Question From ( 150 To 200 )
151. A 40 y.o. man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP- 170/130 mm Hg. On EchoCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the probable diagnosis?
A. Essential arterial hypertension
B. Chronic pyelonephritis
C. Chronic glomerulonephritis
D. Polycystic disease of the kidneys
E. Cushing’s disease
Answer: Essential arterial hypertension
Explanation
| The probable diagnosis in this case is essential arterial hypertension, which is characterized by high blood pressure that has no identifiable cause. The patient in this case is a 40-year-old male who complains of headache in the occipital area, has pale skin, and presents with face and hand edema. These symptoms are consistent with hypertension, which is a condition in which the force of blood against the walls of the arteries is too high. The high blood pressure in this case is also supported by the reading of 170/130 mmHg. The concentric hypertrophy of the left ventricle seen on EchoCG is another indication of chronic hypertension. This occurs when the walls of the heart’s left ventricle thicken due to prolonged exposure to high blood pressure. The thinned cortical layer of the kidney revealed on ultrasound is also a common finding in patients with hypertension. This results from the narrowing and thickening of the small blood vessels in the kidney, which can lead to kidney damage and proteinuria (excess protein in the urine), as seen in this patient’s urine analysis. Therefore, based on the patient’s symptoms, physical examination, and test results, the most likely diagnosis is essential arterial hypertension. |
152. A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?
A. Threatened spontaneous abortion
B. Spontaneous abortion which has begun
C. Stopped pregnancy
D. Hydatid molar pregnancy
E. Placenta presentation
Answer: Threatened spontaneous abortion
Explanation
| The patient is a 28-year-old primigravida, who is at 15-16 weeks of gestation and presents to the maternity clinics with dull pain in the lower part of the abdomen and lumbar area. On vaginal examination, the uterus cervix is 2.5 cm, and the external isthmus allows the passage of the fingertip. The uterus body is enlarged according to the pregnancy term, and the genital discharges are mild and mucous. A threatened spontaneous abortion is a condition in which vaginal bleeding and/or abdominal pain occur during the first half of pregnancy, but the cervix remains closed, and the fetus is still alive. The symptoms in this patient are consistent with a threatened spontaneous abortion. The enlarged uterus and the mucous discharge are indicative of a viable pregnancy, while the dull pain in the lower part of the abdomen and lumbar area suggest the possibility of a miscarriage. The fact that the cervix is still closed is a positive sign, indicating that the pregnancy is still intact. However, close monitoring of the patient is necessary as she is at risk of developing a spontaneous abortion. Therefore, based on the patient’s symptoms and examination findings, the most probable diagnosis is threatened spontaneous abortion. |
153. A primapara with pelvis size 25-28- 31-20 cm has active labor activity. Waters poured out, clear. Fetus weight is 4500 g, the head is engaged to the small pelvis inlet. Vasten’s sign as positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?
A. Caesarean section
B. Vacuum extraction of the fetus
C. Obstetrical forseps
D. Conservative tactics of labor
E. Stimulation of the labor activity
Answer: Caesarean section
Explanation
| The patient is a primapara with a pelvis size of 25-28-31-20 cm, and the fetus weight is 4500 g. The head is engaged in the small pelvis inlet, and Vasten’s sign is positive. These findings suggest that the fetus may be too large to pass through the birth canal safely. The fully dilated cervix of the uterus and the absence of the amniotic sac indicate that the patient is in the second stage of labor and that the fetus is in the birth canal. The clear, rhythmic fetal heartbeat of 136 bpm is reassuring. However, given the large size of the fetus and the narrow dimensions of the patient’s pelvis, a vaginal delivery is likely to be difficult and may result in fetal distress or injury to the mother. Therefore, a Caesarean section is the most appropriate labor tactic in this case. A Caesarean section is a surgical procedure in which the baby is delivered through an incision made in the mother’s abdomen and uterus. This procedure is safer for the mother and the baby in cases where a vaginal delivery may be difficult or dangerous. Therefore, based on the patient’s clinical presentation, the most appropriate labor tactic would be a Caesarean section. |
154. A 41 y.o. man complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious: lips and mucous are cyanotic, breathing rate is 28 per min, pulse- 122 bpm., AP- 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S2 is accentuated over pulmonary artery. What is the urgent measure on the prehospital stage?
A. Air aspiration from the pleural cavity
B. Epinephrine introduction
C. Euphilline introduction
D. Call for cardiologic team
E. Oxygen inhalation
Answer: Air aspiration from the pleural cavity
Explanation
| The patient is a 41-year-old man who complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious, with lips and mucous membranes cyanotic, breathing rate of 28 per minute, pulse of 122 bpm, and an arterial blood pressure of 80/40 mmHg. On examination, there is tympanitis on percussion and weakened breathing on auscultation on the right, and S2 is accentuated over the pulmonary artery. These findings are suggestive of a tension pneumothorax, which is a medical emergency that occurs when air accumulates in the pleural cavity, causing the lung to collapse and the pressure inside the chest to increase. This can lead to compression of the heart and great vessels, resulting in decreased cardiac output and shock. The urgent measure on the prehospital stage for a tension pneumothorax is air aspiration from the pleural cavity, which involves inserting a large-bore needle or catheter into the pleural space to release the trapped air and relieve the pressure on the heart and lungs. This procedure can be life-saving and should be performed as soon as possible. Therefore, based on the patient’s clinical presentation, the most urgent measure on the prehospital stage in this case is air aspiration from the pleural cavity. |
155. A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?
A. Autoimmune
B. Viral
C. Bacterial
D. Neurogenic
E. Virus-bacterial
Answer: Autoimmune
Explanation
| Type 1 diabetes mellitus is a chronic autoimmune disorder that occurs when the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This results in a deficiency of insulin, a hormone that regulates blood sugar levels, leading to hyperglycemia. The patient in this case is a 6-year-old child who complains of thirst, polyuria, increased appetite for 2 months, and weight loss of 3 kg. These symptoms are consistent with diabetes mellitus, and the hyperglycemia reading of 14 mol/L confirms the diagnosis. The development of nocturnal enuresis may also be related to the high blood sugar levels. Type 1 diabetes mellitus is often diagnosed in childhood or adolescence, and the autoimmune process leading to the destruction of pancreatic beta cells may begin months or even years before the clinical symptoms appear. The exact cause of the autoimmune process is not fully understood, but it is thought to involve a combination of genetic and environmental factors. Therefore, based on the patient’s clinical presentation and diagnosis, the probable genesis of type 1 diabetes mellitus in this case is autoimmune. |
156. A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from heart ichemia, postinfarction and diffusive cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable diagnosis?
A. Mesenterial vessels thrombosis
B. Volvulus
C. Acute intestinal obstruction
D. Ichemic abdominal syndrome
E. Erysipelas
Answer: Mesenterial vessels thrombosis
Explanation
| The patient is a 74-year-old female with a history of heart ischemia, postinfarction, and diffuse cardiosclerosis. She complains of pain, distended abdomen, and nausea. On examination, she is in a grave condition, with a distended abdomen and abdominal wall that fails to take an active part in breathing. On laparoscopy, there is cloudy effusion, and one of the bowel loops is dark-blue. These findings are indicative of mesenteric vessels thrombosis, which is a condition in which the blood flow to the intestines is blocked due to a clot forming in one or more of the mesenteric arteries or veins. The symptoms of mesenteric vessels thrombosis include sudden onset of severe abdominal pain, nausea, vomiting, and abdominal distension. The severity of the symptoms depends on the extent of the clot and the degree of obstruction of blood flow to the intestines. In this case, the patient’s history of cardiovascular disease and the findings on laparoscopy support the diagnosis of mesenteric vessels thrombosis. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is mesenteric vessels thrombosis. |
157. A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2- 3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase – 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?
