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All Previous Years Krok 2 Papers with Explanations
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151. A 74 y.o. patient complains of abdomen pain and sweling, nausea. She suffers from ischemic heart disease, postinfarction and atherosclerotic cardiosclerosis. Objectively: the patient is in grave condition, abdomen is swollen, abdominal wall doesn’t take active part in respiration. Laparoscopy revealed a small amount of muddy effusion in abdominal cavity, one of the loops of small intestine is dark-cyan. What is the most probable diagnosis?

A. Thrombosis of mesenteric vessels

B. Twisted bowels

C. Acute intestinal obstruction

D. Ischemic abdominal syndrome

E. Erysipelas

Answer:  Thrombosis of mesenteric vessels

Explanation

In a 74-year-old patient with complaints of abdominal pain and swelling, nausea, and a history of ischemic heart disease, postinfarction, and atherosclerotic cardiosclerosis, and with the presence of a swollen abdomen and abdominal wall that doesn’t take an active part in respiration, and laparoscopy revealing a small amount of muddy effusion in the abdominal cavity and a dark-cyan loop of small intestine, the most probable diagnosis is thrombosis of mesenteric vessels.   Mesenteric ischemia is a condition that occurs when the blood supply to the small intestine is reduced or blocked, typically due to a blood clot or embolism in one of the mesenteric arteries. The condition can cause severe abdominal pain, nausea, vomiting, and other gastrointestinal symptoms, and can progress rapidly to gangrene and sepsis if left untreated.   In this case, the patient’s symptoms, including abdominal pain and swelling, nausea, and a cyanotic loop of small intestine on laparoscopy, are highly suggestive of mesenteric ischemia, and the presence of a history of cardiovascular disease increases the likelihood of thrombosis of mesenteric vessels.   Twisted bowels (option B) and acute intestinal obstruction (option C) can also cause abdominal pain and swelling, but the presence of a dark-cyan loop of small intestine on laparoscopy suggests a vascular cause. Ischemic abdominal syndrome (option D) is a non-specific term that refers to a group of conditions that cause abdominal pain and other symptoms due to decreased blood flow to the abdominal organs, including mesenteric ischemia. Erysipelas (option E) is a skin infection that typically causes red, swollen, and painful areas of skin, and is not likely to cause the symptoms described in this case.   Therefore, based on the patient’s symptoms, medical history, and laparoscopy findings, the most probable diagnosis is thrombosis of mesenteric vessels, and urgent treatment, such as thrombolytic therapy or surgical intervention, may be necessary to restore blood flow to the affected area and prevent further complications.

152. A 10 y.o. child who is at oligoanuretic stage of acute renal insufficiency has got sensations of pricking in the mucous membrane of oral cavity and tongue, extremities numbness, reduced reflexes, respiratory disturbance, arrhythmia. What are these symptoms caused by?

A. Hyperkaliemia

B. Hyponatremia

C. Hyperazotemia

D. Acidosis

E. Alkalosis

Answer:  Hyperkaliemia

Explanation

In a 10-year-old child who is at the oligoanuretic stage of acute renal insufficiency and has sensations of pricking in the mucous membrane of the oral cavity and tongue, numbness in the extremities, reduced reflexes, respiratory disturbance, and arrhythmia, these symptoms are most likely caused by hyperkalemia.   Hyperkalemia is a condition characterized by an abnormally high level of potassium in the blood, which can occur in patients with renal insufficiency due to a reduced ability of the kidneys to excrete potassium. The symptoms of hyperkalemia can range from mild tingling or pricking sensations in the mucous membranes of the mouth and tongue to more severe symptoms, such as muscle weakness, paralysis, respiratory failure, and cardiac arrhythmias.   In this case, the patient’s symptoms, including sensations of pricking in the mucous membrane of the oral cavity and tongue, numbness in the extremities, reduced reflexes, respiratory disturbance, and arrhythmia, are highly suggestive of hyperkalemia. The fact that the patient is at the oligoanuretic stage of acute renal insufficiency also increases the likelihood of hyperkalemia.   Hyponatremia (option B) is a condition characterized by a low level of sodium in the blood, and is unlikely to cause the symptoms described in this case. Hyperazotemia (option C) refers to an abnormally high level of nitrogenous waste products in the blood, and is a common finding in patients with renal insufficiency, but is not likely to cause the specific symptoms described in this case. Acidosis (option D) and alkalosis (option E) are conditions characterized by an imbalance of acid-base status in the body, and can cause a wide range of symptoms, but are less likely to be the primary cause of the symptoms described in this case.   Therefore, based on the patient’s symptoms and medical history, the most likely cause of the symptoms is hyperkalemia (option A), and urgent treatment, such as administration of intravenous calcium, insulin and glucose, or potassium-binding medications, may be necessary to lower the potassium level and prevent further complications.

153. A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours. Hearbeat of fetus is muffled, arrhythmic, 100/min. Vaginal examination: cervix of uterus is completely opened, fetus head is level with outlet from small pelvis. Saggital suture is in the straight diameter, small crown is near symphysis. What is the further tactics of handling the delivery?

A. Use of obstetrical forceps

B. Stimulation of labour activity by oxytocin

C. Cesarean section

D. Cranio-cutaneous (Ivanov’s) forceps

E. Use of cavity forceps

Answer:  Use of obstetrical forceps

Explanation

In a 30-year-old woman who is in her second stage of labor lasting for 14 hours, with muffled and arrhythmic fetal heartbeat at 100 beats per minute, and with a completely opened cervix and fetal head at the level with outlet from the small pelvis, with the sagittal suture in the straight diameter and the small crown near the symphysis, the further tactics of handling the delivery would be the use of obstetrical forceps.   Obstetrical forceps are a special instrument used to assist with delivery by applying traction to the fetal head during the second stage of labor. They are typically used when there is a delay in the progress of labor or when there is fetal distress, such as in this case.   In this case, the prolonged second stage of labor, along with the muffled and arrhythmic fetal heartbeat, suggests that the fetus may be experiencing fetal distress. The use of obstetrical forceps may be necessary to facilitate delivery and reduce the risk of further complications.   Stimulation of labor activity by oxytocin (option B) may be helpful in some cases to increase the frequency and strength of uterine contractions, but it is not indicated in this case as the cervix is fully dilated and the fetal head is at the level of the outlet. Cesarean section (option C) may be necessary in some cases of prolonged labor or fetal distress, but it is typically reserved for cases where other interventions, such as forceps delivery, have been unsuccessful. Cranio-cutaneous (Ivanov’s) forceps (option D) and cavity forceps (option E) are specific types of forceps that are not indicated in this case.   Therefore, in this case, the most appropriate further tactic for handling the delivery would be the use of obstetrical forceps (option A) to assist with delivery and reduce the risk of further complications.

154. A 75 y.o. man with IHD (atherosclerotic cardiosclerosis, atrial fibrillation, cardiac insufficiensy stage 2 B; chronic pyelonephritis) was prescribed digoxin. During the first 6 days the digoxin dose amounted 0,25 mg twice per day that let to abatement of dyspnea, edemata and cyanosis. But on the 7-th day the patient developed nausea and bradycardia. What is the most probable cause of digoxin intoxication?

