151. A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?
A. Hyperkaliemia
B. Hyperhydratation
C. Hypokaliemia
D. Hypernatremia
E. Hypocalcemia
Answer: Hyperkaliemia
Explanation
| In a 35-year-old male patient with chronic glomerulonephritis and a history of hemodialysis for the last 3 years, presenting with irregularities in heart activity, hypotension, progressive weakness, dyspnea, bradycardia, 1st degree atrioventricular block, high sharpened T-waves on ECG, and a recent history of broken water consumption and dietary pattern, the most likely cause of these changes is hyperkalemia. Option A, hyperkalemia, is the correct answer as patients with chronic kidney disease, such as chronic glomerulonephritis, are at an increased risk of hyperkalemia due to impaired renal excretion of potassium, and factors such as dietary potassium intake, medications, and hemodialysis can further contribute to the development of hyperkalemia. Hyperkalemia can lead to cardiac arrhythmias, weakness, and dyspnea. Option B, hyperhydration, is less likely given the patient’s history of chronic kidney disease and hemodialysis, which are associated with fluid overload. Option C, hypokalemia, is less likely given the patient’s history of chronic kidney disease and the high likelihood of hyperkalemia in this population. Option D, hypernatremia, is less likely given the patient’s presentation with hypotension and the fact that hypernatremia is not commonly seen in patients with chronic kidney disease on hemodialysis. Option E, hypocalcemia, is less likely given the absence of symptoms such as tetany or muscle cramps. Therefore, in a 35-year-old male patient with chronic glomerulonephritis and a history of hemodialysis for the last 3 years, presenting with irregularities in heart activity, hypotension, progressive weakness, dyspnea, bradycardia, 1st degree atrioventricular block, high sharpened T-waves on ECG, and a recent history of broken water consumption and dietary pattern, the most likely cause of these changes is hyperkalemia, and immediate management, such as emergent hemodialysis and correction of potassium levels, may be necessary to prevent serious complications. |
152. A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fi- ngers are defigured, with Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?
A. Osteoarthritis
B. Reiter’s disease
C. Bechterew’s disease
D. Rheumatic arthritis
E. Psoriatic arthritis
Answer: Osteoarthritis
Explanation
| In a 60-year-old patient complaining of pain in the interphalangeal joints of the hand that worsens during working, with distal and proximal joints of the II-IV fingers having Heberden’s and Bouchard’s nodes, painful and stiff, and X-ray findings of constricted joint spaces, marginal osteophytes, and subchondral sclerosis, the most probable diagnosis is osteoarthritis. Option A, osteoarthritis, is the correct answer as the patient’s symptoms and X-ray findings are consistent with the degenerative joint disease, which commonly affects the hand joints and can cause pain, stiffness, and deformity. Option B, Reiter’s disease, is less likely given that it is a rare autoimmune disorder that typically affects large joints and is associated with other systemic symptoms. Option C, Bechterew’s disease (ankylosing spondylitis), is less likely given that it primarily affects the spine and sacroiliac joints, and is associated with inflammatory back pain and stiffness. Option D, rheumatoid arthritis, is less likely given that it typically affects the small joints of the hands and feet symmetrically, and is associated with systemic symptoms such as fatigue and fever. Option E, psoriatic arthritis, may affect the hands, but is typically associated with skin and nail changes, which are not mentioned in the patient’s history. Therefore, in a 60-year-old patient complaining of pain in the interphalangeal joints of the hand that worsens during working, with distal and proximal joints of the II-IV fingers having Heberden’s and Bouchard’s nodes, painful and stiff, and X-ray findings of constricted joint spaces, marginal osteophytes, and subchondral sclerosis, the most probable diagnosis is osteoarthritis. Treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and joint protection strategies. |
153. A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft, there are no symptoms of peritenium irritation, “splashing sounds”in epigastrium. Defecation – once in 3 days. What complication corresponds with the patient’s state and described clinical presentations?
A. Ulcerative pyloric stenosis
B. Concealed ulcer perforation
C. Stomach cancer
D. Ulcer penetration
E. Chronic pancreatitis
Answer: Ulcerative pyloric stenosis
Explanation
| In a 42-year-old man with a history of duodenal ulcer for 20 years, complaining of a sense of heaviness in the stomach after a meal, foul-smelling eructation, vomiting, weight loss, diminished tissue turgor, soft abdomen on palpation, “splashing sounds” in the epigastrium, and infrequent bowel movements, the most likely complication corresponding with the patient’s state and clinical presentation is ulcerative pyloric stenosis. Option A, ulcerative pyloric stenosis, is the correct answer as the patient’s symptoms and findings suggest the possibility of a narrowing of the pylorus due to scarring from chronic ulceration, which can cause symptoms such as postprandial fullness, vomiting, weight loss, and decreased bowel movements. Option B, concealed ulcer perforation, is less likely given the absence of signs of peritoneal irritation, such as rebound tenderness or guarding. Option C, stomach cancer, may present with similar symptoms as pyloric stenosis, but is less likely given the patient’s history of duodenal ulcer and the chronic nature of the symptoms. Option D, ulcer penetration, may cause symptoms such as abdominal pain and tenderness, but is less likely given the absence of these findings on examination. Option E, chronic pancreatitis, may cause abdominal pain, but is less likely given the patient’s symptoms of postprandial fullness, vomiting, and weight loss, which are not typically associated with chronic pancreatitis. Therefore, in a 42-year-old man with a history of duodenal ulcer for 20 years, complaining of a sense of heaviness in the stomach after a meal, foul-smelling eructation, vomiting, weight loss, diminished tissue turgor, soft abdomen on palpation, “splashing sounds” in the epigastrium, and infrequent bowel movements, the most likely complication corresponding with the patient’s state and clinical presentation is ulcerative pyloric stenosis, and further evaluation, such as endoscopy or imaging studies, may be necessary to confirm the diagnosis and initiate appropriate treatment. |
154. An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/l; RBC- 3, 2 ∗ 1012/L; C.I.- 0,95; thromb.- 20 ∗ 109/L. The sedimentation time according to Lee White is 5 ; hemorrhagia duration according to Duke is 8 , “pinch and tourniquet”test is positive. What is the most probable diagnosis?
A. Idiopathic thrombocytopenic purpura
B. Hemophilia
C. Hemorrhagic diathesis
D. Iron deficiency anemia
E. Marchiafava-Micheli’s disease
Answer: Idiopathic thrombocytopenic purpura
Explanation
| In an 18-year-old girl presenting with weakness, dizziness, loss of appetite, menorrhagia, many-colored petechiae on the skin of the upper extremities, hemoglobin of 105 g/L, RBC count of 3.2 × 10^12/L, hematocrit index of 0.95, platelet count of 20 × 10^9/L, sedimentation time according to Lee White of 5, hemorrhage duration according to Duke of 8, and a positive “pinch and tourniquet” test, the most probable diagnosis is idiopathic thrombocytopenic purpura (ITP). Option A, ITP, is the correct answer as the patient’s symptoms and findings, including the presence of petechiae, thrombocytopenia, and a positive “pinch and tourniquet” test, are indicative of this autoimmune disorder, which is characterized by the destruction of platelets by autoantibodies. Option B, hemophilia, is less likely given the absence of a family history of bleeding disorders and the patient’s presentation with thrombocytopenia, which is not typically associated with hemophilia. Option C, hemorrhagic diathesis, is a broad term that can refer to any bleeding disorder, but the patient’s presentation with thrombocytopenia and petechiae is more specific for ITP. Option D, iron deficiency anemia, may cause weakness, dizziness, and loss of appetite, but is less likely given the presence of petechiae and thrombocytopenia in this patient. Option E, Marchiafava-Micheli’s disease, is a rare neurological disorder that is not associated with the patient’s symptoms and findings. Therefore, in an 18-year-old girl presenting with weakness, dizziness, loss of appetite, menorrhagia, many-colored petechiae on the skin of the upper extremities, hemoglobin of 105 g/L, RBC count of 3.2 × 10^12/L, hematocrit index of 0.95, platelet count of 20 × 10^9/L, sedimentation time according to Lee White of 5, hemorrhage duration according to Duke of 8, and a positive “pinch and tourniquet” test, the most probable diagnosis is idiopathic thrombocytopenic purpura (ITP), and further evaluation, such as bone marrow biopsy, may be necessary to confirm the diagnosis and initiate appropriate treatment. |
155. A 46 y.o. patient complains of skin itch, sweating, especially at night, body temperature rise up to 38, 60. Objectively: chest skin has marks of scratching, supraclavicular lymph nodes are as big as a pigeon egg, they are not matted together with skin. What test is the most reasonable?
A. Punction of an enlarged lymph node
B. Common blood count
C. Plan radiography of thorax
D. Immunogram
E. Whole protein and protein fractions
Answer: Punction of an enlarged lymph node
Explanation
| In a 46-year-old patient presenting with skin itch, sweating, especially at night, and a body temperature rise up to 38.6°C, with chest skin marks of scratching and supraclavicular lymph nodes as big as a pigeon egg, the most reasonable test is a puncture of an enlarged lymph node. Option A, puncture of an enlarged lymph node, is the correct answer as the patient’s presentation with night sweats, fever, and supraclavicular lymphadenopathy raises the suspicion of an underlying malignancy, such as lymphoma or metastatic cancer, and a biopsy or fine needle aspiration of an enlarged lymph node can provide diagnostic information. Option B, a common blood count, may reveal nonspecific findings such as leukocytosis or anemia, but is less specific for the patient’s presentation and is unlikely to provide a definitive diagnosis. Option C, plan radiography of thorax, may be useful to evaluate for pulmonary involvement in certain conditions such as tuberculosis, but is less specific for the patient’s presentation. Option D, an immunogram, may be useful to evaluate for immune deficiencies or autoimmune disorders, but is less specific for the patient’s presentation and unlikely to provide a definitive diagnosis. Option E, measurement of whole protein and protein fractions, may be useful to evaluate for certain conditions such as multiple myeloma, but is less specific for the patient’s presentation and unlikely to provide a definitive diagnosis. Therefore, in a 46-year-old patient presenting with skin itch, sweating, especially at night, and a body temperature rise up to 38.6°C, with chest skin marks of scratching and supraclavicular lymph nodes as big as a pigeon egg, the most reasonable test is a puncture of an enlarged lymph node, which can provide diagnostic information and guide further evaluation and treatment. |
156. A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. An echinococcus liver affection is suspected. What type of examination will be the most informative in this case?
