, expiration is significantly prolonged. Heart sounds are muffled, tachycardia is present. Ps – 112/min., AP – 110/70 mm Hg. Liver is located near the costal arch. There are no peripheral edemata. What is your provisional diagnosis?
A. Status asthmaticus
B. Chronic obstructive bronchitis
C. Bronchiale asthma, moderate gravity
D. Foreign object aspiration
E. Cardiac asthma
Answer: Status asthmaticus
Explanation
| The muffled heart sounds and tachycardia, along with the presence of liver displacement, suggest the possibility of cardiac involvement. However, given the history of asthma and the characteristic respiratory symptoms, status asthmaticus is more likely. Chronic obstructive bronchitis (B) and bronchial asthma, moderate gravity (C) are less likely given the severity of the patient’s symptoms and lack of response to standard asthma medications. Foreign object aspiration (D) is a possibility, but it would typically present with more acute onset of symptoms and is less likely given the patient’s history of asthma. Cardiac asthma (E) is also a possibility, but it typically presents in older patients with a history of heart failure and is less likely given the patient’s younger age and history of asthma. |
130. A 3-year-old girl presents with pertussis-like cough with thick sputum. There have been persistent changes in lungs since the age of 6 months when she was first diagnosed with acute pneumonia. Chloride concentration in the perspiration is 112 mEq/l. The child has been diagnosed with mucoviscidosis. What is the basis for autosomal recessive disease – mucoviscidosis?
A. Inadequate transport of sodium and chloride ions
B. α1-antitrypsin deficiency
C. Deposition of calcium triphosphates and carbotates in the alveoles
D. Pulmonary cysts
E. Pulmonary artery hypoplasia
Answer: Inadequate transport of sodium and chloride ions
Explanation
| Cystic fibrosis is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which encodes a protein that regulates the transport of chloride ions across cell membranes. In individuals with cystic fibrosis, the CFTR protein is either absent or dysfunctional, leading to reduced chloride and water secretion and increased sodium and water absorption across epithelial surfaces, including those in the lungs, pancreas, and sweat glands. The thick sputum and persistent lung changes in this 3-year-old girl, along with the elevated chloride concentration in her perspiration, are consistent with a diagnosis of cystic fibrosis. The thick sputum is caused by the reduced secretion of fluid in the airways, leading to the accumulation of mucus and increased susceptibility to respiratory infections. The persistent lung changes since the age of 6 months, along with the elevated chloride concentration in her perspiration, further support the diagnosis of cystic fibrosis. α1-antitrypsin deficiency (B) is a genetic disorder that can also cause lung disease, but it is different from cystic fibrosis and is characterized by a deficiency of the α1-antitrypsin protein, which can lead to the destruction of lung tissue. Deposition of calcium triphosphates and carbonates in the alveoli (C), pulmonary cysts (D), and pulmonary artery hypoplasia (E) are not features of cystic fibrosis and are not associated with the pathogenesis of the disease. |
131. A parturient woman is 23 years old. Vaginal obstetric examination reveals full cervical dilatation. There is no fetal bladder. Fetal head is in the plane of pelvic outlet. Sagittal suture is in mesatipellic pelvis, anterior fontanel is closer to pubes. The fetal head diameter in such presentation will be:
A. Suboccipito-bregmaticus
B. Fronto-occipitalis recta
C. Biparietal
D. Suboccipitio-frontalis
E. Mento-occipitali
Answer: Suboccipito-bregmaticus
Explanation
| In this case, the fetal head is in the plane of pelvic outlet, and the sagittal suture is in a mesatipellic pelvis, with the anterior fontanel closer to the pubic symphysis. Based on this information, the most likely fetal head diameter is suboccipito-bregmaticus (A). Suboccipito-bregmaticus is the smallest diameter of the fetal head, measuring approximately 9.5 cm, and it is the one that typically passes through the maternal pelvis during delivery. The other options, including fronto-occipitalis recta (B), biparietal (C), suboccipitio-frontalis (D), and mento-occipitalis (E), are larger fetal head diameters and are not likely to pass through the maternal pelvis in this presentation. |
132. A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological 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