A. Disturbed elimination of the medication by kidneys

B. Too long intake of saturating dose

C. Exceeding daily saturating dose

D. Disturbed metabolism of digoxin in liver

E. Treatment complex doesn’t include unitiole

Answer: Disturbed elimination of the medication by kidneys

Explanation

In a 75-year-old man with a history of ischemic heart disease, atherosclerotic cardiosclerosis, atrial fibrillation, cardiac insufficiency stage 2B, and chronic pyelonephritis who was prescribed digoxin, the most probable cause of digoxin intoxication after 6 days of treatment with a dose of 0.25 mg twice per day that led to an abatement of dyspnea, edema, and cyanosis, but on the 7th day, the patient developed nausea and bradycardia, is disturbed elimination of the medication by kidneys.   Digoxin is a medication used to treat heart failure and atrial fibrillation, but it has a narrow therapeutic index and can cause toxicity if the dose is not carefully monitored. Digoxin is primarily eliminated from the body by the kidneys, and impaired renal function can lead to an accumulation of the medication in the body and an increased risk of toxicity.   In this case, the patient has a history of chronic pyelonephritis, which suggests impaired renal function, and the symptoms of nausea and bradycardia are consistent with digoxin toxicity. The fact that the patient had a positive response to the medication initially suggests that the dose was appropriate, but the development of toxicity after 6 days of treatment suggests that the medication is not being eliminated from the body effectively.   Exceeding the daily saturating dose (option C) or taking a saturating dose for too long (option B) can also lead to digoxin toxicity, but in this case, the patient was taking a relatively low dose of the medication, and the symptoms developed after 6 days of treatment. Disturbed metabolism of digoxin in the liver (option D) is not a common cause of digoxin toxicity. The use of unitiole (option E), which is a medication used to treat digoxin toxicity, may be necessary in some cases, but it is not the most probable cause of the symptoms in this case.   Therefore, based on the patient’s medical history and symptoms, the most probable cause of digoxin intoxication after 6 days of treatment is disturbed elimination of the medication by the kidneys (option A), and the dose of digoxin may need to be adjusted or the medication may need to be discontinued to prevent further complications.

155. A patient who has been contacting with benzol for 6 years has a nonevident leukopenia, moderate reticulocytosis, gingival hemorrhage, dizziness, asthenovegetative syndrome. What a severity degree of chronic intoxication with benzol corresponds with described symptoms?

A. Minor

B. Moderate

C. Severe

D. Disease is not connected with work conditions

E. –

Answer: Minor

Explanation

In a patient who has been in contact with benzene for 6 years and is presenting with non-evident leukopenia, moderate reticulocytosis, gingival hemorrhage, dizziness, and asthenovegetative syndrome, the severity degree of chronic intoxication with benzene that corresponds with the described symptoms is minor.   Benzene is a toxic chemical that is commonly used in industrial settings and can cause a range of health problems, including hematological disorders, such as leukopenia and reticulocytosis, as well as bleeding disorders, such as gingival hemorrhage. Dizziness and asthenovegetative syndrome are also common symptoms of benzene exposure.   In this case, the symptoms described suggest a mild degree of chronic benzene intoxication. While the leukopenia and reticulocytosis indicate a hematological effect of benzene exposure, the symptoms are not severe enough to suggest a more advanced stage of chronic intoxication.   The other options, such as moderate (option B) or severe (option C), are not supported by the description of the symptoms. The option D, that the disease is not connected with work conditions, is unlikely in this case, since the patient has a history of contact with benzene.   Therefore, based on the symptoms described, the severity degree of chronic intoxication with benzene that corresponds with the symptoms is minor (option A), and the patient should be monitored closely for any worsening of symptoms or development of new symptoms, and appropriate measures should be taken to minimize exposure to benzene in the workplace.

156. A 30 y.o. man was always reserved by nature. He never consulted psychiatrists. He complains of headache, sensation “as if something bursts, moves, bubbles under his skin”. Objectively: no pathology was revealed. What is the most probable psychopathologic symptom in this case?

A. Cenestopathy

B. Paresthesia

C. Hallucination

D. Hypersthesia

E. Dysmorphopsia

Answer: Cenestopathy

Explanation

In a 30-year-old man who complains of headaches and a sensation of something bursting, moving, or bubbling under his skin, with no pathology detected on objective examination, the most probable psychopathologic symptom in this case is cenestopathy.   Cenestopathy is a symptom of a variety of psychiatric disorders characterized by a distorted sense of bodily awareness or perception. It can manifest as a variety of sensations, including tingling, numbness, pressure, and other unusual sensations, such as the sensation of something bursting or moving under the skin, as described in this case.   Paresthesia (option B) refers to abnormal sensations, such as tingling or numbness, that are typically related to a peripheral nerve disorder. Hallucination (option C) refers to a perception of something that is not actually present, such as hearing voices or seeing things that are not there. Hypersthesia (option D) refers to an increased sensitivity to touch or other sensory stimuli. Dysmorphopsia (option E) refers to a distorted perception of the size, shape, or appearance of one’s body or other objects.   Therefore, based on the patient’s symptoms and medical history, the most probable psychopathologic symptom in this case is cenestopathy (option A), and further evaluation by a psychiatrist or mental health professional may be necessary to determine the underlying cause and appropriate treatment.

157. A 45 y.o. man complains of having intensive pain in the epigastric region 1,5- 2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively: t 0- 36, 50, RR- 16/min, Ps70 bpm, AP- 120/80 mm Hg. On palpation: local painfulness in the right epigastric region. What parameters of intragastric Ph-meter in the region of stomach body are the most typical for this patient’s disease? A. рН = 1,0-2,0 B. рН = 3,0-4,0 C. рН = 4,0-5,0 D. рН = 5,0-6,0 E. рН = 6,0-7,0 158. A 13 y.o. teenager who suffers from hemophilia A was taken to the hospital after a fight at school. His diagnosis is right-sided hemarthros of knee joint, retroperitoneal hematoma. What should be primarily prescribed?

A. Fresh frozen plasma

B. Aminocapronic acid

C. Washed thrombocytes

D. Placental albumin

E. Dry plasma

Answer: Fresh frozen plasma

Explanation

In a 45-year-old man with a history of ulcer for 11 years who complains of intensive pain in the epigastric region after food intake and local painfulness on palpation in the right epigastric region, the most typical parameters of intragastric pH-meter in the region of the stomach body for this patient’s disease are pH = 3.0-4.0 (option B).   Intragastric pH monitoring is a diagnostic test used to assess the acidity of the stomach. In patients with peptic ulcer disease, the pH in the stomach is often elevated, which can contribute to the development of ulcers and related symptoms, such as epigastric pain.   The normal pH range in the stomach is usually between 1.0 and 3.5, with a pH of 3.0-4.0 being the most typical for peptic ulcer disease. This pH range is indicative of a decrease in acid secretion in the stomach due to the inhibition of the proton pump by proton pump inhibitors that are commonly used to treat peptic ulcer disease.   Therefore, based on the patient’s symptoms and medical history, the most typical parameters of intragastric pH-meter in the region of the stomach body for this patient’s disease are pH = 3.0-4.0 (option B).   In a 13-year-old teenager with hemophilia A who was taken to the hospital after a fight at school and was diagnosed with right-sided hemarthrosis of the knee joint and retroperitoneal hematoma, the primary treatment that should be prescribed is fresh frozen plasma (option A).   Fresh frozen plasma contains clotting factors that can help to replace those that are missing in patients with hemophilia A and stop bleeding. It is typically the first-line treatment for hemophilic bleeding, particularly in cases of joint bleeding, such as hemarthrosis.   Aminocaproic acid (option B) is an antifibrinolytic medication that can help to prevent the breakdown of clots but is not typically used as a primary treatment for hemophilic bleeding. Washed thrombocytes (option C) are platelets that have been washed to remove any potential contaminants but are not typically used in the treatment of hemophilic bleeding. Placental albumin (option D) and dry plasma (option E) are not typically used in the treatment of hemophilic bleeding.   Therefore, based on the patient’s diagnosis and medical history, the primary treatment that should be prescribed is fresh frozen plasma (option A) to stop the bleeding and prevent further complications.