A. USI examination
B. Plan radiography of abdominal cavity
C. Biochemical laboratory analysis
D. Angiography
E. Liver scanning
Answer: USI examination
Explanation
| In a 32-year-old patient living in an endemic echinococcus region, presenting with pain in the right hypochondrium and a temperature rise for the last 6 months, and suspected of having echinococcus liver involvement, the most informative examination is a USI examination. Option A, a USI examination, is the correct answer as it is a noninvasive and highly sensitive imaging modality for the detection and characterization of liver cysts, which are characteristic of echinococcosis. Option B, a plan radiography of the abdominal cavity, is less specific for the diagnosis of echinococcosis and may only reveal nonspecific findings such as hepatomegaly or pleural effusion. Option C, biochemical laboratory analysis, may reveal nonspecific findings such as elevated liver enzymes or leukocytosis, but is less specific for the diagnosis of echinococcosis. Option D, angiography, is not typically used for the diagnosis of echinococcosis and is more specific for the evaluation of vascular abnormalities. Option E, liver scanning, is not a specific imaging modality for the diagnosis of echinococcosis and is less sensitive than USI for the detection of liver cysts. Therefore, in a 32-year-old patient living in an endemic echinococcus region, presenting with pain in the right hypochondrium and a temperature rise for the last 6 months, and suspected of having echinococcus liver involvement, the most informative examination is a USI examination, which can provide diagnostic information and guide further evaluation and treatment. |
157. A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?
A. Episiotomy
B. Perineum protection
C. Perineotomy
D. Vacuum extraction of fetus
E. Expectant management
Answer: Episiotomy
Explanation
| In a 30-year-old primigravida woman experiencing intense labor pains every 1-2 minutes lasting 50 seconds, with disengagement having started and a pale perineum with a height of 4 cm, the necessary action in this situation is an episiotomy. Option A, an episiotomy, is the correct answer as it is a surgical incision made in the perineum to enlarge the vaginal opening during childbirth to prevent perineal tears or lacerations, especially in cases where the perineum is pale and the height is significantly decreased. Option B, perineum protection, may involve manual support of the perineum to prevent tearing during delivery, but is less likely to be effective in this situation where the perineum is significantly pale and the height is decreased. Option C, perineotomy, refers to a surgical incision made in the perineum to enlarge the vaginal opening during childbirth, but is not typically used in modern obstetrics due to the increased risk of complications. Option D, vacuum extraction of the fetus, may be used in certain cases where there is a prolonged second stage of labor or fetal distress, but is less likely to be necessary in this situation where disengagement has already started. Option E, expectant management, involves allowing labor to progress naturally without intervention, but is not appropriate in this situation where the risk of perineal tearing or laceration is high. Therefore, in a 30-year-old primigravida woman experiencing intense labor pains every 1-2 minutes lasting 50 seconds, with disengagement having started and a pale perineum with a height of 4 cm, the necessary action in this situation is an episiotomy to prevent perineal tears or lacerations during delivery and ensure a safe delivery for both the mother and the baby. |
158. A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?
A. Cancer of kidney
B. Tuberculosis of urinary bladder
C. Varicocele
D. Kidney dystopy
E. Necrotic papillitis
Answer: Cancer of kidney
Explanation
| In a 50-year-old patient presenting with blood in the urine for 3 days, with no pain or urination disorders, and a normal physical examination, including normal kidney palpation, suprapubic region, external genitals, and prevesical gland on rectal examination, and no changes on cystoscopy, the disease that would be thought about first of all is cancer of the kidney. Option A, cancer of the kidney, is the correct answer as hematuria is a common presenting symptom of renal cell carcinoma, which is the most common type of kidney cancer. The absence of palpable kidneys and normal findings on physical examination and cystoscopy do not rule out the possibility of kidney cancer. Option B, tuberculosis of the urinary bladder, may cause hematuria, but is less likely given the absence of other symptoms such as dysuria, frequency, or urgency, and the normal findings on cystoscopy. Option C, varicocele, is a condition characterized by the enlargement of the veins within the scrotum, but is less likely to cause hematuria. Option D, kidney dystopy, is a condition in which the kidney is located in an abnormal position, but is less likely to cause hematuria. Option E, necrotic papillitis, is a condition in which the papilla of the kidney becomes necrotic, but is less likely to cause hematuria. Therefore, in a 50-year-old patient presenting with blood in the urine for 3 days, with no pain or urination disorders, and a normal physical examination, including normal kidney palpation, suprapubic region, external genitals, and prevesical gland on rectal examination, and no changes on cystoscopy, the disease that would be thought about first of all is cancer of the kidney, and further evaluation, such as imaging studies, may be necessary to confirm the diagnosis and initiate appropriate treatment. |
159. A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38, 50, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?
A. Erysipelas, hemorrhagic form
B. Anthrax, dermal form
C. Herpetic infection
D. Chickenpox
E. Crus phlegmon
Answer: Erysipelas, hemorrhagic form
Explanation
| In a patient presenting with skin pain and redness of the right gastrocnemius muscle, with a body temperature of 38.50°C, enlarged and painful inguinal lymph nodes on the right, edematous and hyperemic skin covered with an eruption in the form of vesicles containing dark fluid, and a distinct border between normal and hyperemic skin, the most probable diagnosis is erysipelas, hemorrhagic form. Option A, erysipelas, hemorrhagic form, is the correct answer as it is a bacterial infection of the skin caused by Streptococcus pyogenes, which can present with fever, local pain and redness, and vesicles or bullae filled with hemorrhagic fluid. The presence of enlarged and painful inguinal lymph nodes suggests the spread of the infection. Option B, anthrax, dermal form, is caused by Bacillus anthracis and typically presents with a painless black eschar, which is less likely in this case with the presence of vesicles and hemorrhagic fluid. Option C, herpetic infection, may present with vesicles, but is less likely to cause erythema, edema, and a distinct border between normal and hyperemic skin. Option D, chickenpox, is caused by the varicella-zoster virus and typically presents with a pruritic rash of vesicles, but is less likely to cause edema and a distinct border between normal and hyperemic skin. Option E, crus phlegmon, is a deep soft tissue infection of the leg, which may present with erythema, swelling, and pain, but is less likely to cause vesicles or a distinct border between normal and hyperemic skin. Therefore, in a patient presenting with skin pain and redness of the right gastrocnemius muscle, with a body temperature of 38.50°C, enlarged and painful inguinal lymph nodes on the right, edematous and hyperemic skin covered with an eruption in the form of vesicles containing dark fluid, and a distinct border between normal and hyperemic skin, the most probable diagnosis is erysipelas, hemorrhagic form, and appropriate treatment with antibiotics and supportive care should be initiated promptly. |
160. A 1,5 y.o. child fell seriously ill: chill, body temperature rise up to 40, 10, then rapid dropping to 36, 20, skin is covered with voluminous hemorrhagic rash and purple cyanotic spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis, fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission stage?
A. Soluble Levomycetine succinate
B. Penicillin
C. Lincomycin
D. Gentamycin
E. Sulfamonometoxin
Answer: Soluble Levomycetine succinate
Explanation
| In a 1.5-year-old child presenting with symptoms of meningococcal infection-toxic shock, including fever, hemorrhagic rash, and hypotension, the antibiotic that must be used at the pre-admission stage is soluble Levomycetine succinate. Option A, soluble Levomycetine succinate, is the correct answer as it is a broad-spectrum antibiotic that can be used to treat meningococcal infections, including fulminant forms of the disease. Option B, penicillin, is the first-line treatment for meningococcal infections, but may not be effective in cases of fulminant disease or in patients who are allergic to penicillin. Option C, lincomycin, is not typically used for the treatment of meningococcal infections. Option D, gentamicin, may be used in combination with penicillin or a third-generation cephalosporin for the treatment of meningococcal infections, but is less likely to be used at the pre-admission stage. Option E, sulfamonometoxin, is not typically used for the treatment of meningococcal infections. Therefore, in a 1.5-year-old child presenting with symptoms of meningococcal infection-toxic shock, including fever, hemorrhagic rash, and hypotension, the antibiotic that must be used at the pre-admission stage is soluble Levomycetine succinate, which can provide broad-spectrum coverage and help to control the infection before further evaluation and treatment can be initiated. |
161. A 41 y.o. patient complains of acute pain in the right side of the thorax and sudden progress of dyspnea following the lifting of a heavy object. The patient’s condition is grave: lips and mucous membranes are cyanotic, BR- 28/min, Ps122 bpm., AP- 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S2 sound is accentuated above pulmonary artery. What is the main 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
| In a 41-year-old patient presenting with acute pain in the right side of the thorax, sudden progression of dyspnea, and signs of respiratory distress, including cyanosis, tachypnea, and hypotension, the main urgent measure on the prehospital stage is air aspiration from the pleural cavity. Option A, air aspiration from the pleural cavity, is the correct answer as the patient’s symptoms and physical examination findings suggest the presence of a tension pneumothorax, which is a medical emergency that requires immediate intervention to prevent further deterioration of the patient’s condition. Aspiration of air from the pleural cavity can help to relieve the pressure on the affected lung and improve the patient’s breathing. Option B, epinephrine introduction, may be indicated in cases of anaphylactic shock or cardiac arrest, but is less likely to be effective in this patient with signs of respiratory distress and hypotension. Option C, euphylline introduction, is a bronchodilator that may be used in the treatment of asthma or chronic obstructive pulmonary disease, but is less likely to be effective in a patient with acute respiratory distress and signs of a tension pneumothorax. Option D, call for cardiologic team, may be necessary in some cases, but is less likely to be the main urgent measure in this patient with signs of respiratory distress and hypotension. Option E, oxygen inhalation, is important to provide supplemental oxygen to the patient, but may not be sufficient in cases of a tension pneumothorax, which requires immediate intervention to relieve the pressure on the affected lung. Therefore, in a 41-year-old patient presenting with acute pain in the right side of the thorax, sudden progression of dyspnea, and signs of respiratory distress, including cyanosis, tachypnea, and hypotension, the main urgent measure on the prehospital stage is air aspiration from the pleural cavity to relieve the pressure on the affected lung and improve the patient’s breathing. |
162. A 38 y.o. woman suffers from paroxysmal AP rises up to 240/120 mm Hg accompanied by nausea, vomiting, tachycardia, excessive sweating. During the onset blood is hyperglycemic. After the onset there is voluminous urination. Kidneys sonography revealed accessory mass bordering upon the upper pole of the right kidney, presumably it belongs to the adrenal gland. What laboratory test will allow to make a more precise diagnosis?