| The most likely diagnosis in this case is uterine endometriosis. The patient’s symptoms of hyperpolymenorrhea and progressing algodismenorrhea, along with the moderate, chocolate-colored discharge, are consistent with endometriosis, which is a condition where the endometrial tissue grows outside the uterus, causing pain and menstrual irregularities. The slightly enlarged and painful uterus on examination, along with the absence of palpable appendages and deep, painless fornices, further support the diagnosis of uterine endometriosis. The absence of cervical changes and the lack of adnexal palpable masses make other diagnoses, such as uterine carcinoma (B), subserous uterine fibromyoma (C), endomyometritis (D), or adnexal endometriosis (E), less likely. Uterine carcinoma typically presents with abnormal vaginal bleeding and may have cervical changes on examination. Subserous uterine fibromyoma is usually asymptomatic and does not typically cause menstrual irregularities. Endomyometritis is a rare condition that typically occurs after childbirth or miscarriage and is characterized by fever and pelvic pain. Adnexal endometriosis typically presents with pelvic pain and may have palpable masses on examination. |
133. Examination of a 38-year-old patient who had been hit with a blunt object on the left side of chest revealed a fracture of the X rib with fragments displacement, parietal pneumothorax. The patient complains of pain in the left subcostal area. Objectively: the patient is pale, AP- 80/40 mm Hg, Ps- 138/min, of poor volume. USI reveals fluid in the left abdomen. Splenic rupture is present. What treatment tactics should be chosen?
A. Drainage of the left pleural cavity and laparotomy
B. Immediate upper middle laparotomy and following drainage of the left pleural cavity
C. Immediate laparotomy and alcoholnovocaine block of the X rib
D. Anti-schock actions and laparotomy following the arterial pressure rise
E. Left-sided thoracotomy and immediately following laparotomy
Answer: Drainage of the left pleural cavity and laparotomy
Explanation
| The patient has suffered a blunt chest trauma resulting in a fracture of the X rib with fragment displacement and parietal pneumothorax. Additionally, the patient has signs of splenic rupture, with fluid in the left abdomen. The patient is also hypotensive, tachycardic, and pale, suggesting hypovolemic shock. The initial step in management would be to stabilize the patient’s condition with anti-shock measures, such as fluid resuscitation and blood transfusions, as needed. After stabilization, the patient should undergo drainage of the left pleural cavity to relieve the pneumothorax and improve respiratory function. Laparotomy should also be performed to address the splenic rupture and any other intraabdominal injuries. Immediate upper middle laparotomy and following drainage of the left pleural cavity (B) or immediate laparotomy and alcohol-novocaine block of the X rib (C) are not appropriate treatment options in this case, as they do not address the pneumothorax and may delay treatment of the splenic rupture. Anti-shock actions and laparotomy following the arterial pressure rise (D) is also not appropriate, as the patient is already in a state of hypovolemic shock and requires immediate intervention. Left-sided thoracotomy and immediately following laparotomy (E) may be considered in cases of penetrating trauma, but in this case, a less invasive approach with drainage of the pleural cavity and laparotomy is appropriate. |
134. 15 minutes after the second vaccination with DTP vaccine a 4-month-old boy exhibited the symptoms of Quincke’s edema. What medication should be given for emergency aid?
A. Prednisolone
B. Heparin
C. Adrenalin
D. Furosemide
E. Seduxen
Answer: Prednisolone
Explanation
| Quincke’s edema, also known as angioedema, is a type of allergic reaction that can cause swelling of the skin and tissues, including the face, lips, tongue, and throat. In severe cases, it can cause airway obstruction and difficulty breathing. Prednisolone is a corticosteroid that can help reduce inflammation and swelling associated with angioedema. It is often used as a first-line treatment for acute episodes of angioedema. Adrenalin (C) may also be used in cases of severe angioedema to help open up the airways and improve breathing, but it is typically reserved for cases where there is significant respiratory distress. Heparin (B), furosemide (D), and seduxen (E) are not appropriate treatments for angioedema and would not be effective in this situation. |
135. On the 2nd day after a surgery for toxic mixed goiter IV a 35-year-old patient complains of heart pain. ECG shows prolonged QT intervals. Chvostek’s and Trousseau symptoms cannot be clearly defined. The patient is provisionally diagnosed with latent tetany. What study will allow to confirm the diagnosis?