A. Pancreatine
B. Contrykal
C. Aminocapron acid
D. Levomicytine
E. Imodium
Answer: Pancreatine
Explanation
| The patient is a 56-year-old man who has taken alcoholic drinks regularly for 20 years and complains of girdle pain in the abdomen, profuse non-formed stool 2-3 times a day, and weight loss of 8 kg over the last 2 years. On examination, the abdomen is soft and painless, and blood amylase is 12g/L. Feces examination reveals neutral fat of 15 g per day and starch grains. These symptoms and findings are suggestive of chronic pancreatitis, which is a condition that occurs when the pancreas becomes inflamed and damaged over time, often due to long-term alcohol consumption. The treatment of chronic pancreatitis usually involves managing the symptoms and preventing further damage to the pancreas. In this case, the most reasonable treatment at this stage is Pancreatine, which is a pancreatic enzyme supplement that can help improve the digestion and absorption of nutrients in the small intestine. Pancreatine can help alleviate the symptoms of chronic pancreatitis, including non-formed stool and weight loss, by improving the digestion and absorption of fats, proteins, and carbohydrates. It can also help reduce the workload of the pancreas by supplementing the digestive enzymes that are deficient in patients with chronic pancreatitis. Therefore, based on the patient’s clinical presentation and examination findings, the most reasonable treatment at this stage is Pancreatine. |
158. A 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is mufflet, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation, fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The small fontanelle is at the symphis. What is the further tactics of the labor?
A. Application of obstetrical forceps
B. Stimulation of the labor activity with oxitocyne
C. Ceasarian section
D. Application of craniodermal forceps by Ivanov’s
E. Application of obstetrical cavity forceps
Answer: Application of obstetrical forceps
Explanation
| The patient is a 30-year-old woman in her second labor, which has lasted for 14 hours. The fetal heartbeat is mufflet, arrhythmic, and only 100 bpm. On vaginal examination, the cervix is fully dilated, and the fetal head is in the area of the small pelvis outlet, with the sagittal suture in the direct size and the small fontanelle at the symphysis. These findings suggest that the fetus is in a difficult position, and the slow fetal heartbeat indicates fetal distress. In this case, the most appropriate further tactic of labor would be the application of obstetrical forceps. Obstetrical forceps are a surgical instrument that can be used to assist in the delivery of a baby during a difficult labor. In this case, the forceps can be used to grasp the fetal head and guide it through the birth canal, reducing the risk of injury to the mother and the fetus. Stimulation of the labor activity with oxytocin is not appropriate in this case, given the slow fetal heartbeat and risk of fetal distress. A Caesarean section may be necessary if the use of obstetrical forceps is unsuccessful, but it is not the first-line option. Therefore, based on the patient’s clinical presentation, the most appropriate further tactic of labor in this case would be the application of obstetrical forceps. |
159. A 31y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has developed fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?
A. Admission to the mental hospital
B. Admission to the nu erological department
C. Out-patient treatment
D. Psychotherapeutic conversation
E. Strict home supervision
Answer: Admission to the mental hospital
Explanation
| The patient is a 31-year-old with a long history of mental disorders, including insomnia, fears, suicidal thoughts, and a recent suicide attempt. The patient’s mood is depressed, and he is refusing treatment. Given the patient’s history of suicidal ideation and attempt, admission to a mental hospital would be the most appropriate and expedient measure for the prevention of suicide. In a mental hospital, the patient can receive close medical and psychiatric supervision, as well as appropriate treatment for their mental health condition. In a mental hospital, the patient can receive medications that can help alleviate the symptoms of depression, anxiety, and insomnia, as well as psychotherapy and counseling to help address the underlying causes of their mental health issues and develop coping strategies. Strict home supervision may not be sufficient to prevent suicide in this case, as the patient has already attempted suicide and is refusing treatment. Out-patient treatment may also not be appropriate given the severity of the patient’s symptoms and the risk of further suicidal behavior. Therefore, based on the patient’s clinical presentation and history of suicidal ideation and attempt, admission to a mental hospital would be the most expedient measure for the prevention of suicide. |
160. A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1,5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkin’s area; sporadic extrasystoles. Liver isn’t palpated, there are no edema. Blood test: WBC- 6, 7∗109/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?
A. Acute myocarditis
B. Climacteric myocardiodystrophia
C. Ichemic heart disease, angina pectoris
D. Rheumatism, mitral insufficiency
E. Hypertrophic cardiomyopathy
Answer: Acute myocarditis
Explanation
| The patient is a 43-year-old woman who complains of shooting heart pain, dyspnea, irregularities in the heart activity, and progressive fatigue for the past 3 weeks. She had an acute respiratory disease a month ago. On examination, the blood pressure is 120/80 mm Hg, and the heart rate is 98 bpm. The heart borders are enlarged by 1.5 cm on the left side, and there are muffled heart sounds and a soft systolic murmur at the apex and Botkin’s area, with sporadic extrasystoles. The liver is not palpated, and there are no edema. Blood tests show a normal white blood cell count and a slightly elevated sedimentation rate. These findings are suggestive of acute myocarditis, which is an inflammatory condition of the myocardium, the muscular tissue of the heart. The symptoms of acute myocarditis can include chest pain, dyspnea, irregular heartbeats, and fatigue, which are consistent with the patient’s presentation. Acute myocarditis can be caused by a viral, bacterial, or fungal infection, which can occur after a recent respiratory infection, as in this case. The enlarged heart borders, muffled heart sounds, and systolic murmur are also consistent with myocarditis. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is acute myocarditis. |
161. A 52 y.o. male patient has become ill gradually. There is pain in the left side of the thorax during 2 weeks, elevation of temperature till 38 − 390C. On examination: left chest side falls behind in breathing movement no voice tremor over the left lung. Dullness that is more intensive in lower parts of this lung. Right heart border is deviated outside. Sharply weakened breathing over the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most probable diagnosis?
A. Exudative pleuritis
B. Spotaneous pneumothorax
C. Atelectasis of lung
D. Cirrhotic tuberculosis
E. Infarction-pneumonia
Answer: Exudative pleuritis
Explanation
| The patient is a 52-year-old male who has been gradually becoming ill over the past two weeks, with pain in the left side of the thorax and a fever of up to 38-39°C. On examination, there is a fall behind in breathing movement on the left chest side, no voice tremor over the left lung, dullness that is more intensive in the lower parts of this lung, and a deviated right heart border outside. There is also sharply weakened breathing over the left lung, no rales, and mufflet heart sounds with tachycardia. These findings are indicative of exudative pleuritis, which is an inflammation of the pleura, the thin membrane that lines the chest cavity and covers the lungs. The pain in the left side of the thorax, fever, and diminished breath sounds over the left lung are consistent with pleuritis. The dullness and deviated heart border suggest the presence of a pleural effusion, which is a buildup of fluid in the pleural space. Exudative pleuritis can be caused by a variety of factors, including infection, autoimmune disorders, and malignancy. In this case, the most likely cause of exudative pleuritis is an infection, such as pneumonia or tuberculosis. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is exudative pleuritis. |
162. A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, then there were seropurulent vesicles about 1cm. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?
A. Newborn pemphigus
B. Vesiculopustulosis
C. Pseudofurunculosis
D. Sepsis
E. Ritter’s dermatitis
Answer: Newborn pemphigus
Explanation
| The mother of the newborn child has chronic pyelonephritis and had an acute respiratory viral disease before labor. The labor was prolonged without waters. The child developed an erythematous eruption on the second day, which progressed to seropurulent vesicles about 1 cm with positive Nikolsky’s sign, erosions, and flabbiness. The temperature is subfebrile. These findings are suggestive of newborn pemphigus, which is a rare autoimmune disorder that causes blistering of the skin and mucous membranes in newborns. The disorder occurs when the mother’s immune system produces antibodies that attack the baby’s skin and mucous membranes. The risk of developing newborn pemphigus is increased in infants born to mothers with autoimmune disorders, such as chronic pyelonephritis, and those who have had an acute viral infection during pregnancy. The vesicles, erosions, and positive Nikolsky’s sign are characteristic findings of newborn pemphigus. Other possible diagnoses, such as vesiculopustulosis and pseudofurunculosis, do not typically present with positive Nikolsky’s sign. Sepsis and Ritter’s dermatitis are also possible diagnoses, but they typically present with more severe symptoms, such as high fever, lethargy, and widespread skin involvement. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is newborn pemphigus. |
163. A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratoty disorders: sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy’s type in the child?