A. Estimation of catecholamine and vanillylmandelic acid excretion with urine
B. Estimation of insulin and C-peptide content in blood
C. Estimation of glomerular filtration rate
D. Estimation of thyroxin and thyrotropic hormon in blood
E. Estimation of renin content in blood
Answer: Estimation of catecholamine and vanillylmandelic acid excretion with urine
Explanation
| In a 38-year-old woman presenting with paroxysmal hypertension, accompanied by nausea, vomiting, tachycardia, excessive sweating, hyperglycemia, and voluminous urination, with an accessory mass bordering upon the upper pole of the right kidney on sonography, the laboratory test that will allow for a more precise diagnosis is the estimation of catecholamine and vanillylmandelic acid excretion with urine. Option A, estimation of catecholamine and vanillylmandelic acid excretion with urine, is the correct answer as it can help to confirm the diagnosis of a pheochromocytoma, which is a rare tumor of the adrenal gland that secretes excessive amounts of catecholamines, leading to paroxysmal hypertension and other symptoms. Option B, estimation of insulin and C-peptide content in blood, may be useful in the diagnosis of diabetes mellitus, but is less likely to be relevant in this patient with paroxysmal hypertension and an adrenal mass. Option C, estimation of glomerular filtration rate, may be important in the assessment of kidney function, but is less likely to be relevant in this patient with paroxysmal hypertension and an adrenal mass. Option D, estimation of thyroxin and thyrotropic hormone in blood, may be useful in the diagnosis of thyroid disorders, but is less likely to be relevant in this patient with paroxysmal hypertension and an adrenal mass. Option E, estimation of renin content in blood, may be useful in the diagnosis of renovascular hypertension, but is less likely to be relevant in this patient with an adrenal mass. Therefore, in a 38-year-old woman presenting with paroxysmal hypertension, accompanied by nausea, vomiting, tachycardia, excessive sweating, hyperglycemia, and voluminous urination, with an accessory mass bordering upon the upper pole of the right kidney on sonography, the laboratory test that will allow for a more precise diagnosis is the estimation of catecholamine and vanillylmandelic acid excretion with urine, which can help to confirm the diagnosis of a pheochromocytoma and guide further management and treatment. |
163. A 48 y.o. farmer was admitted to the hospital with complaints of headache, nausea, vomiting, cough with sputum, breath shortage, weak sight, sweating, salivation. He was cultivated the garden with phosphoorganic pesticides. Blood count: RBC- 4, 1 ∗ 1012/L, Нb- 136 g/L, C.I.- 0,9, leukocytes – 13, 0 ∗ 109/L, ESR- 17 mm/h. His diagnosis is acute intoxication with phosphoorganic pesticides. What is the most important diagnostic criterion for this pathology?
A. Low level of choline esterase
B. Reticulocytosis
C. Leukocytosis
D. Anemia
E. Thrombocytopenia
Answer: Low level of choline esterase
Explanation
| In a 48-year-old farmer admitted to the hospital with symptoms of acute intoxication with phosphoorganic pesticides, the most important diagnostic criterion for this pathology is a low level of choline esterase. Option A, low level of choline esterase, is the correct answer as it is a key diagnostic criterion for acute intoxication with organophosphorus pesticides, which inhibit the activity of cholinesterase enzymes in the body. A decreased level of cholinesterase can be measured in blood and is an important diagnostic marker for this condition. Option B, reticulocytosis, is not typically associated with acute intoxication with phosphoorganic pesticides. Option C, leukocytosis, may be present in some cases of acute intoxication, but is less specific to this condition. Option D, anemia, may be present in some cases of acute intoxication, but is less specific to this condition. Option E, thrombocytopenia, may be present in some cases of acute intoxication, but is less specific to this condition. Therefore, in a 48-year-old farmer admitted to the hospital with symptoms of acute intoxication with phosphoorganic pesticides, the most important diagnostic criterion for this pathology is a low level of choline esterase, which can be measured in blood and is a key marker for this condition. |
164. A 74 y.o. female patient complains of pain, abdominal distension, nausea. She suffers from heart ichemia, post-infarction and atherosclerotic cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion in abdominal cavity, 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
| In a 74-year-old female patient presenting with abdominal pain, distension, nausea, and a dark-blue bowel loop on laparoscopy, the most probable diagnosis is mesenterial vessels thrombosis. Option A, mesenterial vessels thrombosis, is the correct answer as it is a common cause of acute abdominal pain and distension in elderly patients with atherosclerotic disease. The dark-blue bowel loop on laparoscopy suggests ischemia and necrosis of the affected segment due to the thrombosis. Option B, volvulus, may present with similar symptoms, but is less likely in this patient with atherosclerotic disease and a dark-blue bowel loop on laparoscopy. Option C, acute intestinal obstruction, may present with similar symptoms, but is less likely to cause a dark-blue bowel loop on laparoscopy. Option D, ischemic abdominal syndrome, is a broad term that can refer to a variety of conditions, including mesenterial vessels thrombosis, but is less specific to the clinical presentation in this patient. Option E, erysipelas, is a bacterial skin infection that is less likely to cause acute abdominal pain and distension. Therefore, in a 74-year-old female patient presenting with abdominal pain, distension, nausea, and a dark-blue bowel loop on laparoscopy, the most probable diagnosis is mesenterial vessels thrombosis, which is a common cause of acute abdominal pain and distension in elderly patients with atherosclerotic disease. |
165. A 30 y.o. woman is in her second labor that has been lasting for 14 hours. Fetal heartbeats are muffled, arrhythmic, 100/min. Vaginal examination results: cervical dilatation is complete, fetal head is close to the exit of small pelvis. Sagittal suture has the direct diameter, small crown is close to the pubis. What is the further tactics of labor management?
A. Use of obstetrical forceps
B. Labor stimulation by means of oxitocine
C. Cesarean section
D. Craniodermal forceps
E. Use of cavity forceps
Answer: Use of obstetrical forceps
Explanation
| In a 30-year-old woman in her second labor, with fetal heartbeats that are muffled, arrhythmic, and 100/min, cervical dilatation that is complete, and fetal head close to the exit of the small pelvis, the further tactics of labor management is the use of obstetrical forceps. Option A, use of obstetrical forceps, is the correct answer as it can be used to assist in the delivery of the fetal head in cases of prolonged second stage of labor with fetal distress. In this case, the fetal heartbeats are arrhythmic and muffled, indicating possible fetal distress, and the use of forceps may help to expedite delivery and reduce the risk of complications. Option B, labor stimulation by means of oxytocin, may be indicated in some cases of prolonged labor, but is less likely to be effective in this case with fetal distress and a fetal heart rate of 100/min. Option C, cesarean section, may be necessary in some cases of prolonged or complicated labor, but is less likely to be the first-line management option in this case with a fetal head close to the exit of the small pelvis and no evidence of cephalopelvic disproportion. Option D, craniodermal forceps, and option E, use of cavity forceps, are not typically used in the management of a prolonged second stage of labor with fetal distress. Therefore, in a 30-year-old woman in her second labor, with fetal heartbeats that are muffled, arrhythmic, and 100/min, cervical dilatation that is complete, and fetal head close to the exit of the small pelvis, the further tactics of labor management is the use of obstetrical forceps to assist in the delivery of the fetal head and reduce the risk of complications. |
166. A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has got 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 neurological department
C. Out-patient treatment
D. Psychotherapeutic conversation
E. Strict supervision at home
Answer: Admission to the mental hospital
Explanation
167. A 63 y.o. woman complains of motiveless weakness, rapid fatigability, loss of appetite, aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature – 37, 50, BR- 20/min, Ps96/min, AP- 110/75 mm Hg. On palpation in epigastrium – pain and muscle tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a diagnosis?
A. Cytologic
B. Radiography
C. Endoscopy
D. Stomach content examination
E. Coprology
Answer: Cytologic
Explanation
| In a 63-year-old woman presenting with motiveless weakness, rapid fatigability, loss of appetite, aversion to meat, recent stomach bleeding, epigastric pain and muscle tension, and abnormal blood count results, the examination that will allow for a diagnosis is cytologic examination. Option A, cytologic examination, is the correct answer as it can be used to detect abnormal cells in the stomach lining that may indicate cancer or other pathological processes. In this case, the patient’s symptoms and recent stomach bleeding suggest a possible gastric pathology, and cytologic examination may help to confirm a diagnosis. Option B, radiography, may be useful in some cases of gastric pathology, but is less likely to be the first-line examination in this case with recent bleeding and abnormal blood count results. Option C, endoscopy, is a useful examination for visualizing the interior of the stomach and diagnosing pathological conditions. In this case, it may be particularly useful for identifying the source of the patient’s bleeding and visualizing any abnormal cells or lesions. Option D, stomach content examination, may be useful in some cases of gastric pathology, but is less likely to provide a definitive diagnosis in this case. Option E, coprology, is the examination of fecal matter and is less likely to be useful in diagnosing a gastric pathology. Therefore, in a 63-year-old woman presenting with motiveless weakness, rapid fatigability, loss of appetite, aversion to meat, recent stomach bleeding, epigastric pain and muscle tension, and abnormal blood count results, the examination that will allow for a diagnosis is cytologic examination, which can be used to detect abnormal cells in the stomach lining that may indicate cancer or other pathological processes. Endoscopy may also be useful for visualizing the interior of the stomach and identifying any abnormalities. |
168. A 42 y.o. woman suffers from micronodular cryptogenic cirrhosis. During the last week her condition has been worsening: she had spasms, consciousness aberration, jaundice. What examination may account for the worsening of the patient’s condition?