A. Determination of blood calcium and phosphor
B. Determination of thyrotropic hormone
C. Determination of potassim
D. Determination of sodium
E. Determination of thyroid hormones
Answer: Determination of blood calcium and phosphor
Explanation
| Latent tetany is a condition characterized by increased neuromuscular excitability due to hypocalcemia, which can occur as a complication of thyroid surgery. The symptoms may include tingling sensations, cramps, and spasms of the muscles, including those of the heart which can lead to prolonged QT intervals on ECG, as seen in this patient. In order to confirm the diagnosis of latent tetany, blood calcium and phosphorus levels should be measured. Hypocalcemia is often associated with low levels of serum calcium and an increased level of serum phosphorus. Determination of thyrotropic hormone (B), potassium (C), sodium (D), and thyroid hormones (E) would not be useful in confirming the diagnosis of latent tetany. While hypothyroidism can cause hypocalcemia, in this case, the patient had surgery for a toxic goiter, indicating hyperthyroidism, so determination of thyroid hormones would not be useful. Potassium and sodium levels are not directly related to the development of latent tetany. Thyrotropic hormone levels may be useful in evaluating thyroid function, but they are not specific to the diagnosis of latent tetany. |
136. A patient with bilateral hydrothorax has repeatedly undergone pleural puncture on both sides. After a regular puncture the patient’s condition has become worse: he presents with fever, chest pain. The next day, the attending physician performing pleural puncture revealed some pus on the right. What is the mechanism of acute right-sided empyema development?
A. Contact-and-aspiration
B. Lymphogenous
C. Hematogenous
D. Implantation
E. Aerial
Answer: Contact-and-aspiration
Explanation
| Contact-and-aspiration is a common mechanism of empyema development, where bacteria from an adjacent infected site spread to the pleural space. In this case, the repeated pleural punctures on both sides may have introduced bacteria into the pleural space, leading to infection and subsequent empyema formation. The presence of pus on the right side during the next day’s puncture supports this mechanism. Lymphogenous (B) and hematogenous (C) mechanisms of empyema development involve the spread of infection through the lymphatic or bloodstream, respectively, and are less likely in this case. Implantation (D) refers to the introduction of infectious material into a wound or surgical site, and aerial (E) refers to the spread of infection through the air, such as in cases of tuberculosis or fungal infections, neither of which are likely in this case. |
137. A student analyzes noise level of cold-pressing process. What device should be applied for this hygienic study?
A. Noise and vibration analyzer
B. Noise analyzer
C. Sound tester
D. Actinometer
E. Pyranometer
Answer: Noise and vibration analyzer
Explanation
| Noise level is a significant occupational hazard in many industries, including manufacturing and production. In order to assess and monitor the noise level in the workplace, a noise and vibration analyzer can be used. This device measures sound pressure levels and provides information about the frequency content of the noise, as well as the duration and intensity of the exposure. A noise analyzer (B) or sound tester (C) may also be used to measure sound pressure levels, but a noise and vibration analyzer is specifically designed to assess occupational noise exposure and is more appropriate for this hygienic study. An actinometer (D) is a device used to measure the intensity of radiation, while a pyranometer (E) is a device used to measure solar radiation. Neither of these devices would be appropriate for assessing the noise level of a cold-pressing process. |
138. Environmental pollution is prevented by mechanical separation of nontoxic solid domestic waste. Specify the method which can be used for mechanical utilization of these wastes:
A. Compressing of wastes into building blocks
B. Hydrolysis
C. Burning as power-plant fuel
D. Burial of wastes
E. Waste neutralization in biothermal boxes
Answer: Compressing of wastes into building blocks
Explanation
| Compressing the waste into building blocks reduces the volume of the waste, making it easier to store and transport. This method can also facilitate the recycling of the waste by making it easier to sort and separate different materials. Hydrolysis (B), burning as power-plant fuel (C), and burial of wastes (D) are not mechanical methods of waste utilization, and they may not be environmentally friendly or sustainable. Hydrolysis involves breaking down waste using water, while burning waste for fuel can release harmful pollutants into the air. Burial of waste in landfills can lead to soil and water pollution. Waste neutralization in biothermal boxes (E) involves using microorganisms to break down and neutralize waste, which is a biological rather than mechanical method of waste utilization. While this method can be effective for certain types of waste, it may not be suitable for all types of non-toxic solid domestic waste. |
139. 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, fever, chest pain, obstructed respiration. 5 weeks ago she underwent an induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was enlarged up to 8-9 weeks of gestation. In blood: Hb – 72 g/l. Urine test for chorionic gonadotropin gave the apparently positive result. What is the most likely diagnosis?