A. Chest X-ray
B. Blood test
C. Blood gases
D. Proteinogram
E. Immunologic investigation
Answer: Chest X-ray
Explanation
| The child was born at 34 weeks of gestation in bad condition, with respiratory distress symptoms such as prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of rough breath sounds. The assessment according to Silverman’s scale was 0, but 3 hours later, it was 6 with the presence of clinical data, indicating worsening respiratory distress. Pneumopathy refers to any disease of the lungs, including pneumonia, bronchitis, and other respiratory infections. A chest X-ray is a common diagnostic tool used to evaluate the lungs and identify any abnormalities, such as infiltrates, consolidation, or atelectasis, which can help determine the type of pneumopathy. Other diagnostic methods, such as blood tests, blood gases, proteinogram, or immunologic investigations, may be useful in evaluating the severity and potential complications of the pneumopathy, but they are not specific for determining the type of pneumopathy. Therefore, based on the patient’s clinical presentation, the most appropriate diagnostic method to determine the type of pneumopathy in this child would be a chest X-ray. |
164. During intramuscular DTP vaccination in clinic, a 3 m.o. child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry”, stop of respiration, tension of the whole body with overturned backward head. Allergological history of the child is not complicated. What is the most probable diagnosis?
A. Spasmophilia, tonic spasms
B. Anaphylactic shock, clonic spasms
C. Meningoencephalitic reaction, clonic and tonic spasms
D. Cerebral haemorrhage, tonic spasms
E. Meningism, clonic and tonic spasms
Answer: Spasmophilia, tonic spasms
Explanation
| The 3-month-old child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry,” stop of respiration, tension of the whole body with an overturned backward head during intramuscular DTP vaccination. The allergological history of the child is not complicated. These symptoms are consistent with spasmophilia, which is a condition characterized by increased excitability of the nervous system and a tendency to develop tonic spasms, particularly in response to stress or stimulation. The laryngospasm, “cock cry,” and tension of the whole body with an overturned backward head are all indicative of tonic spasms. Anaphylactic shock, meningoencephalitic reaction, cerebral hemorrhage, and meningism are less likely diagnoses in this case, as they do not typically present with tonic spasms. Anaphylactic shock may present with clonic spasms, and meningoencephalitic reactions or meningism may present with both clonic and tonic spasms, but the presence of laryngospasm and the lack of a complicated allergological history make spasmophilia a more likely diagnosis. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is spasmophilia with tonic spasms. |
165. A 60 y.o. man complains of signifi- cant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head. Pain occured 2 days ago. On examination: Vis OD- 0,03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS0,8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?
A. Acute glaucoma attack
B. Right eye’s uveitis
C. Right eye’s keratitis
D. Eye nerve’s neuritis
E. Maculodystrophy
Answer: Acute glaucoma attack
Explanation
| The patient is a 60-year-old man who complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, and headache on the right side of the head. The pain started 2 days ago. On examination, there is a congested injection of the eye ball, significant cornea edema, a deep front chamber, narrow pupil, athrophic iris, optic nerve excavation on the eye fundus, and an intraocular pressure of 38 mm Hg in the right eye. In the left eye, the vision is 0.8 unadjustable, and the eye is calm and healthy, with an intraocular pressure of 22 mm Hg. These findings are suggestive of an acute glaucoma attack, which is a medical emergency caused by a sudden increase in intraocular pressure that can result in irreversible vision loss if not treated promptly. The symptoms of an acute glaucoma attack can include severe eye pain, headache, photophobia, reduced vision, and lacrimation. The significant cornea edema, narrow pupil, and deep front chamber are all consistent with an acute glaucoma attack. The optic nerve excavation on the eye fundus is also a typical finding in glaucoma. Uveitis, keratitis, eye nerve neuritis, and maculodystrophy are less likely diagnoses in this case, as they do not typically present with a sudden increase in intraocular pressure and the characteristic findings seen on examination. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is an acute glaucoma attack. |
166. A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous. In blood: WBC- 9, 8 ∗ 109/L, RBC- 3, 0 ∗ 1012/L, sedimentation rate52 mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Answer: Sulfasalasine
Explanation
| The most appropriate medication for the pathogenetic treatment of this patient with nonspecific ulcerative colitis would be sulfasalazine. Nonspecific ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum, characterized by inflammation and ulceration of the mucous membrane. The marked inflammatory process of lower intestinal parts and pseudopolyposive changes of mucous seen on rectoromanoscopy are consistent with this diagnosis. Sulfasalazine is a medication that is commonly used in the treatment of ulcerative colitis. It works by reducing inflammation in the colon and rectum. It is a combination of sulfapyridine, an antibiotic, and 5-aminosalicylic acid, an anti-inflammatory drug. Motilium, Vikasolum, Linex, and Kreon are all medications used to treat gastrointestinal disorders, but they are not typically used for the pathogenetic treatment of ulcerative colitis. Therefore, based on the patient’s clinical presentation and examination findings, the most appropriate medication for the pathogenetic treatment of this patient with nonspecific ulcerative colitis would be sulfasalazine. |
167. A 49 y.o. female patient presents with acute attacks of headache associated with pulsation in temples, increasing AP to 280/140 mm Hg. Pheochromocytoma is suspected. What is the mechanism of hypertensive crisis in this patient?
A. Increasing of catecholamines concentration
B. Increasing of aldosterone level in blood
C. Increasing of plasma renin activity
D. Increasing of vasopressin excretion
E. Increasing of thyroxine excretion
Answer: Increasing of catecholamines concentration
Explanation
| The mechanism of hypertensive crisis in this patient is most likely due to an increasing concentration of catecholamines, which is a characteristic feature of pheochromocytoma. Pheochromocytoma is a rare tumor that develops in the adrenal gland, which can cause excessive release of catecholamines, such as adrenaline and noradrenaline, into the bloodstream. These hormones can cause a sudden increase in blood pressure, leading to a hypertensive crisis. The acute attacks of headache associated with pulsation in temples and the significant increase in blood pressure to 280/140 mm Hg are all consistent with a hypertensive crisis caused by excessive catecholamine release. Increasing aldosterone levels in blood, increasing plasma renin activity, increasing vasopressin excretion, and increasing thyroxine excretion are all less likely mechanisms of hypertensive crisis in this case, as they are not typically associated with pheochromocytoma. Therefore, based on the patient’s clinical presentation and examination findings, the most likely mechanism of hypertensive crisis in this patient is an increasing concentration of catecholamines due to pheochromocytoma. |
168. To replace the blood loss replacement 1000 ml of the same group of Rhesuscompatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?
A. Citrate intoxication
B. Citrate shock
C. Allergic reaction
D. Anaphylactic shock
E. Pyrogenous reaction
Answer: Citrate intoxication
Explanation
| Sodium citrate is commonly used as an anticoagulant in blood transfusions to prevent the blood from clotting. However, it can also cause side effects, particularly if the volume of blood transfused is large or if the patient has impaired liver or kidney function. The symptoms of excitement, pale skin, tachycardia, and muscle cramps that occurred at the end of the hemotransfusion are all consistent with citrate intoxication. Citrate intoxication can cause a decrease in ionized calcium levels, which can lead to muscle cramps, cardiac arrhythmias, and other symptoms. Allergic reactions, anaphylactic shock, and pyrogenous reactions are less likely complications in this case, as they typically present with different symptoms, such as rash, itching, hives, difficulty breathing, fever, and chills. Therefore, based on the patient’s clinical presentation and examination findings, the most likely complication in this case is citrate intoxication. |
169. A 20 y.o. patient suddely felt ill 12 hours ago. There was pain in epigactric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC- 12, 2∗109/L. What is the most probable diagnosis?