159. A 3 m.o. child fell seriously ill, body temperature rised up to 37, 80C, there is semicough. On the 3-rd day the cough grew worse, dyspnea appeared. On percussion: tympanic sound above lungs, on auscultation: a lot of fine moist and wheezing rales during expiration. What is the most probable diagnosis?

A. Acute respiratory viral infection, bronchiolitis

B. Acute respiratory viral infection, bronchopneumonia

C. Acute respiratory viral infection, bronchitis

D. Acute respiratory viral infection, bronchitis with asthmatic component

E. Acute respiratory viral infection, focal pneumonia

Answer: Acute respiratory viral infection, bronchiolitis

Explanation

In a 3-month-old child who fell seriously ill with a body temperature of 37.8°C and semicough, which grew worse on the 3rd day with the appearance of dyspnea, tympanic sound above lungs on percussion, and fine moist and wheezing rales during expiration on auscultation, the most probable diagnosis is acute respiratory viral infection, bronchiolitis (option A).   Bronchiolitis is a lower respiratory tract infection that commonly affects infants and young children, often caused by respiratory syncytial virus (RSV) or other respiratory viruses. The symptoms of bronchiolitis typically begin with upper respiratory tract symptoms, such as cough and fever, and progress to lower respiratory tract symptoms, such as dyspnea, wheezing, and rales on auscultation.   In this case, the child’s symptoms are consistent with bronchiolitis, with the presence of fine moist and wheezing rales during expiration on auscultation, which suggests narrowing of the airways due to inflammation and mucus buildup. The tympanic sound above lungs on percussion may be indicative of hyperinflation of the lungs, which can occur in bronchiolitis due to air trapping.   Acute respiratory viral infection, bronchopneumonia (option B) and focal pneumonia (option E) may also cause similar symptoms in infants and young children, but the presence of fine moist and wheezing rales during expiration on auscultation suggests involvement of the smaller airways, which is more characteristic of bronchiolitis.   Acute respiratory viral infection, bronchitis (option C) may cause cough and fever but typically does not result in dyspnea or wheezing. Acute respiratory viral infection, bronchitis with an asthmatic component (option D) may present with wheezing, but the presence of fine moist and wheezing rales during expiration on auscultation suggests bronchiolitis rather than asthma.   Therefore, based on the child’s symptoms and medical history, the most probable diagnosis is acute respiratory viral infection, bronchiolitis (option A), and appropriate treatment should be initiated to manage the symptoms and prevent complications.

160. A worker at a porcelain factory who has been in service for 10 years complains of cough, dyspnea, ache in his chest. What occupational disease are these complaints most typical for?

A. Silicosis

B. Multiple bronchiectasis

C. Chronic dust bronchitis

D. Occupational bronchial asthma

E. Chronic cor pulmonale

Answer: Silicosis

Explanation

In a worker at a porcelain factory who has been in service for 10 years and complains of cough, dyspnea, and chest pain, the most typical occupational disease for these complaints is silicosis (option A).   Silicosis is a lung disease caused by the inhalation of silica dust, which is commonly found in certain types of industries, such as mining, quarrying, and manufacturing of construction materials like porcelain. Workers who are exposed to silica dust over a prolonged period can develop lung fibrosis and other respiratory symptoms.   The symptoms of silicosis typically include cough, dyspnea, and chest pain, which are consistent with the worker’s complaints. Other symptoms may include fatigue, weight loss, and respiratory infections.   Multiple bronchiectasis (option B) is a condition in which the bronchial tubes become permanently and abnormally widened, leading to chronic cough, sputum production, and recurrent infections. While exposure to dust and other environmental factors can contribute to the development of bronchiectasis, it is not typically associated with porcelain manufacturing.   Chronic dust bronchitis (option C) is a chronic inflammation of the bronchial tubes caused by exposure to airborne dust particles, which can lead to cough, sputum production, and wheezing. While this condition may also be associated with exposure to dust in certain occupational settings, it is not typically associated with porcelain manufacturing.   Occupational bronchial asthma (option D) is a type of asthma that is triggered by exposure to workplace irritants, such as dust, chemicals, or fumes. While this condition may also be associated with exposure to dust in certain occupational settings, it is not typically associated with porcelain manufacturing.   Chronic cor pulmonale (option E) is a condition in which the right side of the heart becomes enlarged and weakened due to chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD). While silicosis and other respiratory diseases can contribute to the development of chronic cor pulmonale, it is not a primary diagnosis and is not typically associated with porcelain manufacturing.   Therefore, based on the worker’s symptoms and occupational history, the most typical occupational disease for these complaints is silicosis (option A), and appropriate measures should be taken to prevent further exposure to silica dust and manage the symptoms.

161. Mother of a newborn child suffers from chronoc pyelonephritis. She survived acute respiratory viral infection directly before labour. Delivery was at term, the period before discharge of waters was prolonged. On the 2-nd day the child got erythematous rash, later on – vesicles about 1 cm large with seropurulent content. Nikolsky’s symptom is positive. Dissection of vesicles results in erosions. The child is inert, body temperature is subfebrile. What is the most probable diagnosis?

A. Impetigo neonatorum

B. Vesicular pustulosis

C. Pseudofurunculosis

D. Sepsis

E. Ritter’s dermatitis

Answer:  Impetigo neonatorum

Explanation

In a newborn child whose mother suffers from chronic pyelonephritis and survived acute respiratory viral infection directly before labor, with delivery at term and prolonged period before discharge of waters, and who developed an erythematous rash on the 2nd day with vesicles about 1 cm large with seropurulent content, positive Nikolsky’s sign, and inertness, the most probable diagnosis is impetigo neonatorum (option A).   Impetigo neonatorum is a skin infection that commonly affects newborns, caused by Staphylococcus aureus or Streptococcus pyogenes bacteria. The infection typically begins as erythematous macules and progresses to vesicles and pustules, which can rupture and form erosions. The lesions are usually located on the face and extremities, and the Nikolsky’s sign may be positive, indicating skin fragility.   The risk factors for impetigo neonatorum include maternal infection during pregnancy or delivery, prolonged rupture of membranes, and low birth weight. The symptoms of impetigo neonatorum may include fever, lethargy, and poor feeding.   Vesicular pustulosis (option B) and Ritter’s dermatitis (option E) are other skin conditions that may present with vesicles and pustules in newborns, but they are typically caused by different pathogens and have different clinical features. Vesicular pustulosis is caused by a viral infection, while Ritter’s dermatitis is caused by a bacterial infection with Staphylococcus aureus exotoxins.   Pseudofurunculosis (option C) is a skin condition that resembles a furuncle or boil, but it is not typically seen in newborns and is not caused by the same pathogens as impetigo neonatorum.   Sepsis (option D) is a serious medical condition that can occur in newborns due to bacterial infection, but it typically presents with more severe symptoms, such as respiratory distress, hypotension, and metabolic acidosis.   Therefore, based on the newborn’s symptoms and medical history, the most probable diagnosis is impetigo neonatorum (option A), and appropriate treatment should be initiated to manage the infection and prevent complications.