A. Chorioepithelioma
B. Metroendometritis
C. Uterus perforation
D. Uterine fibromyoma
E. Uterine carcinoma
Answer: Chorioepithelioma
Explanation
| Chorioepithelioma is a rare malignant tumor that arises from the trophoblastic tissue, which is the tissue that normally develops into the placenta during pregnancy. It can occur following a normal pregnancy or an induced abortion, and is characterized by abnormal growth of trophoblastic tissue. In this case, the patient had an induced abortion 5 weeks ago and is now presenting with symptoms of vaginal bleeding, abdominal pain, weight loss, and an enlarged uterus. The positive urine test for chorionic gonadotropin is also suggestive of trophoblastic tissue growth. Other potential diagnoses, such as metroendometritis (B), uterus perforation (C), uterine fibromyoma (D), and uterine carcinoma (E), may also cause some of the symptoms described, but they are less likely given the patient’s history and examination findings. Metroendometritis may cause vaginal bleeding and abdominal pain, but is typically associated with fever and purulent discharge, which are not mentioned in this case. Uterus perforation is a potential complication of induced abortion, but it would more likely present with acute pain and bleeding rather than a delayed onset of symptoms. Uterine fibromyoma and uterine carcinoma may cause vaginal bleeding and an enlarged uterus, but are less likely given the patient’s young age and recent history of induced abortion. |
140. A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has been found to have body weight loss and xerodermia. The pulse is 100 bpm. Body temperature is 37, 2oC. Diuresis is low. USI shows 5-6 weeks of pregnancy. What is the most likely diagnosis?
A. Moderate vomiting of pregnancy
B. Mild vomiting of pregnancy
C. I degree preeclampsia
D. Premature abortion
E. Food poisoning
Answer: Moderate vomiting of pregnancy
Explanation
| Nausea and vomiting are common symptoms of early pregnancy, and in some cases, they can be severe enough to require medical intervention. Moderate vomiting of pregnancy is diagnosed when the patient experiences nausea and vomiting more than 3 times a day, but is still able to tolerate some food and fluids, which is consistent with the symptoms described in this case. The weight loss and xeroderma may be due to dehydration resulting from excessive vomiting. The elevated pulse rate may also be a sign of dehydration. The low diuresis may be due to decreased fluid intake or dehydration. Preeclampsia (C) is a pregnancy complication that typically occurs after 20 weeks of gestation and is characterized by high blood pressure and protein in the urine. Premature abortion (D) is the loss of a pregnancy before 20 weeks of gestation. While these conditions can cause nausea and vomiting, they are less likely given the patient’s gestational age of 5-6 weeks. Food poisoning (E) may cause nausea and vomiting, but it is less likely given the duration and severity of the symptoms described. |
141. A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score – 8-10 points. What is the optimum time for the first breast-feeding?