A. Acute appendicitis
B. Acute pancreatitis
C. Perforated ulcer
D. Rightside kidney colic
E. Acute cholecystitis
Answer: Acute appendicitis
Explanation
| The patient is a 20-year-old who suddenly felt ill 12 hours ago, with pain in the epigastric.The white blood cell count was 12.2 x 10^9/L. These clinical findings are suggestive of acute appendicitis, which is a common condition caused by inflammation of the appendix. The pain typically starts in the epigastric or periumbilical region and then migrates to the right lower quadrant of the abdomen, where positive rebound tenderness is commonly noted. Nausea and vomiting are also common symptoms. Acute pancreatitis, perforated ulcer, right-side kidney colic, and acute cholecystitis are all possible differential diagnoses, but they are less likely in this case, given the patient’s clinical presentation and examination findings. Therefore, based on the patient’s clinical presentation and examination findings, the most probable diagnosis in this case is acute appendicitis. |
170. A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?
A. I degree
B. II degree
C. III degree
D. IV degree
E. V degree
Answer: I degree
Explanation
| First-degree frostbite, also known as frostnip, is the mildest form of frostbite. It occurs when skin and underlying tissues are exposed to cold temperatures but do not freeze. Symptoms of first-degree frostbite can include pain, tingling, and numbness in the affected area. The skin may appear pale at first, but then becomes red and warm after rewarming. There is no significant edema or blistering, and all types of sensitivity are preserved. In this case, the patient had been fishing in the winter and had experienced pain in the feet upon returning home. On examination, the feet skin was initially pale but became red and warm after rewarming. There was no significant edema or blistering, and all types of sensitivity were preserved. These findings are consistent with the diagnosis of first-degree frostbite. Second, third, fourth, and fifth-degree frostbite are progressively more severe forms of frostbite, with increasing tissue damage and loss of function. However, based on the provided information, it is unlikely that the patient has more than first-degree frostbite. Therefore, based on the patient’s clinical presentation and examination findings, the most likely degree of frostbite observed in this case is first degree. |
171. A 24 y.o. emotionally-labile woman presents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue following the divorce. On examination: palm hyperhydrosis, pulse rate- 72-78 bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case?
A. Neurasthenia
B. Ipochondric neurosis
C. Compulsive neurosis
D. Schizophrenia
E. Depressive neurosis
Answer: Neurasthenia
Explanation
| Neurasthenia is a condition characterized by emotional instability, irritability, fatigue, and a host of other physical and psychological symptoms, such as palpitations, shooting pain in the heart area, and generalized fatigue. The condition is often triggered by stress, such as the patient’s recent divorce. On examination, palm hyperhidrosis and a labile pulse rate are consistent with neurasthenia. The absence of any changes in the heart and normal ECG also support this diagnosis. Hypochondriacal neurosis, compulsive neurosis, schizophrenia, and depressive neurosis are all possible differential diagnoses, but they are less likely in this case, given the patient’s clinical presentation and examination findings. Therefore, based on the patient’s clinical presentation and examination findings, the most probable pathology in this case is neurasthenia. |
172. A 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. “Furrow symptom “is positive on the left. Pulse on foot arteries and popliteal artery isn’t palpated, on the femoral artery it’s weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?
A. Arteriosclerosis obliterans
B. Obliterating endarteritis
C. Hemoral arthery thombosis
D. Raynauld’s disease
E. Buerger’s disease (thromboangiitis obliterans)
Answer: Arteriosclerosis obliterans
Explanation
| Neurasthenia is a condition characterized by emotional instability, irritability, fatigue, and a host of other physical and psychological symptoms, such as palpitations, shooting pain in the heart area, and generalized fatigue. The condition is often triggered by stress, such as the patient’s recent divorce. On examination, palm hyperhidrosis and a labile pulse rate are consistent with neurasthenia. The absence of any changes in the heart and normal ECG also support this diagnosis. Hypochondriacal neurosis, compulsive neurosis, schizophrenia, and depressive neurosis are all possible differential diagnoses, but they are less likely in this case, given the patient’s clinical presentation and examination findings. Therefore, based on the patient’s clinical presentation and examination findings, the most probable pathology in this case is neurasthenia. |
173. A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4,9 mmol/L, uric acid0,211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?
A. Obesity
B. Arterial hypertension
C. Hyperglycemia
D. Hypercholesterolemia
E. Hyperuricemia
Answer: Obesity
Explanation
| Obesity is a major risk factor for cardiovascular disease, including myocardial infarction. In this case, the patient is overweight by 36%, which puts him at a higher risk for future cardiovascular events. Arterial hypertension, hyperglycemia, hypercholesterolemia, and hyperuricemia are all important risk factors for cardiovascular disease as well. However, in this case, the patient’s blood pressure, blood sugar, cholesterol, and uric acid levels are within normal limits or only slightly elevated. Therefore, while these risk factors should also be addressed during the secondary prevention of myocardial infarction, obesity is the most urgent risk factor that should be targeted for eradication. Lifestyle modifications, such as dietary changes and increased physical activity, are important components of managing and eradicating obesity. Additionally, medical interventions, such as weight loss medications or bariatric surgery, may be considered in some cases. Therefore, based on the patient’s clinical presentation and examination findings, the most urgent risk factor that should be eradicated during the secondary prevention of myocardial infarction in this patient is obesity. |
174. A 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia, following the semolina’s introduction (since 5 months). The child is adymanic, flabby, pale dry skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?
A. Celiakia (celiac disease)
B. Mucoviscidosis (cystic fibrosis)
C. Intestinal dysbacteriosis
D. Chronic enteritis
E. Disaccharidase insufficiency
Answer: Celiakia (celiac disease)
Explanation
| Celiac disease is a digestive disorder that is triggered by the consumption of gluten, a protein found in wheat, barley, and rye. In celiac disease, the immune system reacts abnormally to gluten, causing damage to the lining of the small intestine and interfering with the absorption of nutrients. This can lead to symptoms such as weight loss, anorexia, diarrhea, and malabsorption. The clinical findings in this case, including weight loss, unstable discharges, anorexia, a flabby and pale appearance, and subcutaneous emaciation, are all consistent with malabsorption. The distended and tensed abdomen, tympanitis on percussion of the upper part of the abdomen, and splashing sounds suggest the presence of intestinal gas and fluid. The foamy, light-colored, and foul-smelling feces are also indicative of malabsorption. Neutral fat in the coprocytogram is a further indication of malabsorption, which is a characteristic feature of celiac disease. In contrast, mucoviscidosis (cystic fibrosis), intestinal dysbacteriosis, chronic enteritis, and disaccharidase insufficiency are less likely causes of the disease in this case. Therefore, based on the patient’s clinical presentation, examination findings, and coprocytogram results, the most probable cause of the disease in this 2-year-old boy is celiac disease. |
175. On medical observation a doctor identified girl (162 cm tall and 59 kg weight) who complained loss of ability to see surrounding objects clearly in the evening. On examination: dry skin, hyperkeratosis. Her daily ration includes the following vitamines: vitamine А– 0,5 mg, vit.1– 2,0 mg, vit.2– 2,5 mg, vit.6– 2 mg, vit.С– 70 mg. What is the hypovitaminosis type?