162. Medical examination of a man revealed “geographic tongue”. This microsymptom is the evidence of the following vitamin deficiency:

A. Vitamins of B group

B. Vitamin A

C. Vitamin C

D. Vitamin D

E. Vitamin P P

Answer: Vitamins of B group

Explanation

The microsymptom “geographic tongue,” which is characterized by irregular patches on the tongue that resemble a map, is evidence of a deficiency in vitamins of the B group (option A).   Vitamins of the B group, also known as B-complex vitamins, play a crucial role in maintaining healthy skin, hair, and nails, as well as in the metabolism of carbohydrates, proteins, and fats. Deficiencies in these vitamins can lead to a variety of symptoms, including dermatitis, glossitis (inflammation of the tongue), and other skin and mucous membrane abnormalities.   Geographic tongue, also known as benign migratory glossitis, is a common condition in which the tongue appears to have irregular, map-like patches on its surface. The exact cause of geographic tongue is unknown, but it is believed to be related to a deficiency of B-complex vitamins, particularly vitamin B2 (riboflavin) and vitamin B3 (niacin).   Vitamin A (option B) is important for maintaining healthy vision, skin, and mucous membranes, but deficiencies in this vitamin are not typically associated with geographic tongue.   Vitamin C (option C) is important for maintaining healthy skin, cartilage, and blood vessels, as well as for supporting the immune system, but deficiencies in this vitamin are not typically associated with geographic tongue.   Vitamin D (option D) is important for maintaining healthy bones and teeth, as well as for supporting the immune system, but deficiencies in this vitamin are not typically associated with geographic tongue.   Vitamin P P (option E) is not a recognized vitamin and is not associated with any specific health benefits or deficiencies.   Therefore, based on the man’s symptoms and medical history, the microsymptom “geographic tongue” is evidence of a deficiency in vitamins of the B group (option A), and appropriate measures should be taken to address the deficiency and prevent complications.

163. 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. Sulfosalasine

B. Motilium

C. Vikasolum

D. Linex

E. Kreon

Answer: Sulfosalasine

Explanation

In a 41-year-old woman who has suffered from nonspecific ulcerative colitis for 5 years, with evident inflammatory process of lower intestinal parts and pseudopolyposive changes of the mucous membrane on rectosigmoidoscopy, and with laboratory findings of leukocytosis, anemia, and elevated sedimentation rate, the medication that provides pathogenetic treatment is sulfasalazine (option A).   Sulfasalazine is a medication that is commonly used to treat inflammatory bowel disease, including ulcerative colitis. The active ingredient of sulfasalazine is sulfapyridine and 5-aminosalicylic acid, which work by reducing inflammation in the colon and rectum.   The symptoms of ulcerative colitis typically include abdominal pain, diarrhea, rectal bleeding, and weight loss. The inflammation and ulceration of the colon and rectum can lead to pseudopolyposis, a condition in which the inflamed and damaged mucosa forms polyp-like projections.   Motilium (option B) is a medication that is commonly used to relieve symptoms of nausea and vomiting, but it does not provide pathogenetic treatment for ulcerative colitis.   Vikasolum (option C) is a medication that contains calcium gluconate and is used to treat hypocalcemia or to restore calcium balance in the body. It is not used to treat ulcerative colitis.   Linex (option D) is a probiotic medication that contains live bacteria and is used to restore the balance of intestinal microflora. While probiotics may be helpful in managing the symptoms of ulcerative colitis, they do not provide pathogenetic treatment.   Kreon (option E) is a medication that contains pancreatic enzymes and is used to treat pancreatic insufficiency. It is not used to treat ulcerative colitis.   Therefore, based on the woman’s symptoms and medical history, the medication that provides pathogenetic treatment for her nonspecific ulcerative colitis is sulfasalazine (option A), and appropriate measures should be taken to manage her symptoms and prevent complications.

164. A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples, AP rised 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 who was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples, with blood pressure raised up to 280/140 mm Hg, and with a suspicion of pheochromocytoma, the mechanism of hypertensive attack is likely due to an increasing of catecholamines concentration (option A).   Pheochromocytoma is a rare tumor of the adrenal gland that produces excessive amounts of catecholamines, such as epinephrine and norepinephrine. These hormones can cause sudden and severe increases in blood pressure, as well as other symptoms, such as headache, palpitations, and sweating.   The mechanism of hypertensive attack in pheochromocytoma is related to the excessive secretion of catecholamines, which activate alpha and beta adrenergic receptors in the blood vessels, leading to vasoconstriction and increased cardiac output. This results in a rapid and severe increase in blood pressure, which can cause damage to the blood vessels and organs if left untreated.   Aldosterone (option B) is a hormone produced by the adrenal gland that regulates water and electrolyte balance in the body. Elevated levels of aldosterone can cause sodium retention and potassium loss, leading to fluid overload and hypertension, but this is not typically associated with pheochromocytoma.   Plasma renin activity (option C) is a measure of the activity of the renin-angiotensin-aldosterone system, which regulates blood pressure and fluid balance in the body. Elevated levels of plasma renin activity can be a sign of renal artery stenosis or other conditions that affect the renin-angiotensin-aldosterone system, but this is not typically associated with pheochromocytoma.   Vasopressin (option D) is a hormone produced by the pituitary gland that regulates water balance in the body. Elevated levels of vasopressin can cause fluid retention and hypertension, but this is not typically associated with pheochromocytoma.   Thyroxine (option E) is a hormone produced by the thyroid gland that regulates metabolism in the body. Elevated levels of thyroxine can cause weight loss, tachycardia, and hypertension, but this is not typically associated with pheochromocytoma.   Therefore, based on the patient’s symptoms and medical history, the mechanism of hypertensive attack in this patient with suspected pheochromocytoma is likely due to an increasing of catecholamines concentration (option A), and appropriate measures should be taken to confirm the diagnosis and manage the symptoms.

165. 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 child who was born with a body weight of 3250 g and body length of 52 cm, and at the age of 1.5 months has sufficient actual weight (4350 g) and psychophysical development, who is breastfed but has occasional regurgitations, the cause of regurgitations is likely aerophagia (option A).   Aerophagia, or swallowing of air, is a common cause of regurgitation in infants. During breastfeeding, infants may swallow air along with milk, which can lead to discomfort and regurgitation. This is more common in infants who are breastfed, as they have to work harder to extract milk from the breast compared to bottle-fed infants.   Pyloric stenosis (option B) is a condition in which the opening between the stomach and small intestine (pylorus) becomes narrowed, leading to vomiting and poor weight gain. It typically presents in infants between 2 and 8 weeks of age, and is more common in males.   Pylorospasm (option C) is a condition in which the pylorus muscle in the stomach spasms, causing vomiting and poor weight gain. It typically presents in infants between 2 and 12 weeks of age, and is more common in firstborn males.   Acute gastroenteritis (option D) is a condition in which the lining of the stomach and intestines become inflamed, leading to diarrhea, vomiting, and fever. It can be caused by a viral or bacterial infection, and is more common in older infants and young children.   Esophageal atresia (option E) is a rare congenital condition in which the esophagus does not develop properly, leading to difficulty swallowing and regurgitation. It is typically diagnosed shortly after birth.   Therefore, based on the child’s symptoms and medical history, the cause of regurgitations is likely aerophagia (option A), and appropriate measures should be taken to manage the symptoms and prevent complications.