A. First 30 minutes
B. First 6 hours
C. First 24 hours
D. First 48 hours
E. After 48 hours
Answer: First 30 minutes
Explanation
| Breast-feeding within the first 30 minutes after birth is recommended by many health organizations, including the World Health Organization and the American Academy of Pediatrics. This early initiation of breast-feeding has been shown to have numerous benefits for both the mother and the baby, including improved bonding between mother and baby, increased milk production, and decreased risk of neonatal hypoglycemia and other complications. Delaying breast-feeding until after 30 minutes (B), 24 hours (C), or 48 hours (D) after birth may result in missed opportunities for the baby to receive important nutrients and establish a successful breast-feeding relationship with the mother. Delaying breast-feeding until after 48 hours (E) may be necessary in certain situations, such as when the baby is critically ill or requires medical intervention that would interfere with breast-feeding, but this is not the optimum time for the first breast-feeding in a healthy full-term baby. |
142. A 26-year-old patient with left lower lobe pneumonia experiences an acute chest pain on the left during coughing. Objectively: diffuse cyanosis, widening of the left half of chest. Percussion reveals high tympanitis. Auscultation reveals no respiratory murmurs above the left half of chest. There is a deviation of the right cardiac border towards the midclavicular line. What examination will be the most informative?
A. X-Ray
B. Bronchoscopy
C. Bronchography
D. Pneumotachometry
E. Spirography
Answer: X-Ray
Explanation
| The patient’s symptoms and physical exam findings suggest the possibility of a pneumothorax, which is a condition where air enters the pleural space, causing the lung to collapse. The high tympanitis on percussion and absence of respiratory murmurs on auscultation are consistent with this diagnosis. An X-ray is a useful diagnostic tool to confirm the presence of a pneumothorax and evaluate its extent. In this case, an X-ray of the chest would likely show a collapsed lung and the presence of air in the pleural space. It may also show the deviation of the cardiac border towards the midclavicular line, which can be a sign of mediastinal shift. Bronchoscopy (B) and bronchography (C) are not likely to be useful in diagnosing a pneumothorax, as they primarily evaluate the airways rather than the pleural space. Pneumotachometry (D) and spirometry (E) are tests used to measure lung function and are not likely to be informative in diagnosing a pneumothorax. |
143. A 3-year-old child has been taken to a pediatrician. He has no recent history of any diseases. Objective examination revealed no pathology of the internal organs. The child needs the routine immunization against the following disease:
A. Poliomyelitis
B. Diphtheria and tetanus
C. Measles, rubella, parotitis
D. Pertussis
E. Type B hepatitis
Answer: Poliomyelitis
Explanation
| Poliomyelitis, also known as polio, is a viral disease that can cause paralysis and even death. Immunization against polio is a routine part of childhood vaccination schedules in many countries. The recommended schedule for polio vaccination varies by country, but in general, the first dose is given in infancy, and subsequent doses are given in early childhood. Diphtheria and tetanus (B) are typically given in combination with pertussis as the DTP vaccine, which is usually given in infancy and early childhood. Measles, rubella, and parotitis (C) are typically given as the MMR vaccine, which is usually given in early childhood. Pertussis (D) is typically given as part of the DTP vaccine. Type B hepatitis (E) is typically given as the Hib vaccine, which is usually given in infancy and early childhood. |
144. A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
A. Sepsis
B. Putrid phlegmon
C. Erysipelas
D. Allergic reaction
E. Erysipeloid
Answer: Sepsis
Explanation
| Sepsis is a potentially life-threatening condition that occurs when the body’s response to an infection causes damage to its own tissues and organs. It is characterized by a systemic inflammatory response, which can lead to fever, leukocytosis, and other symptoms of inflammation. In this case, the patient underwent an operation for a lumbar phlegmon, which is a localized infection in the tissue of the lower back. The wound initially appeared to be healing well, with granulation tissue forming. However, the development of fever, leukocytosis, and discharge of pus from the wound are all signs of an infection that has progressed to sepsis. Putrid phlegmon (B) is a form of necrotizing soft tissue infection that is characterized by the presence of foul-smelling pus. Erysipelas (C) is a skin infection that typically causes redness, swelling, and fever, but is unlikely to cause pus discharge from a surgical wound. Allergic reaction (D) is a hypersensitivity response to an allergen, which is not likely in this case given the patient’s history of an infection and surgical intervention. Erysipeloid (E) is a skin infection caused by a bacterium found in fish and meat, and is not likely in this case given the patient’s history of a lumbar phlegmon. |