A. A-hypovitaminosis
B. B1-hypovitaminosis
C. B2-hypovitaminosis
D. B6-hypovitaminosis
E. C-hypovitaminosis
Answer: A-hypovitaminosis
Explanation
| The patient is a girl who complains of loss of ability to see surrounding objects clearly in the evening. On examination, she has dry skin and hyperkeratosis. These symptoms are consistent with hypovitaminosis A, which is a condition caused by a deficiency of vitamin A. Vitamin A is essential for vision, immune function, and skin health. A deficiency of vitamin A can lead to night blindness, dry skin, and hyperkeratosis, among other symptoms. The patient’s daily intake of vitamin A is only 0.5 mg, which is lower than the recommended daily intake for adults (0.7-0.9 mg for females). Hypovitaminosis B1, B2, B6, and C are also possible differential diagnoses, but they are less likely in this case, given the patient’s clinical presentation and examination findings. Therefore, based on the patient’s clinical presentation and examination findings, the most probable hypovitaminosis type in this case is A-hypovitaminosis. |
176. A woman in labor, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?
A. Cervix dilation stage
B. Preliminary stage
C. Prodromal stage
D. Expulsion of fetus stage
E. Placental stage
Answer: Cervix dilation stage
Explanation
| During the cervix dilation stage, the cervix gradually opens (dilates) to allow the baby to pass through the birth canal. The cervix dilation is up to 2 cm in this case, which is consistent with the early phase of the cervix dilation stage. The intact fetal bladder indicates that the amniotic sac has not yet ruptured. The fact that the sacral cavity is free and the sacral promontory is reachable only with a bent finger suggests that the baby has not yet descended into the pelvis, which is also consistent with the early phase of the cervix dilation stage. The position of the baby’s head, with the sagittal suture occupying the transverse diameter of the pelvic inlet and the small fontanel to the left, suggests that the baby is in the occiput transverse position. This is a common position for babies during the cervix dilation stage. The preliminary stage, prodromal stage, expulsion of fetus stage, and placental stage are all later stages of labor that occur after the cervix has dilated fully. Therefore, based on the provided information, the stage of labor in this woman is the cervix dilation stage. |
177. A 30 y.o. patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?
A. Septicotoxemia
B. Primary burn shock
C. Secondary burn shock
D. Acute burn toxemia
E. Convalescence
Answer: Septicotoxemia
Explanation
| Septicotoxemia is a serious complication of burns that can occur several days to weeks after the initial injury. It is characterized by continued fever, loss of appetite, night sweats, and weak granulation of the burned surface. Septicotoxemia is caused by the invasion of bacteria into the bloodstream, which can lead to sepsis and septic shock. In this case, the patient had a deep burn covering 30% of the body 30 days ago, which puts him at a higher risk for septicotoxemia. The continued fever, loss of appetite, and night sweats are all indicative of an ongoing systemic inflammatory response, which could be caused by the presence of bacteria in the bloodstream. The weak granulation of the burned surface also suggests that the wound is not healing properly, which can increase the risk of infection and septicotoxemia. Primary burn shock and secondary burn shock are early stages of burn disease that occur immediately after the burn injury and within the first few hours after the injury, respectively. Acute burn toxemia is a less commonly used term for the septicotoxemia stage. Convalescence is a later stage of burn disease that occurs during the healing process. Therefore, based on the patient’s clinical presentation and history of burn injury, the stage of burn disease in this patient is septicotoxemia. |
178. A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?
A. Cancer of cervix of uterus
B. Cancer of body of uterus
C. Fibromatous node which is being born
D. Cervical pregnancy
E. Polypose of cervix of uterus
Answer: Cancer of cervix of uterus
Explanation
| The patient presents with contact bleeding during 5 months and on speculum examination, the cervix of the uterus looks like a cauliflower and bleeds on probing. These findings are highly suggestive of cervical cancer. On bimanual examination, the cervix is of dense consistency, which is a characteristic feature of cervical cancer. The uterus body is not enlarged and is mobile, which suggests that the cancer has not spread beyond the cervix at this stage. The nonpalpable adnexa and free parametrium are also consistent with early-stage cervical cancer. Fibromatous node, cervical pregnancy, and polypose of the cervix of the uterus are less likely diagnoses, given the patient’s clinical presentation and examination findings. Therefore, based on the patient’s clinical presentation and examination findings, the most likely diagnosis in this case is cancer of the cervix of the uterus. |
179. A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, people’s faces get cartoon features, loss of time and space judgement. What is the most likely diagnosis?
A. Cocainism
B. Morphinism
C. Barbiturism
D. Nicotinism
E. Cannabism
Answer: Cocainism
Explanation
| The patient, a 20-year-old female, experienced a peculiar inebriation after smoking, which included a burst of energy, elation, and a feeling of irreality. These symptoms are consistent with the effects of cocaine, which is a stimulant drug that can cause euphoria, increased energy, and altered perception of reality. The patient also described changes in her surroundings, including the world becoming full of bright colors and objects appearing to change in size and shape. These are also characteristic symptoms of cocaine use. Loss of time and space judgement is another common symptom of cocaine use, which can lead to risky behavior and accidents. Morphinism, barbiturism, nicotinism, and cannabism are less likely diagnoses, given the patient’s clinical presentation and history of smoking. Therefore, based on the patient’s clinical presentation and history of smoking, the most likely diagnosis in this case is cocainism. |
180. A 75 y.o patient can not tell the month, date and season of the year. After long deliberations she manages to tellher name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as “invaluable books”. What is the most probable diagnosis?
A. Senile dementia
B. Atherosclerotic (lacunar) dementia
C. Presenile melancholia
D. Behaviour disorder
E. Dissociated personality (psychopathy)
Answer: Senile dementia
Explanation
| The patient, a 75-year-old, has difficulty telling the month, date, and season of the year, which is a sign of cognitive impairment. The fact that she is irritable and dissatisfied suggests a change in her personality, which can be a symptom of dementia. The patient’s behavior of carrying a bundle of belongings and hiding a parcel with bread, shoes, and “invaluable books” in her underwear and bosom is also suggestive of dementia. This behavior may be due to confusion or delusions that commonly occur in dementia patients. Senile dementia is a type of dementia that is characterized by a progressive decline in cognitive function, including memory, attention, and language skills. It is more common in older adults, particularly those over the age of 65, and is often caused by degenerative changes in the brain. Atherosclerotic (lacunar) dementia is a type of dementia that is caused by damage to the small blood vessels in the brain due to atherosclerosis. Presenile melancholia is a type of depression that occurs in younger individuals. Behavior disorder and dissociated personality (psychopathy) are less likely diagnoses in this case, given the patient’s clinical presentation and age. Therefore, based on the patient’s clinical presentation and behavior, the most probable diagnosis in this case is senile dementia. |
181. A 29 y.o. patient was admitted to the hospital with acute girdle pain in epigastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive SchotkinBlumberg’s symptom. What is the maximal term to make a diagnosis?
A. In 2 hours
B. In 0,5 hours
C. In 1 hour
D. In 3 hours
E. In 6 hours
Answer: In 2 hours
Explanation
| The patient presents with acute girdle pain in the epigastric area, vomiting, and signs of shock, including pallor and acrocyanosis. The frequent, shallow breathing and tensed abdominal muscles with a positive Schotkin-Blumberg’s sign are also suggestive of a serious abdominal pathology. Given the severity of the patient’s symptoms, it is important to make adiagnosis as soon as possible to initiate appropriate treatment. However, some diagnostic tests may take time to perform, such as laboratory tests and imaging studies. In this case, the diagnosis is likely to be made within 2 hours, based on the urgency of the patient’s condition and the need for prompt intervention. This may include imaging studies such as an abdominal ultrasound or CT scan, as well as blood tests to evaluate the patient’s electrolyte balance, liver function, and other parameters. Waiting longer than 2 hours to make a diagnosis and initiate treatment may increase the risk of complications and poor outcomes for the patient. Therefore, based on the patient’s clinical presentation and examination findings, the maximal term to make a diagnosis in this case is 2 hours. |
182. A 33 y.o. patient was admitted to the hospital with stopped recurrent peptic ulcer bleeding. On examination he is exhausted, pale. Нb– 77 g/L, Нt– 0,25. Due to anemia there were two attempts of blood transfution of identical blood group ()Rh+. Both attempts were stopped because of anaphylactic reaction. What blood transfution environment is desirable in this case?