166. A patient with hepatic cirrhosis drank some spirits that resulted in headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, abdominal swelling. What complication of hepatic cirrhosis is meant?

A. Hepatocellular insufficiency

B. Hemorrhage from varicosely dilatated veins of esophagus

C. Portal hypertension

D. Acute stomach ulcer

E. Thrombosis of mesenteric vessels

Answer:  Hepatocellular insufficiency

Explanation

In a patient with hepatic cirrhosis who drank alcohol and subsequently developed symptoms of headache, vomiting, aversion to food, insomnia, jaundice, fetor hepaticus, and abdominal swelling, the complication of hepatic cirrhosis that is likely meant is hepatocellular insufficiency (option A).   Hepatic cirrhosis is a chronic liver disease characterized by the replacement of healthy liver tissue with fibrous scar tissue. This can lead to a variety of complications, including hepatocellular insufficiency, portal hypertension, and variceal bleeding.   Hepatocellular insufficiency is a complication of advanced liver disease in which the liver is unable to perform its normal metabolic functions, such as detoxification of toxins, metabolism of drugs and hormones, and production of essential proteins. This can lead to a variety of symptoms, including jaundice, coagulation disorders, and encephalopathy.   Portal hypertension (option C) is a complication of liver disease in which the blood pressure in the portal vein, which carries blood from the digestive organs to the liver, becomes elevated. This can lead to the formation of varices, or dilated veins, in the esophagus and stomach, which can rupture and cause life-threatening bleeding.   Hemorrhage from varicose veins of the esophagus (option B) is a common complication of portal hypertension and can occur due to rupture of varices in the esophagus or stomach.   Acute stomach ulcer (option D) is not a typical complication of hepatic cirrhosis, although it can occur in individuals with liver disease who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.   Thrombosis of mesenteric vessels (option E) is a rare complication of liver disease in which the blood vessels that supply blood to the intestines become blocked, leading to abdominal pain and diarrhea.   Therefore, based on the patient’s symptoms and medical history, the complication of hepatic cirrhosis that is likely meant is hepatocellular insufficiency (option A), and appropriate measures should be taken to manage the symptoms and prevent complications.

167. On the 4-th day of injections a 60 y.o. patient felt pain and tissue induration in the left buttock. Objectively: the skin in the superexternal quadrant of the left buttock is red and hot, palpation reveals a painful infiltrate 6х6 cm large with softening in the centre. Body temperature is 37, 90. What action is necessary to di-agnose an abscess?

A. Punction

B. Biopsy

C. Ultrasonic examination

D. X-ray investigation

E. Clinical blood analysis

Answer: Punction

Explanation

In a 60-year-old patient who is receiving injections and on the 4th day of injections develops pain and tissue induration in the left buttock, with redness and heat in the superexternal quadrant of the left buttock, and a painful infiltrate of 6×6 cm with softening in the center, the necessary action to diagnose an abscess is to perform a puncture (option A).   An abscess is a localized collection of pus within a tissue, which may develop as a result of infection or inflammation. It typically presents as a painful, swollen, and tender area with redness and warmth, and can be diagnosed by performing a puncture to obtain a sample of the pus for culture and sensitivity testing.   Biopsy (option B) is a procedure in which a small sample of tissue is removed for histological examination, and is not typically used to diagnose an abscess.   Ultrasonic examination (option C) can be helpful in identifying the presence and extent of an abscess, but puncture is necessary to obtain a sample of the pus for diagnosis.   X-ray investigation (option D) is not typically used to diagnose an abscess, although it may be helpful in identifying underlying conditions that predispose to the development of abscesses, such as osteomyelitis or foreign body.   Clinical blood analysis (option E) can be helpful in identifying signs of infection, such as leukocytosis or elevated C-reactive protein levels, but is not specific for the diagnosis of an abscess.   Therefore, based on the patient’s symptoms and medical history, the necessary action to diagnose an abscess is to perform a puncture (option A), and appropriate measures should be taken to manage the infection and prevent complications.

168. A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?

A. Dilated cardiomyopathy

B. Exudative pericarditis

C. Restrictive cardiomyopathy

D. Hypertrophic cardiomyopathy

E. Thyreotoxic cardiomyopathy

Answer: Dilated cardiomyopathy

Explanation

In a 39-year-old patient who complains of dyspnea during physical activity, edema of the legs, palpitations, and heart intermissions, and on examination has a heart rate of 150 bpm with atrial fibrillation, both ways enlarged heart with muted heart sounds, and liver enlarged 6 cm below the costal margin, and echocardiogram findings of dilated heart chambers with an end-diastolic volume of left ventricle of 6.8 cm and an ejection fraction of 29% with unchanged valve apparatus, the most probable diagnosis is dilated cardiomyopathy (option A).   Dilated cardiomyopathy is a type of heart disease characterized by dilation (enlargement) of the heart chambers and reduced heart function, typically with an ejection fraction less than 40%. The condition can be caused by genetic mutations, viral infections, alcohol abuse, and other factors. Symptoms include shortness of breath, fatigue, palpitations, and edema.   Exudative pericarditis (option B) is a condition in which there is inflammation and fluid accumulation in the pericardial sac surrounding the heart, leading to symptoms such as chest pain and shortness of breath.   Restrictive cardiomyopathy (option C) is a type of heart disease in which the heart muscle becomes stiff and rigid, leading to impaired filling of the heart chambers and reduced heart function. It can be caused by a variety of factors, including amyloidosis and sarcoidosis.   Hypertrophic cardiomyopathy (option D) is a type of heart disease in which the heart muscle becomes thickened, leading to impaired filling of the heart chambers and reduced heart function. It can be caused by genetic mutations and is a common cause of sudden cardiac death in young athletes.   Thyreotoxic cardiomyopathy (option E) is a type of heart disease that can occur in individuals with hyperthyroidism, in which the overactive thyroid gland leads to increased heart rate, blood pressure, and cardiac output, which can eventually lead to heart failure.   Therefore, based on the patient’s symptoms and medical history, the most probable diagnosis is dilated cardiomyopathy (option A), and appropriate measures should be taken to manage the symptoms and prevent complications.

169. The major repair of a hospital included renewal of colour design of hospital premises because it is of great psychological and aesthetical importance; and so the walls of patient wards will be painted under consideration of:

A. Windows orientation

B. Hospital profile

C. Diseases of patients who will be staying in these wards

D. Wall reflection coefficient

E. Creation of cozy atmosphere

Answer: Windows orientation

Explanation

When choosing the color design of a hospital, it is important to consider the orientation of the windows in the patient wards. This is because the orientation of the windows will affect the amount and quality of natural light that enters the room, and this can have a significant impact on the psychological and aesthetic well-being of the patients.   For example, if the windows face north, the room may receive less natural light and appear colder and less inviting. In contrast, if the windows face south, the room may receive more natural light and appear warmer and more inviting. In addition to considering the windows orientation, other factors such as the hospital profile, diseases of patients, wall reflection coefficient, and creation of a cozy atmosphere may also be taken into account when choosing the color design of a hospital.