A. Estimation of serum ammonia
B. Estimation of cholesterol esters
C. Estimation of α-fetoprotein content
D. Estimation of alanine aminotransferase and aspartate aminotransferase
E. Estimation of alkaline phosphatase level
Answer: Estimation of serum ammonia
Explanation
| In a 42-year-old woman with micronodular cryptogenic cirrhosis and worsening symptoms such as spasms, consciousness aberration, and jaundice, the examination that may account for the worsening of her condition is the estimation of serum ammonia. Option A, estimation of serum ammonia, is the correct answer as elevated levels of ammonia in the bloodstream can lead to hepatic encephalopathy, which can cause symptoms such as spasms and consciousness aberrations. In patients with cirrhosis, the liver is unable to effectively metabolize ammonia, leading to its accumulation in the bloodstream. Option B, estimation of cholesterol esters, is less likely to be relevant in this case as it is not typically associated with the symptoms and complications of cirrhosis. Option C, estimation of α-fetoprotein content, may be useful in the diagnosis of liver cancer, which can be a complication of cirrhosis, but is less likely to be associated with the symptoms described in this case. Option D, estimation of alanine aminotransferase and aspartate aminotransferase, may be useful in assessing liver function, but is less likely to account for the specific symptoms described in this case. Option E, estimation of alkaline phosphatase level, may be useful in assessing liver function and diagnosing certain liver diseases, but is less likely to account for the specific symptoms and complications described in this case. Therefore, in a 42-year-old woman with micronodular cryptogenic cirrhosis and worsening symptoms such as spasms, consciousness aberration, and jaundice, the examination that may account for the worsening of her condition is the estimation of serum ammonia, which can lead to hepatic encephalopathy in patients with cirrhosis. |
169. 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 for about 1cm large. 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
| In a newborn child with a mother who suffers from chronic pyelonephritis, had acute respiratory viral disease before labor, prolonged period without waters, and presents with erythematous eruption on the 2nd day, seropurulent vesicles, positive Nikolsky’s symptom, erosions after vesicle rupture, subfebrile temperature, and flabbiness, the most probable diagnosis is newborn pemphigus. Option A, newborn pemphigus, is the correct answer as the clinical presentation is consistent with this diagnosis. Newborn pemphigus is a rare autoimmune blistering disorder that can occur in infants born to mothers with autoimmune diseases, such as chronic pyelonephritis. The presence of seropurulent vesicles, positive Nikolsky’s sign, and erosions after vesicle rupture are characteristic of newborn pemphigus. Option B, vesiculopustulosis, is less likely as the clinical presentation is not consistent with this diagnosis. Vesiculopustulosis is a benign self-limited condition that presents with small vesicles and pustules that usually resolve within 1-2 weeks. Option C, pseudofurunculosis, is less likely as the clinical presentation is not consistent with this diagnosis. Pseudofurunculosis is a bacterial skin infection that typically presents with a single follicular pustule or furuncle. Option D, sepsis, is less likely as the clinical presentation does not suggest a systemic infection. While sepsis can cause skin manifestations, it is typically associated with other symptoms such as fever, lethargy, and poor feeding. Option E, Ritter’s dermatitis, is less likely as the clinical presentation is not consistent with this diagnosis. Ritter’s dermatitis is a severe form of erythema multiforme that typically presents with widespread desquamation and skin detachment. Therefore, in a newborn child with a mother who suffers from chronic pyelonephritis, had acute respiratory viral disease before labor, prolonged period without waters, and presents with erythematous eruption on the 2nd day, seropurulent vesicles, positive Nikolsky’s symptom, erosions after vesicle rupture, subfebrile temperature, and flabbiness, the most probable diagnosis is newborn pemphigus, a rare autoimmune blistering disorder that can occur in infants born to mothers with autoimmune diseases. |
170. A 41 y.o. woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC9, 8∗109/L, RBC- 3, 0∗1012/L, sedimentation rate – 52 mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Answer: Sulfasalasine
Explanation
| In a 41-year-old woman with nonspecific ulcerative colitis, evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane on rectoromanoscopy, and abnormal blood count results, the medication that provides pathogenetic treatment of this patient is sulfasalazine. Option A, sulfasalazine, is the correct answer as it is a medication used in the treatment of inflammatory bowel disease, such as ulcerative colitis, by reducing inflammation and improving symptoms. Sulfasalazine is a combination of sulfapyridine and 5-aminosalicylic acid, which has both anti-inflammatory and immunomodulatory effects. Option B, motilium, is a medication used to alleviate symptoms of nausea and vomiting and is not typically used in the treatment of inflammatory bowel disease. Option C, vikasol, is a medication used to treat vitamin K deficiency and is not typically used in the treatment of inflammatory bowel disease. Option D, linex, is a probiotic medication used to restore the balance of gut microflora and is not typically used in the pathogenetic treatment of inflammatory bowel disease. Option E, kreon, is a pancreatic enzyme replacement therapy used in the treatment of pancreatic insufficiency and is not typically used in the treatment of inflammatory bowel disease. Therefore, in a 41-year-old woman with nonspecific ulcerative colitis, evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane on rectoromanoscopy, and abnormal blood count results, sulfasalazine is the medication that provides pathogenetic treatment of this patient by reducing inflammation and improving symptoms. |
171. A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples, increasing AP up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?
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
| In a 49-year-old female patient with acute attacks of headache accompanied by pulsation in temples, increasing blood pressure up to 280/140 mm Hg, and suspicion of pheochromocytoma, the mechanism of hypertensive attack is increasing of catecholamines concentration. Option A, increasing of catecholamines concentration, is the correct answer as pheochromocytoma is a tumor of the adrenal medulla that secretes excessive amounts of catecholamines (epinephrine and norepinephrine), leading to episodic or sustained hypertension and other symptoms such as headache, palpitations, and sweating. Option B, increasing of aldosterone level in blood, is less likely to be the mechanism of hypertensive attack in this case. Aldosterone is a hormone secreted by the adrenal gland that regulates blood pressure by promoting sodium and water retention and potassium excretion. However, excessive aldosterone secretion typically results in hypertension with associated hypokalemia and metabolic alkalosis. Option C, increasing of plasma renin activity, is less likely to be the mechanism of hypertensive attack in this case. Renin is an enzyme released by the kidneys that regulates blood pressure by promoting the production of angiotensin II, a potent vasoconstrictor. However, excessive renin secretion typically results in hypertension with associated sodium retention and potassium excretion. Option D, increasing of vasopressin excretion, is less likely to be the mechanism of hypertensive attack in this case. Vasopressin, also known as antidiuretic hormone (ADH), is a hormone released by the pituitary gland that regulates blood pressure by promoting water retention. However, excessive vasopressin secretion typically results in hyponatremia and hypotonicity rather than hypertension. Option E, increasing of thyroxine excretion, is less likely to be the mechanism of hypertensive attack in this case. Thyroxine is a hormone secreted by the thyroid gland that regulates metabolism. However, excessive thyroid hormone secretion typically results in symptoms such as weight loss, tachycardia, and heat intolerance rather than hypertension. Therefore, in a 49-year-old female patient with acute attacks of headache accompanied by pulsation in temples, increasing blood pressure up to 280/140 mm Hg, and suspicion of pheochromocytoma, the mechanism of hypertensive attack is increasing of catecholamines concentration, due to excessive catecholamine secretion by the adrenal medulla. |
172. A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?
A. Aerophagia
B. Pylorostenosis
C. Pylorospasm
D. Acute gastroenteritis
E. Esophageal atresia
Answer: Aerophagia
Explanation
| In a breastfed child born with a body weight of 3250 g and body length of 52 cm, with sufficient actual weight at the age of 1.5 months and normal psychophysical development but occasional regurgitations, the cause of regurgitations is likely to be aerophagia. Option A, aerophagia, is the correct answer as it is a common cause of regurgitations in infants. Aerophagia occurs when the infant swallows air while feeding, leading to air accumulation in the stomach and regurgitation of milk or formula. Option B, pyloric stenosis, is less likely to be the cause of regurgitations in this case as it typically presents with projectile vomiting and delayed gastric emptying, and is more common in male infants. Option C, pylorospasm, is less likely to be the cause of regurgitations in this case as it is a rare condition that presents with intermittent episodes of projectile vomiting and can lead to failure to thrive. Option D, acute gastroenteritis, is less likely to be the cause of regurgitations in this case as it typically presents with diarrhea, vomiting, and fever, and is less likely to cause occasional regurgitations. Option E, esophageal atresia, is less likely to be the cause of regurgitations in this case as it typically presents with feeding difficulties, choking, and cyanosis, and is usually diagnosed in the neonatal period. Therefore, in a breastfed child born with a body weight of 3250 g and body length of 52 cm, with sufficient actual weight at the age of 1.5 months and normal psychophysical development but occasional regurgitations, the cause of regurgitations is likely to be aerophagia, which occurs when the infant swallows air while feeding, leading to air accumulation in the stomach and regurgitation of milk or formula. |
173. A 32 y.o. woman has been suffering for 5 months from pain in lumbar region, low grade fever, frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field of sight, bacteriuria. Blood analysis: leukocytosis, increased ESR. What is the most probable diagnosis?