A. Washed erythrocytes
B. Freshcitrated blood
C. Erythrocyte mass (native)
D. Erythrocyte emulsion
E. Erythrocyte mass poor for leucocytes and thrombocytes
Answer: Washed erythrocytes
Explanation
| The patient has a history of recurrent peptic ulcer bleeding and is now presenting with severe anemia, with an Hb of 77 g/L and Ht of 0.25. Blood transfusion is necessary in this case to correct the anemia, but the patient has experienced an anaphylactic reaction to two previous transfusions of identical blood group and Rh factor. Anaphylactic reactions to blood transfusions are often caused by antibodies in the recipient’s plasma reacting with antigens on the surface of the transfused red blood cells. Washing the erythrocytes can remove the plasma and reduce the risk of anaphylactic reaction, as it removes some of the proteins and other substances that can trigger an immune response. Therefore, washed erythrocytes would be the most desirable blood transfusion environment in this case, as it reduces the risk of anaphylactic reaction. Other options, such as fresh citrated blood, erythrocyte mass (native), erythrocyte emulsion, and erythrocyte mass poor for leukocytes and thrombocytes, may still contain substances that could trigger an immune response and are therefore less desirable in this situation. |
183. A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. On operation multiple ruptures of spleen and small intestine were revealed. AP is falling, it is necessary to perform hemotransfusion. Who can determine patient’s blood group and rhesus compatibility?
A. A doctor of any speciality
B. A laboratory physician
C. A surgeon
D. A traumotologist
E. An anaesthesilogist
Answer: A doctor of any speciality
Explanation
| Blood group and rhesus compatibility are determined by performing a blood test to identify the ABO blood group and Rh factor. This test can be performed by any healthcare professional who is trained to collect and handle blood samples, including doctors of any specialty, laboratory physicians, nurses, or medical technicians. In the case of the 19-year-old boy with closed abdominal trauma, it may be necessary to perform a blood transfusion to correct the hypotension caused by the ruptured spleen and small intestine. The patient’s blood group and rhesus compatibility must be determined before the transfusion can be performed to ensure that the transfused blood is compatible and does not cause an adverse reaction. Therefore, in this case, any doctor or healthcare professional who is trained to collect and handle blood samples can determine the patient’s blood group and rhesus compatibility. However, it is important to ensure that the person performing the test has the appropriate training and skills to handle blood samples and perform the test accurately. |
184. A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor’s tactics in this case?
A. Immediate pregancy interruption
B. Pregnancy interruption after urine normalization
C. Maintenance of pregnancy till 36 weeks
D. Pregnancy interruption at 24-25 weeks
E. Maintenance of pregnancy till delivery term
Answer: Immediate pregancy interruption
Explanation
| The patient has pyelonephritis of the only kidney, and her urine test shows a high level of albumin and a large number of leukocytes. These findings suggest that the patient has significant renal impairment and may be at risk of further complications if the pregnancy is allowed to continue. Pregnancy can put additional stress on the kidneys, and in this case, the patient’s existing renal impairment may be exacerbated by the pregnancy. Continuing the pregnancy may result in worsening of the pyelonephritis, leading to serious complications such as sepsis, renal failure, or pre-eclampsia. Therefore, immediate pregnancy interruption would be the most appropriate course of action in this case to protect the patient’s health and prevent further complications. This would involve terminating the pregnancy through medical or surgical means. Maintenance of the pregnancy until term or delivery would not be appropriate in this case, given the patient’s existing renal impairment and the risk of complications. Similarly, delaying pregnancy interruption until urine normalization or a specific gestational age would not be advisable, as it could increase the risk of harm to the patient and the fetus. Therefore, based on the patient’s clinical presentation and examination findings, immediate pregnancy interruption would be the most appropriate course of action. |
185. A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It’s been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiting with blood reoccured in 2-3- hours. Hemoglobin decreased to 93,1 g/L then to 58,1 g/L. What is the tactics of treatment?
A. Urgent surgery
B. Deferred surgery
C. Conservative treatment
D. Conservative treatment with following surgery
E. Taylor’s treatment
Answer: Urgent surgery
Explanation
| The patient has presented with symptoms of ulcerative gastric hemorrhage and has experienced multiple episodes of bleeding in the past 2 years. Despite initial conservative treatment, the patient has experienced profuse vomiting with blood, and her hemoglobin levels have decreased significantly. Given the severity of the bleeding and the patient’s history of recurrent hemorrhages, urgent surgical intervention is necessary to control the bleeding and prevent further complications. The exact type of surgery will depend on the location and extent of the bleeding, but options may include gastrectomy, partial gastrectomy, or local resection of the ulcer. Deferred surgery or conservative treatment alone may not be effective in controlling the bleeding and preventing further hemorrhages. Taylor’s treatment, which involves using a combination of shock therapy, antibiotics, and vasoactive drugs, is not appropriate in this case, as it is primarily used for treating septic shock and not for controlling bleeding. Therefore, based on the patient’s clinical presentation and history of recurrent hemorrhages, urgent surgery would be the most appropriate course of action to control the bleeding and prevent further complications. |
186. A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient’s blood from the abdominal cavity be used for autotransfusion?
A. Stomach rupture
B. Bladder rupture
C. Liver rupture
D. Splenic rupture
E. Small intestines rupture
Answer: Stomach rupture
Explanation
| In general, blood from the abdominal cavity can be used for autotransfusion in cases where there is no evidence of contamination or infection. However, the specific situation in which autotransfusion is appropriate will depend on the nature and severity of the injury. In this case, the patient has undergone surgery for intraperitoneal hemorrhage, which may have resulted from a rupture of one or more abdominal organs. The question asks in which case can the patient’s blood from the abdominal cavity be used for autotransfusion, and the most appropriate answer is stomach rupture. Stomach rupture is less likely to be contaminated by bowel contents or other infectious material compared to other abdominal organs such as the small intestines or bladder. Therefore, in cases of stomach rupture, the patient’s blood from the abdominal cavity can be collected and processed for autotransfusion, provided that there is no evidence of contamination or infection. In cases of bladder rupture, there is a higher risk of contamination with urine, which can lead to infection if the collected blood is used for autotransfusion. In cases of liver or splenic rupture, the collected blood may be contaminated with bile or other organ contents, which can also increase the risk of infection. In cases of small intestine rupture, there is a higher risk of contamination with intestinal contents, which can lead to infection and sepsis. Therefore, based on the information provided, stomach rupture would be the most appropriate option for autotransfusion of blood from the abdominal cavity. However, it is important to assess the condition of the patient and the nature of the injury before making a decision about autotransfusion. |
187. A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 390. Sudden onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without defi- nite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
A. Gout
B. Infectional arthritis
C. Rheumatoid arthritis
D. Erysipelatous inflammation
E. Osteoarthritis
Answer: Gout
Explanation
| Gout is a type of arthritis caused by the buildup of uric acid crystals in the joints. It often presents with sudden onset of intense pain, swelling, and redness in the affected joint, along with fever and other systemic symptoms. The ankle joint is a common site for gout attacks. The patient’s history of similar attacks lasting 5-6 days without residual changes in the joint is also consistent with gout, which typically presents as acute attacks followed by periods of remission. Infectional arthritis and erysipelatous inflammation can also cause joint pain, swelling, and redness, but they are usually associated with other signs of infection, such as fever, chills, and malaise. Rheumatoid arthritis is a chronic autoimmune condition that causes joint pain, stiffness, and deformity, usually affecting multiple joints. Osteoarthritis is a degenerative joint disease that typically presents with gradual onset of joint pain and stiffness, usually affecting weight-bearing joints such as the hips and knees. Therefore, based on the symptoms and history described, gout would be the most likely diagnosis. However, further evaluation and testing, such as joint aspiration and analysis of synovial fluid, may be necessary to confirm the diagnosis and rule out other possible causes. |
188. A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Which complication development aggravated the patient’s state?