170. A 10 y.o. child has average indices of body length and her chest circumference exceeds average indices, body weight index is heightened due to lipopexia. Functional characteristics of physical development are below average. Physical development of this child can be estimated as:

A. Disharmonic

B. Average

C. Below average

D. Harmonic

E. Deeply disharmonic

Answer: Disharmonic

Explanation

The description of the physical characteristics of the 10-year-old child in the question suggests that there are significant differences between various aspects of her physical development. Specifically, her chest circumference is greater than average while her functional characteristics of physical development are below average. Additionally, her body weight index is heightened due to lipopexia, which may indicate a lack of coordination between her body weight and height.   Taken together, these factors suggest that the child’s physical development is disharmonic, meaning that there is a lack of balance or coordination between different aspects of her physical development. While her body length may be average, her chest circumference and functional characteristics are not, and her body weight index is also elevated due to lipopexia. This indicates that her physical development is not following a typical or expected pattern, and there may be underlying health or developmental issues that need to be addressed.

171. Atmospheric air of an industrial centre is polluted with the following wastes of metallurgical plants: sulphuric, nitric, metal, carbon oxides that have negative influence upon the inhabitants’ health. The effct of these hazards can be characterized as:

A. Combined

B. Complex

C. Associated

D. Adjacent

E. Mixed

Answer: Combined

Explanation

The pollutants listed in the question, such as sulphuric, nitric, metal, and carbon oxides, are all harmful to human health and can have a negative impact on the respiratory system, cardiovascular system, and other organs. When multiple pollutants are present in the environment, the effects can be compounded, resulting in a greater overall impact on human health.   In this case, the combination of pollutants in the atmospheric air of the industrial center can be characterized as “combined.” This means that the pollutants are acting together to produce a greater negative effect on the health of the inhabitants than they would individually. Other possible terms for describing the effects of these pollutants could include “complex” or “mixed,” but “combined” is the most accurate and specific term for describing the synergistic effects of multiple pollutants on human health.

172. X-ray pattern of thorax organs revealed a large intensive inhomogeneous opacity with indistinct outlines on the right side at the level of the 4-th rib. In the centre of this opacity there is a horizontal level and clearing of lung tissue above it. What disease does this X-ray pattern correspond with?

A. Abscess of the right lung

B. Peripheral cancer

C. Tuberculoma of the right lung

D. Right-sided pneumothorax

E. –

Answer: Abscess of the right lung

Explanation

An abscess is a localized collection of pus within a tissue, and it can occur in the lung as a result of an infection. Common symptoms of a lung abscess include cough, fever, chest pain, and difficulty breathing.   Among the options provided, Abscess of the right lung is the most likely diagnosis based on the information provided. Peripheral cancer and tuberculoma can also present with similar symptoms, but the presence of pus and the associated symptoms suggest an infectious process rather than a tumor. Right-sided pneumothorax is characterized by a collapsed lung due to air escaping from the lung into the pleural space, and it typically presents with sudden onset of chest pain and shortness of breath. However, it does not involve the presence of pus or infection.   Therefore, based on the information provided, abscess of the right lung is the most probable diagnosis. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

173. A 30 y.o. patient has got multiple body skin rash consisting of small paired elements that are scattered on the skin diorderly and mostly focally, they are accompanied by itch. The rash appeared a few days after attending sport centre and sauna. What is the most probable diagnosis?

A. Scab

B. Eczema

C. Contact dermatitis

D. Allergic dermatitis

E. Neurodermitis

Answer: Scab

Explanation

The symptoms described in the question, including multiple body skin rash with small paired elements that are scattered on the skin disorderly and mostly focally, along with itching and a recent history of attending a sports center and sauna, are highly suggestive of scabies.   Scabies is a skin infestation caused by the Sarcoptes scabiei mite, which burrows into the skin and lays eggs. The resulting rash is typically characterized by small, raised, red bumps that may be paired or appear in a line, and is often accompanied by intense itching, especially at night. Scabies is highly contagious and can be spread through close physical contact or by sharing clothing or bedding.   Scab, or crust, is a dry, rough surface that forms over a healing wound or sore, and is not related to the symptoms described in the question. Eczema, contact dermatitis, allergic dermatitis, and neurodermatitis can also cause skin rash and itching, but they are less likely given the history of attending a sports center and sauna, and the specific characteristics of the rash as described in the question.   Therefore, the most probable diagnosis based on the information provided is scabies. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

174. A 56 y.o. patient ill with cholecystectomy suddenly had an intense hemorrhage. She needs blood transfusion. Her blood group is (V )Rh−. Hemotransfusion station doesn’t dispose of this group. What group of donors can be involved?

A. Donors of rare blood groups

B. Donors of active group

C. Relatives

D. Emergency donors

E. Reserve donors

Answer: Donors of rare blood groups

Explanation

The patient in this scenario has a blood group of (V) Rh-, which is a rare blood group. The hemotransfusion station does not have this blood group readily available, so other options must be considered.   Donors of rare blood groups are individuals who have the same rare blood group as the patient, and they may be able to donate blood for transfusion. These donors may be individuals who have previously been identified as having a rare blood group, or they may be identified through further testing of potential donors.   Donors of active group, relatives, emergency donors, and reserve donors may not be suitable in this case if they do not have the same rare blood group as the patient. It is important to ensure that blood transfusions are carefully matched to the patient’s blood group to prevent adverse reactions and ensure the success of the transfusion.   Therefore, in this case, donors of rare blood groups are the most likely group of donors that can be involved in providing blood for transfusion to the patient.

175. A 33 y.o. patient was admitted to the hospital with stopped repeated ulcerative bleeding. He was pale and exhausted. Blood count: Нb- 77 g/l, Нt- 0,25. In view of anemia there were made two attempts of blood transfusion of the same group – ()Rh+. In both cases the transfusion had to be stopped because of development of anaphylactic reaction. What transfusion medium would be advisable in this case?

A. Washed erythrocytes

B. Fresh citrate blood

C. Erythrocytic mass (native)

D. Erythrocytic suspension

E. Erythrocytic mass poor in leukocytes and thrombocytes

Answer: Washed erythrocytes

Explanation

The patient in this scenario has a history of stopped repeated ulcerative bleeding and is severely anemic. However, the patient has had two failed attempts at blood transfusion due to anaphylactic reactions, which can be life-threatening. In this case, washed erythrocytes would be the most advisable transfusion medium.   Washed erythrocytes are red blood cells that have been separated from the plasma and washed to remove any remaining plasma proteins, such as antibodies, that could potentially cause an allergic reaction. This process reduces the risk of anaphylactic reactions and makes the transfusion safer for patients who have a history of allergic reactions to blood products.   Fresh citrate blood, erythrocytic mass (native), erythrocytic suspension, and erythrocytic mass poor in leukocytes and thrombocytes all contain plasma proteins and could potentially trigger anaphylactic reactions in patients with a history of allergic reactions to blood products.   Therefore, in this case, washed erythrocytes would be the most advisable transfusion medium for the patient to reduce the risk of anaphylactic reactions and ensure a successful blood transfusion.