145. After a car accident a 37-year-old patient has an acute pain and bleeding in the middle third of his right thigh. Objectively: there is a wound on the anterior surface of the right thigh with massive bleeding, abnormal mobility at the level of the middle third of the thigh. The first aid is to be started with:
A. Digital occlusion of the femoral artery
B. Injection of pain-killers
C. Tourniquet application
D. Immobilization of the extremity with a transportation splint
E. Venipuncture and intravenous infusion of polyglycine
Answer: Digital occlusion of the femoral artery
Explanation
| The patient’s symptoms and physical exam findings suggest the possibility of a femoral artery injury, which is a potentially life-threatening condition. The massive bleeding and abnormal mobility at the middle third of the thigh are concerning for a significant vascular injury. Digital occlusion of the femoral artery can help to control bleeding and prevent further blood loss while awaiting definitive medical intervention. This can be done by applying pressure to the femoral artery with the fingers or hand, using enough pressure to occlude the artery but not so much as to completely cut off blood flow to the lower extremity. Injection of pain-killers (B) may provide temporary relief of pain, but it is not the first priority in this case. Tourniquet application (C) should be considered if digital occlusion is not effective in controlling bleeding, but it can be associated with significant complications and should only be used as a last resort. Immobilization of the extremity with a transportation splint (D) may be necessary for safe transport of the patient, but it does not address the immediate concern of bleeding control. Venipuncture and intravenous infusion of polyglycine (E) may be necessary for fluid resuscitation, but it should not be the first priority in this case. |
146. A 9-year-old boy fell from a tree and hit the occipital region, there was a momentary loss of consciousness. Objectively: the child’s condition is satisfactory, he complains of the headache and dizziness. The X-ray of skull reveals a comminuted depressed fracture of occipital bone in the region of inion. What treatment is indicated for the patient?
A. Surgical intervention
B. Anti-inflammatory therapy
C. Hemostatic therapy
D. Therapeutic lumbar punctures
E. Complex conservative treatment
Answer: Surgical intervention
Explanation
| A depressed skull fracture is a type of skull fracture in which a portion of the skull is pushed inwards towards the brain. In this case, the X-ray reveals a comminuted depressed fracture of the occipital bone, which is a fracture in the bone at the back of the skull. Surgical intervention is generally indicated for a comminuted depressed skull fracture, as it can help to relieve pressure on the brain and reduce the risk of complications such as bleeding, infection, and brain damage. During surgery, the bone fragments are elevated and replaced, and any bleeding or other damage is repaired. Anti-inflammatory therapy (B) and hemostatic therapy (C) may be useful in managing certain complications of a skull fracture, but they are not the primary treatment for a comminuted depressed skull fracture. Therapeutic lumbar punctures (D) are not indicated in the treatment of a skull fracture. Complex conservative treatment (E) may be used in some cases, but it is not likely to be sufficient for a comminuted depressed skull fracture and may lead to complications. |
147. A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
A. Iridocyclitis
B. Iritis
C. Keratitis
D. Choroiditis
E. Acute attack of glaucoma
Answer: Iridocyclitis
Explanation
| Iridocyclitis, also known as anterior uveitis, is an inflammation of the iris and ciliary body in the eye. It is often associated with autoimmune conditions such as rheumatoid arthritis, and can also occur as a result of infection or trauma. The symptoms of iridocyclitis include pain, redness, photophobia, and blurred vision, which are consistent with the patient’s presentation. The flattening of iris relief and iris discoloration are also characteristic findings in iridocyclitis. Iritis (B) is a term used to describe inflammation of the iris, but it is often used interchangeably with iridocyclitis. Keratitis (C) is an inflammation of the cornea, which can also cause pain, redness, and blurred vision, but it is not likely to cause iris flattening or discoloration. Choroiditis (D) is an inflammation of the choroid layer of the eye, which can cause vision loss and other symptoms, but it is not likely to cause the specific symptoms and findings seen in this patient. Acute attack of glaucoma (E) is a sudden increase in intraocular pressure that can cause severe eye pain, but it is not likely to cause the specific findings of iris flattening and discoloration seen in this patient. |
148. 14 days ago a 49-year-old patient was operated on for perforated appendicitis and disseminated fibrinopurulent peritonitis. The postoperative period was uneventful. On the 9th day the patient presented with low-grade fever, abdominal pain, frequent liquid stools. USI of the left mesogastrium reveals a fluid formation 9×10 cm large. In blood: leukocytosis with the left shift. What is your provisional diagnosis?