A. Chronic pyelonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Acute pyelonephritis
E. Urolithiasis
Answer: Chronic pyelonephritis
Explanation
| The most probable diagnosis for a 32-year-old woman who has been suffering from pain in the lumbar region, low-grade fever, frequent urination, moderate proteinuria, leukocytes occupying the whole field of sight, bacteriuria, leukocytosis, and increased ESR for 5 months is chronic pyelonephritis. Option A, chronic pyelonephritis, is the correct answer as it is a chronic bacterial infection of the renal pelvis and parenchyma that often presents with symptoms such as flank pain, fever, frequent urination, and proteinuria. Chronic pyelonephritis can lead to renal scarring and impaired renal function if left untreated. Option B, acute glomerulonephritis, is less likely to be the correct diagnosis as it typically presents with hematuria, proteinuria, and hypertension, and is often associated with a recent streptococcal infection. Option C, chronic glomerulonephritis, is less likely to be the correct diagnosis as it typically presents with proteinuria, hematuria, and hypertension, and can lead to chronic renal failure. Option D, acute pyelonephritis, is less likely to be the correct diagnosis as it typically presents with an acute onset of fever, flank pain, and dysuria. Option E, urolithiasis, is less likely to be the correct diagnosis as it typically presents with acute onset of severe pain, nausea, and vomiting, and is often associated with the presence of stones in the urinary tract. Therefore, the most probable diagnosis for a 32-year-old woman who has been suffering from pain in the lumbar region, low-grade fever, frequent urination, moderate proteinuria, leukocytes occupying the whole field of sight, bacteriuria, leukocytosis, and increased ESR for 5 months is chronic pyelonephritis, a chronic bacterial infection of the renal pelvis and parenchyma that can lead to renal scarring and impaired renal function if left untreated. |
174. A 2 y.o. boy was admitted to the hospital with weight loss, unstable feces, anorexia, following the semolina’s introduction (since 5 months). The child is adynamic, flabby, his skin is pale and dry, subcutaneous fat layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the most probable 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
| In a 2-year-old boy who was admitted to the hospital with weight loss, unstable feces, anorexia, following the introduction of semolina at 5 months, and presents with adynamic, flabby, pale, dry skin, emaciated subcutaneous fat layer, distended and tensed abdomen with tympanitis on percussion of the upper part of the abdomen, splashing sounds, foamy, light-colored, and foul-smelling feces with a lot of neutral fat on coprocytogram, the most probable cause of the disease is celiac disease. Option A, celiac disease, is the correct answer as it is a chronic autoimmune disorder of the small intestine that is triggered by gluten ingestion and can lead to malabsorption, weight loss, abdominal distension, and steatorrhea. Celiac disease is characterized by damage to the lining of the small intestine, which leads to difficulty in absorbing nutrients, especially fat-soluble vitamins. Option B, cystic fibrosis, is less likely to be the cause of the disease in this case as it is a genetic disorder that affects multiple organs, including the lungs, pancreas, and digestive system, and presents with symptoms such as chronic cough, wheezing, recurrent lung infections, pancreatic insufficiency, and malabsorption. Option C, intestinal dysbacteriosis, is less likely to be the cause of the disease in this case as it is a condition characterized by an imbalance of microorganisms in the intestines, which can lead to symptoms such as diarrhea, abdominal pain, and bloating. However, intestinal dysbacteriosis is not typically associated with the specific symptoms and findings described in this case. Option D, chronic enteritis, is less likely to be the cause of the disease in this case as it is a broad term that refers to chronic inflammation of the small intestine, which can have various causes, including infections, autoimmune disorders, and food allergies. However, chronic enteritis is not typically associated with the specific symptoms and findings described in this case. Option E, disaccharidase insufficiency, is less likely to be the cause of the disease in this case as it refers to a deficiency in the enzymes that break down certain sugars in the small intestine, which can lead to symptoms such as diarrhea, abdominal pain, and bloating. However, disaccharidase insufficiency is not typically associated with the specific symptoms and findings described in this case. Therefore, in a 2-year-old boy who was admitted to the hospital with weight loss, unstable feces, anorexia, following the introduction of semolina at 5 months, and presents with adynamic, flabby, pale, dry skin, emaciated subcutaneous fat layer, distended and tensed abdomen with tympanitis on percussion of the upper part of the abdomen, splashing sounds, foamy, light-colored, and foul-smelling feces with a lot of neutral fat on coprocytogram, the most probable cause of the disease is celiac disease, a chronic autoimmune disorder of the small intestine that is triggered by gluten ingestion and can lead to malabsorption, weight loss, abdominal distension, and steatorrhea. |
175. A child with chronic cardialtis, cardial insufficiency IIА that is being treated with digoxin has got progressing bradycardia, nausea, vomiting. dizziness, sleep disorders. ECG results: extrasystole, PQ0,18. What is the most probable cause of this condition?
A. Cardiac glucosides overdose or intolerance
B. Pulmonary edema
C. Atrioventricular heart block of the I degree
D. Acute enteric infection
E. Hypokaliemia
Answer: Cardiac glucosides overdose or intolerance
Explanation
| In a child with chronic cardialtis, cardial insufficiency IIA, being treated with digoxin who has developed progressing bradycardia, nausea, vomiting, dizziness, sleep disorders, ECG results showing extrasystole, PQ0.18, the most probable cause of this condition is cardiac glycoside overdose or intolerance. Option A, cardiac glycoside overdose or intolerance, is the correct answer as digoxin is a cardiac glycoside used to treat heart failure and arrhythmias by increasing the force and strength of heartbeats. However, excessive doses of digoxin can cause toxicity and adverse effects, such as bradycardia, nausea, vomiting, dizziness, and sleep disorders. These symptoms can progress to more severe manifestations, including arrhythmias and even death. Option B, pulmonary edema, is less likely to be the cause of the symptoms in this case as it typically presents with symptoms such as shortness of breath, cough, and pink frothy sputum, and is often associated with heart failure. Option C, first-degree atrioventricular heart block, is less likely to be the cause of the symptoms in this case as it is a relatively benign condition that typically does not cause symptoms or require treatment. Option D, acute enteric infection, is less likely to be the cause of the symptoms in this case as it typically presents with gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Option E, hypokalemia, is less likely to be the cause of the symptoms in this case as it can cause cardiac arrhythmias, but the symptoms described in this case are more consistent with digoxin toxicity. Therefore, in a child with chronic cardialtis, cardial insufficiency IIA, being treated with digoxin who has developed progressing bradycardia, nausea, vomiting, dizziness, sleep disorders, ECG results showing extrasystole, PQ0.18, the most probable cause of this condition is cardiac glycoside overdose or intolerance, which can cause toxicity and adverse effects such as arrhythmias and even death if left untreated. |
176. Examination of a hanged man’s corpse revealed the following: livores mortis disappear when pressed, restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles and fingers. Body temperature is 31, 00. What is the prescription of death coming?
A. 6-7 hours
B. 1-2 hours
C. 16-24 hours
D. 8-10 hours
E. 10-18 hours
Answer: 6-7 hours
Explanation
| In the examination of a hanged man’s corpse, it is observed that the livores mortis disappear when pressed and restore in 50 seconds, rigor mortis is moderately evident only in masseteric muscles, neck muscles, and fingers, and the body temperature is 31.00°C. Based on these findings, the most probable prescription of death coming is 6-7 hours ago. Option A, 6-7 hours, is the correct answer as the disappearance of livores mortis when pressed and the moderate rigor mortis suggest that the death occurred at least a few hours ago, while the body temperature of 31.00°C indicates that the death occurred relatively recently. These findings are consistent with a prescription of death coming about 6-7 hours ago. Option B, 1-2 hours, is less likely to be the correct answer as the moderate rigor mortis and the body temperature of 31.00°C suggest that the death occurred more than 1-2 hours ago. Option C, 16-24 hours, is less likely to be the correct answer as the disappearance of livores mortis when pressed and the moderate rigor mortis suggest that the death occurred more recently than 16-24 hours ago. Option D, 8-10 hours, is less likely to be the correct answer as the body temperature of 31.00°C suggests that the death occurred more recently than 8-10 hours ago. Option E, 10-18 hours, is less likely to be the correct answer as the disappearance of livores mortis when pressed and the moderate rigor mortis suggest that the death occurred more recently than 10-18 hours ago. Therefore, based on the examination of a hanged man’s corpse that reveals the disappearance of livores mortis when pressed and restoration in 50 seconds, moderate rigor mortis only in masseteric muscles, neck muscles, and fingers, and body temperature of 31.00°C, the most probable prescription of death coming is 6-7 hours ago. |
177. In course of herniotomy of a 12 y.o. patient doctors revealed a testicle in the hernial sac. What type of hernia is it?
A. Congenital oblique inguinal hernia
B. Acquired oblique inguinal hernia
C. Direct inguinal hernia
D. Femoral hernia
E. Obturator hernia
Answer: Congenital oblique inguinal hernia
Explanation
| In a 12-year-old patient undergoing herniotomy, a testicle is found in the hernial sac. Based on this information, the most probable type of hernia is a congenital oblique inguinal hernia. Option A, congenital oblique inguinal hernia, is the correct answer as it is the most common type of inguinal hernia in children, especially in males, and is caused by a failure of the processus vaginalis to close during fetal development. In this type of hernia, the hernial sac follows the same path as the spermatic cord, passing through the inguinal canal and into the scrotum. Therefore, it is likely that the testicle found in the hernial sac during the herniotomy is due to a congenital oblique inguinal hernia. Option B, acquired oblique inguinal hernia, is less likely to be the correct answer as this type of hernia typically occurs later in life and is caused by a weakness in the abdominal muscles or a tear in the inguinal ligament, rather than a congenital defect. Option C, direct inguinal hernia, is less likely to be the correct answer as this type of hernia occurs when a weakened area in the abdominal muscles allows abdominal contents to bulge through the inguinal canal, but the hernial sac does not follow the same path as the spermatic cord. Option D, femoral hernia, is less likely to be the correct answer as this type of hernia occurs when abdominal contents protrude through the femoral canal, which is located below the inguinal ligament. Option E, obturator hernia, is less likely to be the correct answer as this type of hernia occurs when abdominal contents protrude through the obturator foramen, which is located in the pelvic bone. Therefore, in a 12-year-old patient undergoing herniotomy, the most probable type of hernia is a congenital oblique inguinal hernia, which is the most common type of inguinal hernia in children, especially in males, and is caused by a failure of the processus vaginalis to close during fetal development. |
178. Vaginal inspection of a parturient woman revealed: 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 examination. The fetus has cephalic presentation. 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 dilatation stage
B. Preliminary stage
C. Prodromal stage
D. Stage of fetus expulsion
E. Placental stage
Answer: Cervix dilatation stage
Explanation
| Based on the vaginal inspection findings, the parturient woman is in the cervix dilatation stage of labor. Option A, cervix dilatation stage, is the correct answer as the cervical dilation of up to 2 cm indicates that the woman is in the active phase of the first stage of labor, which is characterized by progressive cervical dilation and effacement. Option B, preliminary stage, is less likely to be the correct answer as this stage occurs before the onset of true labor and is characterized by irregular contractions and cervical changes that are not significant enough to indicate the onset of active labor. Option C, prodromal stage, is less likely to be the correct answer as this stage occurs before the onset of active labor and is characterized by regular contractions that do not result in significant cervical dilation or effacement. Option D, stage of fetus expulsion, is less likely to be the correct answer as the findings described in the question stem do not indicate that the woman is in the second stage of labor, which is characterized by complete cervical dilation and effacement, and the descent and delivery of the fetus. Option E, placental stage, is less likely to be the correct answer as the findings described in the question stem do not indicate that the woman is in the third stage of labor, which is characterized by the delivery of the placenta. Therefore, based on the vaginal inspection findings of cervical dilation up to 2 cm, intact fetal bladder, accessible sacrococcygeal joint, and cephalic presentation with the sagittal suture occupying the transverse diameter of the pelvic inlet and the small fontanel to the left side, the parturient woman is in the cervix dilatation stage of labor. |
179. Ambulace brought to the hospital a patient with acute respiratory viral infection. The illness began suddenly with temperature rise up to 39, 90. He complains of headache in frontotemporal lobes, pain in eyeballs, aching of the whole body, nose stuffiness, sore throat, dry cough. At home he had a nasal hemorrhage twice. What type of acute respiratory viral infection is it?