176. 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

Blood group and Rh compatibility testing is an important step in ensuring the safety and effectiveness of blood transfusions. In this scenario, the patient is in need of an emergency blood transfusion to address the rapid fall in blood pressure and the multiple ruptures of the spleen and small intestine.   While any doctor may be able to obtain a blood sample from the patient, it is the laboratory physician who is responsible for determining the patient’s blood group and Rh compatibility. Laboratory physicians are trained to perform blood typing and cross-matching tests, which involve testing the patient’s blood sample against potential donor blood samples to ensure compatibility.   Surgeons, traumatologists, and anesthesiologists may all be involved in the care of the patient, but they are not typically responsible for determining blood group and Rh compatibility. Therefore, the laboratory physician is the most appropriate healthcare provider to determine the patient’s blood group and Rh compatibility in this scenario.

177. 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 described in the question, including amenorrhea, hirsutism, obesity with fat tissue prevailing on the face, neck, and upper part of the body, acne vulgaris, striae cutis distense, and vaginal and uterine hypoplasia, are all consistent with Itsenko-Cushing syndrome (also known as Cushing’s syndrome).   Cushing’s syndrome is a condition caused by prolonged exposure to high levels of the hormone cortisol, which is produced by the adrenal glands. This can be due to a variety of causes, including a pituitary tumor, adrenal gland tumor, or prolonged use of corticosteroid medications. Symptoms can include weight gain, particularly in the face, neck, and upper body, hirsutism, acne, and menstrual irregularities in women.   Turner’s syndrome (B) is a genetic condition that affects females and is characterized by short stature, ovarian failure, and other physical features such as a webbed neck and a low hairline at the back of the neck. Stein-Leventhal syndrome (C), also known as polycystic ovary syndrome, can cause irregular periods, hirsutism, and acne, among other symptoms, but it typically does not involve obesity or the other physical features described in the question. Shichan syndrome (D) and Babinski-Froehlich syndrome (E) are not recognized medical conditions.   Therefore, based on the information provided, Itsenko-Cushing syndrome is the most probable diagnosis for this patient. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

178. A 14 y.o. girl got a bad mark at the lesson of math as well as teacher’s reprimand that made her cry for a long time. At the end of the lesson she suddenly lost consciousness and fell down. Objectively: skin is of pale pink colour, Ps- 100 bpm, satisfactory, AP- 110/70 mm Hg. Eyelids are closed and don’t give away to the tries of their opening. There are no evident injuries. What is the provisional diagnosis?

A. Hysteric syncope

B. Epilepsy

C. Vagotonic syncope

D. Long QT syndrome

E. Sympathicotonic collapse

Answer:  Hysteric syncope

Explanation

The symptoms described in the question, including the sudden loss of consciousness following a stressful event, along with pale skin, normal heart rate and blood pressure, and closed eyelids that do not open, are consistent with hysteric syncope.   Hysteric syncope, also known as psychogenic syncope, is a type of fainting that is triggered by psychological stress or emotional trauma. It is a form of conversion disorder, in which psychological distress manifests as physical symptoms. In hysteric syncope, the body responds to emotional stress by decreasing blood flow to the brain, resulting in loss of consciousness and other physical symptoms such as pale skin.   Epilepsy (B) is a neurological disorder characterized by recurrent seizures, which can cause loss of consciousness and other symptoms. Vagotonic syncope (C) is a type of fainting that is caused by excessive stimulation of the vagus nerve, which can lead to a sudden drop in heart rate and blood pressure. Long QT syndrome (D) is a heart rhythm disorder that can cause fainting, but it typically involves abnormal heart rhythms on an electrocardiogram. Sympathicotonic collapse (E) is not a recognized medical condition.   Therefore, based on the information provided, hysteric syncope is the most probable diagnosis for this patient. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may involve psychological counseling or therapy to address the underlying emotional stress or trauma.

179. A newborn child has purulent discharges from the umbilical wound, skin around the umbilicus is swollen. Objectively: the child’s skin is pale, of yellowgreyish colour, generalized hemorrhagic rash. Body temperature is of hectic nature. What is the most probable diagnosis?

A. Sepsis

B. Hemorrhagic disease of newborn

C. Hemolytic disease of newborn

D. Thrombocytopathy

E. Omphalitis

Answer: Sepsis

Explanation

The symptoms described in the question, including purulent discharge from the umbilical wound, swollen skin around the umbilicus, pale yellow-greyish skin color, a generalized hemorrhagic rash, and a hectic fever, suggest a serious bacterial infection known as sepsis.   Sepsis is a potentially life-threatening condition that can occur when the body’s immune response to an infection causes widespread inflammation and damage to tissues and organs. Newborns are particularly vulnerable to infections, which can spread quickly and lead to sepsis if left untreated.   Hemorrhagic disease of newborn (B) is a bleeding disorder that can occur due to vitamin K deficiency in newborns, but it typically does not involve fever or skin infections. Hemolytic disease of newborn (C) is caused by an incompatibility between the mother’s and baby’s blood types and can lead to anemia and jaundice, but it does not typically involve skin infections or hemorrhagic rash. Thrombocytopathy (D) is a bleeding disorder caused by abnormalities in platelet function, but it does not typically involve fever or skin infections. Omphalitis (E) is an infection of the umbilical stump, but it typically does not involve the systemic symptoms described in the question, such as fever and hemorrhagic rash.   Therefore, based on the information provided, sepsis is the most probable diagnosis for this newborn. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may involve antibiotics and supportive care to manage the symptoms of sepsis.

180. Elderly people develop tumors more frequently. One of the main causes is:

A. Decreased activity of cellular immunity

B. Decreased intensity of antibodies formation

C. Increased disfunctioning of mitoses

D. Increased activity of cellular immunity

E. Increased intensity of antibodies formation

Answer: Decreased activity of cellular immunity

Explanation

Elderly people are more prone to developing tumors due to a variety of factors, including changes in their immune system. One of the main causes of increased cancer risk in the elderly is a decreased activity of cellular immunity.   Cellular immunity is a type of immune response that involves the activation of immune cells, such as T cells and natural killer cells, to detect and destroy abnormal cells, including cancer cells. As people age, their immune system undergoes changes that can weaken the effectiveness of cellular immunity, making them more susceptible to cancer.   Additionally, aging can lead to DNA damage and mutations in cells, which can increase the risk of cancer development. The accumulation of environmental exposures and lifestyle factors over time can also contribute to cancer risk in the elderly.   Decreased intensity of antibodies formation (B) and increased intensity of antibodies formation (E) are not typically associated with increased cancer risk in the elderly. Increased dysfunctioning of mitoses (C) is not a recognized factor in cancer development, and increased activity of cellular immunity (D) is not typically associated with increased cancer risk in the elderly.   Therefore, the most probable cause for increased cancer risk in the elderly is a decreased activity of cellular immunity. It is important for elderly individuals to engage in healthy lifestyle habits, such as regular exercise and a balanced diet, and to undergo age-appropriate cancer screening to detect and treat cancer early.