A. Interloop abscess
B. Abdominal cavity tumour
C. Liver abscess
D. Left kidney cyst
E. Spleen abscess
Answer: Interloop abscess
Explanation
| An interloop abscess is a type of abdominal abscess that occurs between two loops of bowel, usually after abdominal surgery. The symptoms of an interloop abscess typically include fever, abdominal pain, and changes in bowel habits. The presence of a fluid collection on USI, along with leukocytosis with left shift, is consistent with this diagnosis. Abdominal cavity tumour (B), liver abscess (C), left kidney cyst (D), and spleen abscess (E) are all possible causes of a fluid collection in the abdomen, but they are less likely in this case given the patient’s history of recent surgery and the specific findings of an interloop abscess. A liver abscess or spleen abscess may also cause fever and leukocytosis, but they are not likely to cause frequent liquid stools or be located in the left mesogastrium. A left kidney cyst would not typically cause the symptoms described in this case. |
149. The Carpathian region is characterized by constant high humidity of atmospheric air (over 80%). Inhabitants of this region feel severe cold in corresponding season at a medium low temperature. It’s caused by heat emission by:
A. Convection
B. Radiation
C. Vaporization
D. Conduction
E. –
Answer: Convection
Explanation
| Convection is the transfer of heat through the movement of fluids, such as air or water. In regions with high humidity, such as the Carpathian region, the moisture content in the air can increase the heat transfer rate through convection. This can cause individuals to feel colder than they would in a drier environment at the same temperature. Radiation (B) is the transfer of heat through electromagnetic waves, and is not likely to be the primary cause of the cold felt in the Carpathian region. Vaporization (C) is the process by which a liquid changes to a gas, and while it can contribute to cooling, it is not likely to be the primary cause in this case. Conduction (D) is the transfer of heat through direct contact between two objects, and is not likely to be the primary cause of the cold felt in the Carpathian region. |
150. A 22-year-old female patient complains of dull pain in her right iliac area that she has been experiencing for a week, morning sickness and gustatory change. She has a histrory of menstruation delay for 3 weeks. Objectively: AP80/50 mm Hg, pulse is 78 bpm, body temperature is 37oC. Bimanual examination reveals that uterus is enlarged, soft, mobile and painless. Uterine appendages are palpable on the right, there is a dense, elastic and moderately painful formation 3×4 cm large. What is the most likely diagnosis?
A. Progressing fallopian pregnancy
B. Interrupted fallopian pregnancy
C. Right ovarian cyst
D. Uterogestation
E. Acute appendicitis
Answer: Progressing fallopian pregnancy
Explanation
| Fallopian tube pregnancy occurs when a fertilized egg implants in the fallopian tube rather than in the uterus, and is a potential medical emergency as the growing embryo can cause the fallopian tube to rupture, leading to severe bleeding and potentially life-threatening complications. The symptoms and examination findings in this case, including the combination of pregnancy-related symptoms (morning sickness, gustatory change, and menstruation delay) with an enlarged, soft, mobile, and painless uterus, and a palpable, dense, elastic, and moderately painful formation in the right uterine appendage, are suggestive of a progressing fallopian pregnancy. Interrupted fallopian pregnancy (B) is a term used to describe a fallopian tube pregnancy that has spontaneously ended or been terminated. Right ovarian cyst (C) is a possibility, but it is less likely given the specific findings on examination. Uterogestation (D) is a general term used to describe pregnancy, but it does not provide a specific diagnosis. Acute appendicitis (E) is a possibility but is less likely given the specific findings on examination and the combination of pregnancy-related symptoms with an enlarged uterus and palpable uterine appendages. |