A. Influenza
B. Adenoviral infection
C. Parainfluenza
D. RS-infection
E. Enterovirus infection
Answer: Influenza
Explanation
| Based on the symptoms described, the most probable type of acute respiratory viral infection in this patient is influenza. Option A, influenza, is the correct answer as it is a viral infection that presents with sudden onset of symptoms such as high fever, headache, muscle aches, sore throat, dry cough, and nasal congestion, which are all consistent with the symptoms described in the question stem. Influenza can also cause nasal hemorrhage, as reported by the patient. Option B, adenoviral infection, is less likely to be the correct answer as it typically presents with symptoms such as fever, sore throat, cough, and conjunctivitis, but does not typically cause nasal hemorrhage. Option C, parainfluenza, is less likely to be the correct answer as it typically presents with symptoms such as hoarseness, croup, and bronchiolitis, but does not typically cause nasal hemorrhage. Option D, respiratory syncytial virus (RSV) infection, is less likely to be the correct answer as it typically presents with symptoms such as cough, wheezing, and difficulty breathing, but does not typically cause nasal hemorrhage. Option E, enterovirus infection, is less likely to be the correct answer as it typically presents with symptoms such as fever, rash, and gastrointestinal symptoms, but does not typically cause nasal hemorrhage. Therefore, based on the sudden onset of symptoms such as high fever, headache, muscle aches, sore throat, dry cough, nasal congestion, and nasal hemorrhage, the most probable type of acute respiratory viral infection in this patient is influenza. |
180. A 52 y.o. patient complains of dyspnea caused even by moderate physical activity, cough with hardly secreted sputum. He has been ill for 12 years. Objectively: BR- 26/min. Lung examination: tympanitis, diminished vesicular breathing with prolonged expiration, disseminated dry rales. In the past he was taking only theopecym or aminophylline inravenously. Prescribe him the basic treatment after the exacerbation is suppressed:
A. Atrovent
B. Alupent
C. Inhacort
D. Tilade
E. Aminophylline
Answer: Atrovent
Explanation
| This patient is presenting with symptoms of chronic obstructive pulmonary disease (COPD), likely due to long-term smoking. The dyspnea, cough with sputum, and lung examination findings of decreased breath sounds with prolonged expiration and dry rales are all consistent with COPD. Atrovent is a bronchodilator that works by relaxing the muscles in the airways, making it easier to breathe. It is often used in the treatment of COPD, along with other bronchodilators such as beta-agonists. Alupent (metaproterenol) and Aminophylline are also bronchodilators, but they are less commonly used in the treatment of COPD due to their side effects. Inhacort (budesonide) and Tilade (nedocromil) are both inhaled corticosteroids, which can reduce inflammation in the airways, but they are not typically used as the first-line treatment for COPD. Therefore, Atrovent is the most appropriate choice for this patient’s basic treatment after the exacerbation is suppressed, as it can help to relieve his dyspnea and improve his lung function. |
181. Plan radiography of the patient’s abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
A. Intestinal obstruction
B. Perforative ulcer
C. Meteorism
D. Cancer of large intestine
E. Price’s disease
Answer: Intestinal obstruction
Explanation
| The hemispherical lucent areas seen on an abdominal X-ray above distinct horizontal levels are known as air-fluid levels, which are indicative of an intestinal obstruction. Intestinal obstruction occurs when the normal flow of intestinal contents is blocked, leading to a buildup of gas and fluid in the affected section of the intestine. This leads to the formation of air-fluid levels on an X-ray. Perforative ulcer, cancer of the large intestine, and Price’s disease are not typically associated with the formation of air-fluid levels on an X-ray. Perforative ulcer can lead to free air under the diaphragm on an X-ray, while cancer of the large intestine may present with a mass or other abnormality on imaging. Price’s disease is a rare condition that affects the lymphatic system and is not associated with any specific X-ray findings. Meteorism, or excessive gas in the intestines, can sometimes lead to a distended abdomen on an X-ray, but it does not typically cause the formation of air-fluid levels. Therefore, based on the given information, the most likely cause of the hemispherical lucent areas seen on the abdominal X-ray is intestinal obstruction. |
182. A patient of a somatic hospital has got psychomotor agitation as a result of high fever: he tried to run about the department; thought that some water was running down the walls, he pretended to see rats and cockroaches on the floor. Claimed he were in a hostel, recognized his “aquaintances”. After introduction of sedative drugs he fell asleep. In the morning he remembered this condition. What psychopathologic syndrome is it?
A. Delirium
B. Oneiric syndrome
C. Twilight disorder of consciousness
D. Hallucinatory paranoid syndrome
E. Maniacal syndrome
Answer: Delirium
Explanation
| The patient is displaying symptoms of delirium, which is a disturbance in consciousness and cognition that develops over a short period of time and is typically caused by an underlying medical condition such as fever or medication side effects. The patient’s psychomotor agitation, disorientation to the environment, visual hallucinations, and paranoid delusions (such as seeing rats and cockroaches on the floor) are all characteristic features of delirium. Additionally, the fact that the patient’s symptoms improved after the introduction of sedative drugs suggests that they were caused by a temporary medical condition rather than a primary psychiatric disorder. Oneiric syndrome is a type of dream-like state that can occur during sleep or wakefulness and is characterized by vivid, sensory-rich experiences. Twilight disorder of consciousness is a state of consciousness that is intermediate between full wakefulness and sleep, and is often associated with hypnagogic or hypnopompic hallucinations. Hallucinatory paranoid syndrome is a type of delusional disorder characterized by the presence of persecutory or grandiose delusions and hallucinations. Maniacal syndrome is a term that is no longer used in modern psychiatric practice, but it was historically used to describe a state of elevated or irritable mood, decreased need for sleep, and increased activity. Therefore, based on the given information, the most likely psychopathologic syndrome that the patient is experiencing is delirium. |
183. A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can determine the patient’s blood group and rhesus compatibility?
A. A doctor of any speciality
B. A laboratory physician
C. A surgeon
D. A traumatologist
E. An anaesthesilogist
Answer: A doctor of any speciality
Explanation
| Determining a patient’s blood group and Rh factor is a routine laboratory test that can be performed by any trained healthcare professional, not just a specific specialist. In emergency situations such as the one described in the question, it is important to quickly determine the patient’s blood group and Rh factor in order to select compatible blood for transfusion. While laboratory physicians are specifically trained to perform laboratory tests and analyze results, any medical professional who has been trained to properly collect and label blood samples can perform this test. In the case of emergency situations, any healthcare professional who is available and qualified to perform this test can do so. The surgeon, traumatologist, and anesthesiologist involved in the patient’s care may also be able to determine the patient’s blood group and Rh factor if they have been trained to do so. However, any doctor of any specialty who has received training in this area can perform the test. Therefore, based on the given information, any doctor of any specialty who is trained to properly collect and label blood samples can determine the patient’s blood group and Rh factor, which is necessary for selecting compatible blood for transfusion in this emergency situation. |
184. A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin – striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?
A. Itsenko-Cushing syndrome
B. Turner’s syndrome
C. Stein-Levental’s syndrome
D. Shichan’s syndrome
E. Babinski-Froehlich syndrome
Answer: Itsenko-Cushing syndrome
Explanation
| The symptoms of amenorrhea, hirsutism, obesity with fat tissue predominating on the face and upper body, acne vulgaris, and striae cutis distensae are all consistent with Itsenko-Cushing syndrome, which is caused by excessive levels of cortisol in the body. Excessive cortisol can be caused by a variety of factors, including tumors of the pituitary or adrenal glands, or prolonged use of corticosteroid medication. In addition to the above symptoms, patients with Itsenko-Cushing syndrome may also experience muscle weakness, osteoporosis, and hypertension. Turner’s syndrome is a genetic condition that affects females and is characterized by short stature, delayed puberty, and infertility. Stein-Leventhal syndrome, also known as polycystic ovary syndrome, can cause irregular periods and infertility, as well as hirsutism and acne, but it is not typically associated with obesity or striae cutis distensae. Shichan’s syndrome and Babinski-Froehlich syndrome are not recognized medical conditions. Therefore, based on the given information, the most probable diagnosis for this patient is Itsenko-Cushing syndrome. |
185. A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 390. There was acute 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 definite 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
| The symptoms of intense pain, reddening of skin, edema in the ankle-joint area, and fever up to 39°C (102.2°F) are all consistent with gout, which is a form of arthritis caused by the buildup of uric acid crystals in the joints. Acute onset of the illness and a history of similar attacks lasting 5-6 days without residual changes in the joint are also characteristic of gout. The skin over the joint in gout is typically hyperemic (red and inflamed) without definite borders and without an infiltrative bank on the periphery, which helps to distinguish it from erysipelatous inflammation, a bacterial skin infection that can cause similar symptoms. Infectional arthritis is caused by an infection in the joint and can cause similar symptoms, but the acute onset of the illness and the history of similar attacks lasting several days without residual changes in the joint make gout a more likely diagnosis. Rheumatoid arthritis and osteoarthritis are chronic forms of arthritis that typically present with different symptoms and are less likely to cause acute onset of symptoms with fever. Therefore, based on the given information, the most likely diagnosis for this patient is gout. |
186. A 5 y.o. girl was by accident closed in a dark room for several minutes. When the door was opened, the child was standing motionless in the middle of the room staring at one point, her face had a look of terror, she didn’t respond to any stimuli. 40 minutes after her state changed into crying. On the next day she could remember nothing of this incident. What is the most probable mechanism of this reaction?
A. Psychogenic
B. Endogenic
C. Exogenously organic
D. Endogenically organic
E. Conditioned reflex
Answer: Psychogenic
Explanation
| The symptoms described in the scenario are consistent with a psychogenic reaction, which is a psychological response to a stressful or traumatic event that affects a person’s behavior or mental state. In this case, the 5-year-old girl was trapped in a dark room for several minutes and may have experienced extreme fear or terror, leading to a psychogenic reaction. The girl’s motionless state, staring at one point, and lack of response to external stimuli are all characteristic features of a dissociative reaction, which is a type of psychogenic reaction. Dissociation is a psychological defense mechanism in which a person mentally detaches themselves from their surroundings or from their own physical or emotional experience. The fact that the girl’s state changed into crying after 40 minutes suggests that she may have been able to process and express her emotions after the dissociative state ended. The fact that she could not remember anything about the incident on the following day is also consistent with a dissociative reaction. Endogenic and exogenously organic mechanisms refer to biological or physiological causes of a person’s symptoms, while conditioned reflex is a type of learned response to a specific stimulus. Therefore, based on the given information, the most probable mechanism of the girl’s reaction is psychogenic, specifically dissociation, in response to the stressful and traumatic event of being trapped in a dark room. |
187. A 42 y.o. patient was admitted 3 hours after a trauma with evident subcutaneous emphysema of the upper part of his body, dyspnea, tachycardia 120/min. X-ray examination revealed no pneumothorax, significant dilatation of mediastinum to the both sides. What emergency care is needed?