A. Malignisation
B. Penetration
C. Perforation
D. Haemorrhage
E. Stenosis
Answer: Malignisation
Explanation
| The patient in this case has a history of stomach ulcer and has received treatment for it. However, two weeks later, they have developed constant pain that is increasing and resistant to medication. The abdomen is painful in the epigastric area, with moderate defense in the pyloroduodenal area. Based on this presentation, it is unlikely that the patient’s symptoms are due to a complication such as penetration, perforation, hemorrhage, or stenosis. Instead, the most likely complication that has developed and aggravated the patient’s state is malignization, or the transformation of the stomach ulcer into a cancerous lesion. Chronic inflammation and ulceration of the stomach lining can increase the risk of developing gastric cancer, especially in patients with Helicobacter pylori infection or a family history of the disease. The development of constant and increasingly severe pain, along with the presence of defensive muscle tension in the abdomen, may suggest the presence of a mass or tumor in the stomach. Other symptoms that may be present with gastric cancer include weight loss, nausea, vomiting, and difficulty swallowing. Therefore, in this case, malignization is the most likely complication that has developed and aggravated the patient’s state. Further evaluation and testing, such as endoscopy and biopsy, may be necessary to confirm the diagnosis and determine the appropriate course of treatment. |
189. A 54 y.o. male patient suffers from dyspnea during mild physical exertion, cough with sputum which is excreted with diffculty. On examination: diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with prolonged expiration and dry whistling rales. AP is 140/80 mm Hg, pulse is 92 bpm, rhythmic. Spirography: vital capacity (VC)/predicted vital capacity- 65%, FEV1/FVC– 50%. Determine the type of respiratory insufficiency (RI).
A. RI of mixed type with prevailing obstruction
B. RI of restrictive type
C. RI of obstructive type
D. RI of mixed type with prevailing resriction
E. There is no RI
Answer: RI of mixed type with prevailing obstruction
Explanation
| The patient has symptoms of dyspnea and cough with sputum, along with diffuse cyanosis and barrel chest, which suggest a chronic respiratory condition. The weakened vesicular breathing with prolonged expiration and dry whistling rales are consistent with obstructive lung disease. The spirometry results show a reduced vital capacity (VC) at 65% of predicted, along with a reduced FEV1/FVC ratio at 50%. These findings indicate that the patient has both restrictive and obstructive lung disease, with a greater degree of obstruction. Therefore, based on the patient’s clinical presentation and spirometry results, the most likely type of respiratory insufficiency is mixed type with prevailing obstruction. This type of RI is commonly seen in chronic obstructive pulmonary disease (COPD), which is characterized by chronic bronchitis and/or emphysema. The reduced VC and FEV1/FVC ratio suggest that the patient has both reduced lung volume and airway obstruction, which can lead to difficulty breathing and reduced exercise tolerance. It is important to note that spirometry results alone cannot provide a definitive diagnosis and that further evaluation and testing may be necessary to confirm the diagnosis and determine the appropriate course of treatment. |
190. A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?
A. Nootropics
B. Neuroleptics
C. Stimulators
D. Tranquillisers
E. Antidepressants
Answer: Nootropics
Explanation
| Nootropics, also known as cognitive enhancers or “smart drugs,” are a class of medications that are used to improve cognitive function, memory, and learning. They are often prescribed to patients who have experienced brain injury or other neurological conditions that can affect cognitive function. In this patient, the cranial injury and comatose state suggest that there may have been damage to the brain, which can lead to cognitive impairment and psychoorganic syndrome in the post-comatose period. Nootropics can help to improve cognitive function and prevent or reduce the severity of psychoorganic syndrome. Neuroleptics, stimulators, tranquilizers, and antidepressants are not appropriate in this case, as they are not specifically designed to improve cognitive function or prevent psychoorganic syndrome. Neuroleptics and tranquilizers are typically used to treat psychiatric conditions such as schizophrenia and anxiety, while stimulators are used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Antidepressants are used to treat depression and other mood disorders. Therefore, based on the patient’s clinical presentation and the goal of preventing psychoorganic syndrome in the post-comatose period, nootropics would be the most appropriate psychotropic medication to administer. However, the specific type and dosage of nootropic medication should be determined by a qualified healthcare professional based on the patient’s individual needs and medical history. |
191. A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?
A. Pleural cavity drainage
B. Intravenous infusions
C. Oxigenotherapy
D. Intubation
E. Analgetics
Answer: Pleural cavity drainage
Explanation
| Tense pneumothorax is a potentially life-threatening condition that occurs when air accumulates in the pleural space and causes the lung to collapse. This can lead to respiratory distress, hypoxia, and cardiovascular compromise. Pleural cavity drainage involves the insertion of a chest tube into the pleural space to remove the accumulated air and allow the lung to re-expand. This procedure is performed under sterile conditions and may require local anesthesia or conscious sedation. Intravenous infusions, oxygen therapy, intubation, and analgesics may also be necessary in the management of chest trauma and pneumothorax, but they are not the most appropriate emergency treatment for a patient with tense pneumothorax. Therefore, in a patient with chest trauma and tense pneumothorax, the most appropriate emergency treatment is pleural cavity drainage. This should be performed as soon as possible to prevent further complications and improve the patient’s respiratory and cardiovascular status. |
192. A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position. positive stretching symptoms were revealed on examination. What is an initial diagnosis?
A. Intervertebral ligaments disorder
B. Spinal cord tumor
C. Arachnomielitis
D. Polyneuritis
E. Myelopathy
Answer: Intervertebral ligaments disorder
Explanation
| Based on the patient’s symptoms and examination findings, the initial diagnosis is likely to be an intervertebral ligament disorder, such as a herniated disc or a strain/sprain of the ligaments or muscles in the lumbar spine. The patient’s complaint of pain in the lumbar spine with radiation to the back surface of the left leg suggests that there may be compression or irritation of a nerve root in the lumbar spine. The pain increasing on change of body position and in vertical position, along with positive stretching symptoms, further supports this possibility. Spinal cord tumor, arachnoiditis, polyneuritis, and myelopathy are less likely diagnoses based on the patient’s presentation, as they typically present with more widespread and persistent neurological symptoms, such as weakness, numbness, or loss of sensation. Therefore, based on the patient’s symptoms and examination findings, the most likely initial diagnosis is an intervertebral ligament disorder, such as a herniated disc or a strain/sprain of the ligaments or muscles in the lumbar spine. Further evaluation and testing, such as imaging studies and nerve conduction studies, may be necessary to confirm the diagnosis and determine the appropriate course of treatment. |
193. A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?
A. Strict following of feeding regimen
B. Common cold prophilaxis
C. Feces observation
D. Gastro-intestinal disease prevention
E. Hardening of the child
Answer: Strict following of feeding regimen
Explanation
| After conservative treatment of invagination, it is important to provide appropriate recommendations to prevent recurrence of the condition. The most appropriate recommendation in this case would be strict following of feeding regimen. Invagination, also known as intussusception, occurs when one segment of the intestine invaginates or telescopes into another segment, causing obstruction and inflammation. While the exact cause of invagination is not always clear, certain factors such as viral infections and changes in bowel movements can contribute to its development. To prevent recurrence of invagination, it is important to maintain a regular feeding regimen for the child. This includes feeding the child at regular intervals and avoiding overfeeding or underfeeding. It is also important to ensure that the child is receiving an appropriate balance of nutrients and fluids to maintain healthy bowel movements. Common cold prophylaxis, feces observation, gastro-intestinal disease prevention, and hardening of the child may also be important measures to promote overall health and prevent other conditions, but they are not specifically targeted at preventing invagination recurrence. Therefore, the most appropriate recommendation to prevent recurrence of invagination after conservative treatment is strict following of feeding regimen. It is important for the mother to follow the advice of a qualified healthcare professional regarding the appropriate feeding regimen for the child based on their individual needs and medical history. |
194. A male patient presents with swollen ankles, face, eyelids, elevated AP- 160/100 mm Hg, pulse- 54 bpm, daily loss of albumine with urine- 4g. What therapy is pathogenetic in this case?