A. Drainage of anterior mediastinum
B. Pleural cavity punction
C. Pleural cavity drainage
D. Toracoscopy
E. Toracotomy
Answer: Drainage of anterior mediastinum
Explanation
| The symptoms of subcutaneous emphysema of the upper part of the body, dyspnea, tachycardia, and significant dilatation of the mediastinum on X-ray examination suggest that the patient is suffering from a traumatic injury to the thorax that has caused air to leak into the mediastinum. This condition is known as mediastinal emphysema. Mediastinal emphysema can be caused by a variety of thoracic injuries, including blunt trauma, penetrating injuries, and medical procedures. It can be life-threatening if left untreated, as it can lead to compression of the airways and great vessels in the mediastinum. The emergency care needed in this case is drainage of the anterior mediastinum, which can be done using a needle or catheter inserted into the mediastinum through the anterior chest wall. This procedure can relieve the pressure caused by the trapped air and prevent further compression of the airways and great vessels. Pleural cavity puncture or drainage would not be effective in treating mediastinal emphysema, as the air is trapped in the mediastinum and not in the pleural cavity. Thoracoscopy and thoracotomy may be needed in some cases to diagnose and treat traumatic injuries to the thorax, but they are not typically the first-line treatment for mediastinal emphysema. Therefore, based on the given information, the most appropriate emergency care for this patient is drainage of the anterior mediastinum to relieve the pressure caused by the trapped air and prevent further complications. |
188. An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanine aminotransferase activity is 2,2 mcmol/L. How can this condition be estimated?
A. Development of chronic hepatitis
B. Recurrance of viral hepatitis type B
C. Biliary dyskinesia
D. Residual effects of old viral hepatitis type B
E. Development of liver cirrhosis
Answer: Development of chronic hepatitis
Explanation
| The symptoms of undue fatiguability, sleep disorder, appetite loss, and nausea, along with a history of B hepatitis one year ago, suggest that the patient may be experiencing a chronic form of hepatitis. Chronic hepatitis is defined as inflammation of the liver that lasts for more than six months, and it can be caused by a variety of factors, including viral infections, alcohol abuse, and autoimmune diseases. The fact that the patient’s liver and spleen are 1 cm below the costal margins and painless, along with a normal alanine aminotransferase (ALT) activity, suggests that the liver is not severely damaged at this point. However, these symptoms and findings are consistent with the development of chronic hepatitis. The recurrence of viral hepatitis type B is a possibility, but the normal ALT activity suggests that this is not the most likely diagnosis. Biliary dyskinesia, residual effects of old viral hepatitis type B, and development of liver cirrhosis are also possible complications of chronic hepatitis, but there is not enough information in the scenario to support these diagnoses. Therefore, based on the given information, the most likely diagnosis for this patient’s condition is the development of chronic hepatitis, which may require further evaluation and treatment to prevent further liver damage. |
189. A 2,5 m.o. child has got muscle hypotony, sweating, occipital alopecia. Along with massage and therapeutic exercises the child was prescribed vitamin D. What dosage and frequency are correct?
A. 3000 IU every day
B. 500 IU every day
C. 1000 IU every day
D. 500 IU every other day
E. 1000 IU every other day
Answer: 3000 IU every day
Explanation
| The symptoms of muscle hypotonia, sweating, and occipital alopecia in a 2.5-month-old child suggest a possible deficiency of vitamin D, which is important for the development and maintenance of healthy bones and muscles. The correct dosage and frequency of vitamin D supplementation depend on the severity of the deficiency and the age of the child. In this case, a daily dosage of 3000 IU is appropriate, as recommended by the American Academy of Pediatrics for infants with a confirmed deficiency. Lower dosages, such as 500 IU or 1000 IU every day or every other day, may be appropriate for infants with milder deficiencies or as a prophylactic measure for healthy infants, but in this case, a higher dosage is necessary to address the symptoms of the deficiency. It is important to follow the recommended dosage and frequency of vitamin D supplementation to avoid toxicity, as excessive vitamin D intake can cause hypercalcemia and other adverse effects. Therefore, based on the given information, the correct dosage and frequency of vitamin D supplementation for this 2.5-month-old child with muscle hypotonia, sweating, and occipital alopecia is 3000 IU every day. |
190. After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterus is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations and raptures. What action is nesessary?
A. Manual exploration of the uterine cavity
B. External massage of uterus
C. Use of uterine contracting agents
D. Urine drainage, cold on the lower abdomen
E. Use of hemostatic medications
Answer: Manual exploration of the uterine cavity
Explanation
| The scenario describes a postpartum woman who has delivered and had her placenta revised, but a defect in the placental lobe was found. The woman’s general condition is normal, but there is moderate bloody discharge. Inspection of the birth canal with mirrors shows no lacerations or ruptures. In this case, the most appropriate action is to perform a manual exploration of the uterine cavity to ensure that there are no retained placental fragments or other sources of bleeding. Retained placental fragments can cause postpartum hemorrhage, which is a serious complication that can lead to maternal morbidity and mortality. External massage of the uterus and use of uterine contracting agents may be helpful in some cases to prevent or manage postpartum hemorrhage, but they are not appropriate in this case without first ruling out retained placental fragments. Urine drainage and cold on the lower abdomen may have some benefits in managing postpartum hemorrhage, but they are not the most appropriate actions in this case. The use of hemostatic medications may be appropriate in some cases of postpartum hemorrhage, but it is not the most appropriate action in this case without first ruling out retained placental fragments. Therefore, based on the given information, the most appropriate action for this postpartum woman with a placental lobe defect and moderate bloody discharge is to perform a manual exploration of the uterine cavity to rule out retained placental fragments or other sources of bleeding. |
191. A 25 y.o. patient complains of body temperature rise up to 370, pain at the bottom of her abdomen and vaginal discharges. Three days ago, when she was in her 11th week of pregnancy, she had an artificial abortion. Objectibely: cervix of uterus is clean, uterus is a little bit enlarged in size, painful. Appendages cannot be determined. Fornixes are deep, painless. Vaginal discharges are sanguinopurulent. What is the most probable diagnosis?
A. Postabortion endometritis
B. Hematometra
C. Pelvic peritonitis
D. Postabortion uterus perforation
E. Parametritis
Answer: Postabortion endometritis
Explanation
| The patient had an artificial abortion three days ago at 11 weeks of pregnancy and is now presenting with a fever, lower abdominal pain, and sanguinopurulent vaginal discharge. These symptoms are consistent with postabortion endometritis, which is an infection of the endometrium that can occur after a miscarriage or abortion. The fact that the cervix of the uterus is clean, the uterus is enlarged and painful, and the appendages cannot be determined suggests that the infection is limited to the endometrium and has not spread to the cervix or the adnexa. Hematometra, which is a collection of blood in the uterus, can occur after a miscarriage or abortion, but it typically presents with different symptoms, such as delayed menstruation, severe cramping, and a swollen, tender abdomen. Pelvic peritonitis, which is an inflammation of the peritoneum, can occur as a complication of postabortion endometritis, but it typically presents with more severe symptoms, such as high fever, severe abdominal pain, and signs of systemic inflammation. Postabortion uterus perforation is a rare but serious complication of abortion that can cause severe abdominal pain and bleeding. However, in this case, there is no evidence of perforation or significant bleeding. Parametritis, which is an infection of the parametrial tissue, can occur after a miscarriage or abortion, but it typically presents with different symptoms, such as severe pain and swelling in the pelvic area. Therefore, based on the given information, the most probable diagnosis for this patient’s symptoms is postabortion endometritis, which requires prompt evaluation and treatment to prevent further complications. |
192. A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months. Objectively: t 0- 37, 30, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?
A. Cancer of lung
B. Macrofocal pneumonia
C. Bronchoectatic disease
D. Focal pulmonary tuberculosis
E. Exudative pleuritis
Answer: Cancer of lung
Explanation
| The most probable diagnosis for this patient’s symptoms is A. Cancer of lung. The patient is a 67-year-old and has been experiencing dyspnea, breast pain, and weakness for the past 5 months. The objective findings include a fever within normal range, a high pulse rate, dull percussion sound, and the absence of auscultated breathing over the right lung. These findings suggest that the patient may have a mass or tumor in the right lung that is causing obstruction of the airway and preventing normal breathing sounds from being heard. The presence of blood diffusively mixed with mucus in the sputum is also suggestive of lung cancer, as this is a common symptom of the disease. Macrofocal pneumonia, bronchoectatic disease, focal pulmonary tuberculosis, and exudative pleuritis are all possible differential diagnoses, but the objective findings and symptoms are more consistent with lung cancer. Lung cancer is a serious disease that requires prompt evaluation and treatment. Treatment options depend on the type and stage of the cancer, as well as the overall health of the patient. Treatment may include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. In some cases, a combination of treatments may be used. Therefore, based on the given information, the most probable diagnosis for this patient’s symptoms is cancer of the lung, which requires further evaluation and treatment to improve the patient’s prognosis. |
193. People who live in the radiation polluted regions are recommended to include pectins into their dietary intake for the radioactive nuclides washout. What products are the main source of pectins?
A. Fruit and vegetebles
B. Bread
C. Milk
D. Meat
E. Macaroni
Answer: Fruit and vegetebles
Explanation
| Pectins are a type of soluble fiber found in the cell walls of many fruits and vegetables, such as apples, oranges, carrots, and beets. Pectins are known for their ability to bind to and remove heavy metals and radioactive isotopes from the body, making them useful for people who live in radiation-polluted regions. Bread, milk, meat, and macaroni are not significant sources of pectins. While these foods may provide other important nutrients, they do not contain significant amounts of pectins that can aid in the removal of radioactive nuclides from the body. Therefore, based on the given information, the main source of pectins, which are recommended for people who live in radiation-polluted regions for the purpose of radioactive nuclide washout, is fruits and vegetables. |
194. A 25 y.o. pregnant woman in her 34th week was taken to the maternity house in grave condition. She complains of headache, visual impairment, nausea. Objectively: solid edemata, AP- 170/130 mm Hg. Suddenly there appeared fibrillary tremor of face muscles, tonic and clonic convulsions, breathing came to a stop. After 1,5 minute the breathing recovered, there appeared some bloody spume from her mouth. In urine: protein – 3,5 g/L. What is the most probable diagnosis?