A. Corticosteroids
B. Diuretics
C. NSAID
D. Calcium antagonists
E. Antibiotics
Answer: A. Corticosteroids
Explanation
| The patient’s presentation is consistent with nephrotic syndrome, a condition characterized by increased urinary protein excretion, edema, and hypertension. The daily loss of albumin with urine at 4g is indicative of significant proteinuria. The most appropriate pathogenic therapy for nephrotic syndrome is corticosteroids. Corticosteroids are immunosuppressive medications that can reduce inflammation and decrease proteinuria by inhibiting the immune system’s response to the underlying kidney damage. Diuretics may be used to manage the edema associated with nephrotic syndrome, but they do not address the underlying cause of the condition. NSAIDs and antibiotics are not indicated in the treatment of nephrotic syndrome. Calcium antagonists, such as amlodipine, may be used to manage hypertension in patients with nephrotic syndrome, but they are not pathogenic therapy for the condition itself. Therefore, in this case, the most appropriate pathogenic therapy for nephrotic syndrome would be corticosteroids. The specific dosage and duration of therapy should be determined by a qualified healthcare professional based on the patient’s individual needs and medical history. |
195. During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?
A. Increase of bleeding speed
B. Developing of cardiac insufficiency
C. Shunting
D. Depositing of blood in venous channel
E. Presence of hypervolemia
Answer: Increase of bleeding speed
Explanation
| The combination of an increase in central venous pressure (CVP) and a decrease in arterial pressure (AP) during dynamic investigation of a patient is suggestive of shunting, not an increase in bleeding speed. Shunting refers to the redirection of blood flow from the arterial circulation to the venous circulation without passing through the capillary beds. This can occur in certain medical conditions, such as congenital heart defects or liver disease, and can result in an increase in CVP and a decrease in AP. An increase in bleeding speed would not be expected to cause an increase in CVP and a decrease in AP, as bleeding typically results in a decrease in blood volume and a decrease in both CVP and AP. Developing cardiac insufficiency, depositing of blood in venous channel, and presence of hypervolemia may also cause an increase in CVP, but they would not necessarily be associated with a decrease in AP. Therefore, based on the given information, the combination of an increase in CVP and a decrease in AP suggests shunting, not an increase in bleeding speed. Further evaluation and testing may be necessary to confirm the diagnosis and determine the appropriate course of treatment. |
196. A male patient complains of heartburn which gest stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disoeder should be expected at gastroscopy?
A. Gastroesophageal reflux
B. Chronic gastritis
C. Gastric peptic ulcer
D. Acute erosive gastritis
E. Duodenal peptic ulcer
Answer: Gastroesophageal reflux
Explanation
| In a patient with heartburn that gets stronger while bending the body, substernal pain during swallowing, and a diagnosed hiatus hernia on X-ray, the most likely disorder that would be expected at gastroscopy is gastroesophageal reflux. Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents, including acid and enzymes, flow back up into the esophagus, causing irritation and inflammation. A hiatus hernia can contribute to the development of GERD by allowing the stomach to protrude into the chest cavity, thereby increasing the risk of reflux. Gastroscopy, also known as an upper endoscopy, is a procedure in which a flexible tube with a camera is passed through the mouth and into the esophagus, stomach, and duodenum to visualize the lining of the upper gastrointestinal tract. During gastroscopy, the physician may observe signs of reflux, such as inflammation or erosion in the esophagus or stomach. Chronic gastritis, gastric peptic ulcer, acute erosive gastritis, and duodenal peptic ulcer may also be observed during gastroscopy, but they are less likely in this case based on the patient’s symptoms and X-ray findings. Therefore, based on the patient’s presentation and the presence of a hiatus hernia on X-ray, the most likely disorder that would be expected at gastroscopy is gastroesophageal reflux. Further evaluation and testing, including pH monitoring and manometry, may be necessary to confirm the diagnosis and determine the appropriate course of treatment. |
197. A 2,5 m.o. child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin D. What is the dosage and frequency of vitamin D administration?
A. 3000 IU daily
B. 500 IU daily
C. 1000 IU daily
D. 500 IU every other day
E. 1000 IU every other day
Answer: 3000 IU daily
Explanation
| In a 2.5-month-old child with muscle hypotonia, sweating, and alopecia of the back of the head, the prescribed treatment includes massage, curative gymnastics, and vitamin D. The appropriate dosage and frequency of vitamin D administration in this case would be 3000 IU daily. Vitamin D is important for bone and muscle development, and deficiency can lead to muscle weakness and hypotonia, as well as alopecia in severe cases. In infants, vitamin D supplementation is generally recommended to prevent deficiency. The American Academy of Pediatrics recommends a daily dose of 400-1000 IU of vitamin D for infants, children, and adolescents, with higher doses recommended for those at increased risk of deficiency. Infants with suspected or confirmed vitamin D deficiency may require higher doses to achieve adequate levels. In this case, the child’s presentation suggests possible vitamin D deficiency, and therefore a higher dose of 3000 IU daily is appropriate. The dosage and duration of vitamin D supplementation should be determined by a qualified healthcare professional based on the individual needs and medical history of the child. Therefore, in a 2.5-month-old child with muscle hypotonia, sweating, and alopecia of the back of the head, the appropriate dosage and frequency of vitamin D administration would be 3000 IU daily, as prescribed by a qualified healthcare professional. |
198. A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Spastic colitis
C. Colitis with hypertonic type dyskinesia
D. Chronic enterocolitis, exacerbation phase
E. Atonic colitis
Answer: Irritable bowel syndrome
Explanation
| The most likely diagnosis for the 43-year-old male with stomach pain, relief with defecation, and alternating constipation and diarrhea along with other symptoms is Irritable Bowel Syndrome (IBS). IBS is a common gastrointestinal disorder characterized by chronic or recurrent abdominal pain, bloating, and changes in bowel habits, such as constipation, diarrhea, or both in alternation. The pain is often relieved by bowel movements. The diagnosis of IBS is usually made based on symptoms, as no specific laboratory or imaging tests can confirm the diagnosis. The other options listed are less likely based on the provided symptoms. Spastic colitis and colitis with hypertonic type dyskinesia are outdated terms and not commonly used in medical practice. Chronic enterocolitis, exacerbation phase typically presents with fever, bloody stools, and significant changes in laboratory tests. Atonic colitis is a rare condition characterized by chronic constipation without any anatomical or neurological abnormalities. |
199. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?
A. Manual exploration of the uterine cavity
B. External massage of uterus
C. Use of uterine contracting agents
D. Urine drainage, cold at lower abdomen
E. Use of hemostatic medications
Answer: Manual exploration of the uterine cavity
Explanation
| The necessary action after delivery and revision of placenta with the finding of a defect in the placental lobe, moderate bloody discharge, and absence of lacerations on inspection of the birth canal with mirrors is to perform a manual exploration of the uterine cavity. The presence of a placental lobe defect can lead to retained placental tissue, which can cause postpartum hemorrhage if not removed. Manual exploration of the uterine cavity is necessary to check for any retained placental tissue and to ensure that the uterus is contracting properly. External massage of the uterus, use of uterine contracting agents, urine drainage, cold at the lower abdomen, and use of hemostatic medications may be necessary in certain situations, but in this case, the most immediate and necessary action is to perform a manual exploration of the uterine cavity. |
200. A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?
A. Paradoxal ischuria
B. Urinary incontinence
C. Dysuria
D. Enuresis
E. Pollakiuria
Answer: Paradoxal ischuria
Explanation
| The symptom observed in this patient is paradoxal ischuria. Paradoxal ischuria is a condition in which urine is retained in the bladder despite a sensation of fullness and the inability to empty the bladder completely. It is often seen in elderly patients and can be caused by a variety of factors, including neurological disorders, bladder outlet obstruction, or weak bladder muscles. In the case described above, the patient is experiencing constant urinary excretion in drops, feeling of fullness in the lower abdomen, and has a spherical protrusion above the pubis, which is indicative of an enlarged bladder. The dullness of percussion sound and positive suprapubic punch further support the diagnosis of paradoxal ischuria. Urinary incontinence refers to the inability to control the release of urine, dysuria refers to painful urination, enuresis refers to bedwetting, and pollakiuria refers to frequent urination. These conditions are not consistent with the symptoms and findings in the case described. |