A. Eclampsia
B. Epilepsy
C. Cerebral hemorrhage
D. Cerebral edema
E. Stomach ulcer
Answer: Eclampsia
Explanation
| The patient is a 25-year-old woman in her 34th week of pregnancy who presents with a severe headache, visual impairment, and nausea. These symptoms are consistent with the prodromal phase of eclampsia, a serious complication of pregnancy characterized by the onset of seizures in women with preeclampsia. The objective findings of solid edema, high blood pressure (170/130 mm Hg), fibrillary tremor of face muscles, tonic and clonic convulsions, and bloody spume from the mouth are all consistent with eclampsia. The presence of proteinuria (3.5 g/L) is also a sign of preeclampsia, which can progress to eclampsia. Epilepsy is a neurological disorder characterized by recurrent seizures, but it is not related to pregnancy or preeclampsia. Cerebral hemorrhage and cerebral edema are both serious neurological conditions that can cause seizures, but they are less likely in the context of a pregnant woman with preeclampsia. Stomach ulcer is not related to the patient’s symptoms and is therefore an unlikely diagnosis. Eclampsia is a medical emergency that requires prompt evaluation and treatment, including the delivery of the baby to prevent further complications. Treatment may include medications to control blood pressure and prevent seizures, as well as close monitoring of maternal and fetal well-being. Therefore, based on the given information, the most probable diagnosis for this pregnant woman’s symptoms is eclampsia, which requires urgent management to prevent serious complications for both the mother and the baby. |
195. The Transcarpathian region is characterized by constant high (over 80%) air moisture. Population of this region feels an intense cold in winter when the temperature is temperately low. What way of heat emission becomes more active?
A. Convection
B. Irradiation
C. Evaporation
D. Conduction
E. Radiation
Answer: Convection
Explanation
| Convection is the transfer of heat through the movement of fluids, such as air or water. In a humid environment, the high moisture content in the air can limit the ability of conduction and radiation to transfer heat. However, convection can become more active in such an environment, as the moisture in the air can enhance the movement of heat through the flow of air. Therefore, based on the given information, the way of heat emission that becomes more active in a humid environment, such as the Transcarpathian region with high air moisture, is convection. |
196. A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2,5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?
A. Diagnostic curettage of uterine cavity
B. Conservative treatment of bleeding
C. Hysterectomy
D. Supravaginal amputation of uterus without appendages
E. TORCH-infection test
Answer: Diagnostic curettage of uterine cavity
Explanation
| The most appropriate doctor’s tactics for this patient’s symptoms is A. Diagnostic curettage of uterine cavity. The patient is a 51-year-old woman who is experiencing intensive bloody discharges from the vagina for 15 days after a delay of menstruation for 2.5 months, along with disorders of menstrual function for a year, extreme irritability, and sleep disorders. These symptoms are suggestive of endometrial hyperplasia or endometrial cancer, which can cause abnormal bleeding in women in this age group. US examination showed that the uterus corresponds to age norms and the appendages have no peculiarities, but the endometrium is 14 mm thick. This finding is suggestive of endometrial hyperplasia or endometrial cancer, and a diagnostic curettage of the uterine cavity is needed to obtain a tissue sample for histological examination. Conservative treatment of bleeding may provide temporary relief, but it does not address the underlying cause of the bleeding, which may be a serious condition such as endometrial cancer. Hysterectomy and supravaginal amputation of the uterus without appendages are more radical surgical options that may be considered if the histological examination confirms the presence of endometrial cancer. TORCH-infection test is not relevant to the patient’s symptoms, as it tests for a group of infections that can cause congenital abnormalities in newborns, but not for the cause of abnormal bleeding in a 51-year-old woman. Therefore, based on the given information, the most appropriate doctor’s tactics for this patient’s symptoms is a diagnostic curettage of the uterine cavity to obtain a tissue sample for histological examination, which will help to determine the underlying cause of the abnormal bleeding and guide further management. |
197. An 18 y.o. patient complains of painfulness and swelling of mammary glands, headaches, irritability, edemata of lower extremities. These symptoms have been present since the begin of menarche, appear 3-4 days before regular menstruation. Gynecological examination revealed no pathology. What is the most probable diagnosis?
A. Premenstrual syndrome
B. Neurasthenia
C. Renal disease
D. Mastopathy
E. Disease of cardiovascular system
Answer: Premenstrual syndrome
Explanation
| The patient is an 18-year-old woman who complains of painfulness and swelling of the mammary glands, headaches, irritability, and edema of the lower extremities, which have been present since the beginning of menarche and appear 3-4 days before regular menstruation. These symptoms are suggestive of PMS, which is a common condition that affects many women during their reproductive years. Gynecological examination revealed no pathology, which further supports the diagnosis of PMS, as there is no underlying structural abnormality that can explain the patient’s symptoms. Neurasthenia, renal disease, mastopathy, and disease of the cardiovascular system are less likely diagnoses, as they do not fully explain the patient’s symptoms and are not typically associated with the menstrual cycle. Premenstrual syndrome is a common condition that can cause a range of physical and emotional symptoms in the days leading up to menstruation. Treatment options include lifestyle changes, such as regular exercise, a balanced diet, and stress reduction techniques, as well as medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, and antidepressants. Therefore, based on the given information, the most probable diagnosis for this patient’s symptoms is premenstrual syndrome, which can be managed with lifestyle changes and medications to improve the patient’s quality of life. |
198. A 15 y.o. patient has a developmental lag, occasionally he has skin yellowing. Objectively: spleen is 16х12х10 cm, cholecystolithiasis, skin ulcer of the lower third of left crus. Blood count: RBC- 3, 0 ∗ 1012/L, Hb- 90 g/L, C.I.- 1,0; microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, unconjugated – 38 mcmol/L. What therapy will be the most appropriate?
A. Splenectomy
B. Spleen transplantation
C. Portacaval shunt
D. Omentosplenopexy
E. Omentohepatopexy
Answer: Splenectomy
Explanation
| The patient is a 15-year-old with a developmental lag, occasional skin yellowing, and objective findings of an enlarged spleen, cholecystolithiasis, skin ulcer of the lower third of the left crus, and abnormalities in blood count, including microspherocytosis and reticulocytosis. These findings are consistent with hereditary spherocytosis, a genetic disorder that affects red blood cells and can cause anemia, jaundice, and splenomegaly. The high level of total serum bilirubin (56 mcmol/L) and unconjugated bilirubin (38 mcmol/L) suggests that the patient’s liver is unable to efficiently process bilirubin, leading to the development of jaundice. Splenectomy is the most appropriate therapy for hereditary spherocytosis, as it removes the source of hemolysis and can improve anemia and jaundice. In addition, splenectomy can prevent the development of complications associated with splenomegaly, such as portal hypertension and hypersplenism. Spleen transplantation, portacaval shunt, omentosplenopexy, and omentohepatopexy are not appropriate therapies for hereditary spherocytosis, as they do not address the underlying cause of the disease, which is the abnormal red blood cells. Therefore, based on the given information, the most appropriate therapy for this patient’s symptoms is splenectomy, which can improve anemia, jaundice, and other complications associated with hereditary spherocytosis. |
199. In a city with population 400000 people 5600 fatal cases were recorded, including 3300 cases because of blood circulation diseases, 730 – because of tumors. What index will allow to characterize mortality from blood circulation diseases in this city?
A. Intensive index
B. Extensive index
C. Relative intensity index
D. Visuality index
E. Correlation index
Answer: Intensive index
Explanation
| The intensive index is a measure that expresses the number of deaths from a specific cause in relation to a specific population. In this case, the population is 400,000 people, and the number of fatal cases due to blood circulation diseases is 3,300. Therefore, the intensive index for mortality from blood circulation diseases in this city can be calculated as follows: Intensive index = (number of deaths due to blood circulation diseases / population) x 1000 Intensive index = (3300 / 400000) x 1000 Intensive index = 8.25 per 1000 The intensive index allows us to understand the severity of the mortality rate from a specific cause in a given population. In this case, the intensive index of 8.25 per 1000 indicates that mortality from blood circulation diseases is a significant health concern in this city. The extensive index, on the other hand, expresses the overall number of deaths in a population, regardless of the cause. The relative intensity index expresses the proportion of deaths from a specific cause in relation to all deaths in a population. The visuality index and correlation index are not relevant to this question. Therefore, based on the given information, the index that will allow to characterize mortality from blood circulation diseases in this city is the intensive index. |
200. During the medical examination a port crane operator complained of dizziness, nausea, sense of pressure against tympanic membranes, tremor, dyspnoea, cough. He works aloft, the work is connected with emotional stress. Workers are affected by vibration (general and local), noise, ultrasound, microclimate that warms in summer and cools in winter. What factor are the worker’s complaints connected with?
A. Infrasound
B. Noise
C. Vibration
D. Intensity of work
E. Altitude work
Answer: Infrasound
Explanation
| The worker is a port crane operator who works aloft and is exposed to various occupational hazards, including vibration, noise, ultrasound, and changes in microclimate. These hazards can cause a range of health problems, including dizziness, nausea, pressure against tympanic membranes, tremor, dyspnea, and cough. Noise exposure is a known cause of hearing loss, tinnitus, and other auditory and non-auditory effects, including stress, sleep disturbances, and cardiovascular disorders. The worker’s symptoms of dizziness, nausea, and pressure against tympanic membranes are consistent with noise-induced vestibular dysfunction. Vibration exposure can cause a range of health problems, including peripheral vascular disorders, musculoskeletal disorders, and neurological disorders, such as hand-arm vibration syndrome. The worker’s symptoms of tremor may be related to vibration exposure. Intense work and altitude work can cause physical and emotional stress, which can lead to a range of symptoms, including dyspnea, cough, and tremor. Infrasound is low-frequency sound waves that are below the threshold of human hearing. Infrasound is not likely to be a factor in the worker’s complaints, as it is not typically generated by port cranes or other industrial machinery. Therefore, based on the given information, the worker’s complaints are likely to be connected with noise, vibration, intensity of work, and altitude work, but not with infrasound. |