181. A 30 y.o. man 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 described in the question, including intense pain, reddening of skin, edema in the ankle-joint area, and fever, suggest an acute attack of gout.   Gout is a type of arthritis that is caused by the buildup of uric acid crystals in the joints, leading to inflammation, pain, and swelling. Gout attacks can be triggered by factors such as diet, alcohol consumption, and certain medications, and often occur in the big toe, ankle, or knee joints.   The history of similar attacks lasting 5-6 days without residual changes in the joint is also consistent with gout, as gout attacks typically resolve within a few days to a week without causing permanent joint damage.   Infectional arthritis (B) is a type of arthritis caused by a bacterial or viral infection, which can cause joint pain, swelling, and fever, but typically involves more severe joint damage than gout. Rheumatoid arthritis (C) is an autoimmune disease that causes chronic joint inflammation and can lead to joint damage over time. Erysipelatous inflammation (D) is a type of skin infection that can cause redness, swelling, and fever, but typically does not involve joint symptoms. Osteoarthritis (E) is a type of arthritis caused by wear and tear on the joints over time, which can lead to joint pain and stiffness, but typically does not involve the acute onset and severe symptoms described in the question.   Therefore, based on the information provided, gout is the most likely diagnosis for this patient. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may involve medication to manage pain and inflammation and lifestyle modifications to prevent future gout attacks.

182. A 7 y.o. boy was admitted to the hospital. He complains of unpleasant sensations in the heart region, pain in the epigastrium, dizziness, vomiting. Objectively: evident paleness of skin, dyspnea, jugular pulse. Heart borders are within the normal range. Heart sounds are clear, HR- 170/min, small pulse. AP- 90/50 mm Hg. EKG showed: paroxysm of ventricular tachycardia. The paroxysm can be suppressed by:

A. Lidocain

B. Morphine

C. Enalapril

D. Nifedipine

E. Strophanthine

Answer: Lidocain

 Explanation

The symptoms described in the question, including unpleasant sensations in the heart region, pain in the epigastrium, dizziness, vomiting, palpitations, dyspnea, jugular pulse, and ventricular tachycardia on EKG, suggest a potentially life-threatening cardiac arrhythmia.   Ventricular tachycardia is a type of arrhythmia that can be caused by a variety of factors, including heart disease, electrolyte imbalances, and medications. It is characterized by a fast heart rate, abnormal heart rhythm, and reduced cardiac output, which can lead to symptoms such as chest pain, dizziness, and shortness of breath.   The paroxysm of ventricular tachycardia can be suppressed by medications such as lidocain (A), which is a local anesthetic and antiarrhythmic agent that works by blocking sodium channels in the heart to prevent abnormal electrical activity. Lidocain is a commonly used medication for the treatment of ventricular arrhythmias.   Morphine (B) is a pain reliever that can reduce anxiety and distress in patients with acute coronary syndromes, but it is not typically used to treat ventricular arrhythmias. Enalapril (C) is an ACE inhibitor that is used to treat hypertension and heart failure, but it is not typically used to treat ventricular arrhythmias. Nifedipine (D) is a calcium channel blocker that is used to treat hypertension and angina, but it is not typically used to treat ventricular arrhythmias. Strophanthine (E) is a cardiac glycoside that is used to treat heart failure, but it is not typically used to treat ventricular arrhythmias.   Therefore, based on the information provided, lidocain is the most appropriate medication to suppress the paroxysm of ventricular tachycardia in this patient. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

183. A child is 2 m.o. Inguinofemoral folds contain acutely inflamed foci with distinct borders in form of spots that are slightly above the surrounding areas due to skin edema. The rash has appeared during the week. Vesiculation and wetting are absent. What is the most probable diagnosis?

A. Napkin-area dermatitis

B. Infantile eczema

C. Dermatomycosis

D. Psoriasis

E. Complicated course of scabies

Answer: Napkin-area dermatitis

Explanation

The symptoms described in the question, including acutely inflamed foci with distinct borders in the inguinofemoral folds of a 2-month-old child, suggest napkin-area dermatitis.   Napkin-area dermatitis, also known as diaper rash, is a common skin condition that can occur in infants due to prolonged contact with urine and feces. The moist environment can lead to skin irritation, inflammation, and infection, which can result in redness, swelling, and distinct border spots in the inguinofemoral folds.   Infantile eczema (B) is a chronic inflammatory skin condition that can cause red, itchy, and scaly rashes on various parts of the body, including the inguinofemoral folds, but typically does not involve distinct border spots or acute inflammation. Dermatomycosis (C) is a fungal infection that can cause skin rashes and itching, but typically involves vesiculation and wetting, which are absent in the described case. Psoriasis (D) is a chronic autoimmune skin condition that can cause scaly red patches on various parts of the body, but typically does not involve the inguinofemoral folds in infants. Scabies (E) is a skin infestation caused by mites, which can cause itching and a rash with raised lines or bumps, but typically does not involve distinct border spots or acute inflammation in the inguinofemoral folds.   Therefore, based on the information provided, napkin-area dermatitis is the most probable diagnosis for this 2-month-old child. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may involve frequent diaper changes, topical creams or ointments, and proper skin care to prevent further irritation and infection.

184. A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the posterior surface of his left leg. The pain increases during changing body position and also in the upright position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?

A. Pathology of intercostal disks

B. Spinal cord tumor

C. Arachnomyelitis

D. Polyneuritis

E. Myelopathy

Answer: Pathology of intercostal disks

Explanation

The symptoms described in the question, including pain in the lumbar part of the spine that radiates to the posterior surface of the left leg, and increases with changes in body position and in the upright position, suggest a pathology of the intervertebral disks.   The intervertebral disks are the cushion-like structures that separate the vertebrae in the spine and act as shock absorbers. Pathologies of the intervertebral disks, such as herniation or bulging, can lead to compression of the spinal nerves, which can cause pain, numbness, or tingling sensations that radiate along the affected nerve pathway.   Positive symptoms of tension, such as increased pain with changes in body position, can also be indicative of a pathology of the intervertebral disks.   Spinal cord tumor (B), arachnomyelitis (C), polyneuritis (D), and myelopathy (E) typically involve more diffuse or widespread neurological symptoms, and are less likely to be associated with positive symptoms of tension. These conditions may present with pain or other neurological symptoms, but require additional diagnostic tests, such as MRI or CT scans, to confirm the diagnosis.   Therefore, based on the information provided, a pathology of intervertebral disks is the most probable preliminary diagnosis for this patient. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may involve pain management, physical therapy, or surgical intervention depending on the severity and cause of the intervertebral disk pathology.

185. A 35 y.o. patient was admitted to the local hospital a week after a road accident with clinical picture of clotted hemothorax. What is the most appropriate treatment tactic for prevention of acute pleural empyema?

A. Surgical removal of clotted hemothorax

B. Treatment by pleural punctions

C. Complex conservative therapy

D. Passive drainage of pleural cavity

E. Active drainage of pleural cavity

Answer: Surgical removal of clotted hemothorax

Explanation

The clinical picture of clotted hemothorax, which is the accumulation of blood in the pleural cavity following a traumatic injury, can be complicated by the development of acute pleural empyema, which is a bacterial infection of the pleural space.   To prevent the development of acute pleural empyema, the most appropriate treatment tactic is surgical removal of the clotted hemothorax. This involves a procedure known as thoracotomy, which is a surgical incision into the chest wall to access the pleural cavity and remove the accumulated blood and any other debris or contaminants that may be present.   Treatment by pleural punctures (B) or passive drainage of the pleural cavity (D) may be appropriate for the initial management of clotted hemothorax, but these methods do not address the underlying risk of infection and may increase the risk of complications such as acute pleural empyema.   Complex conservative therapy (C) may be appropriate for the treatment of acute pleural empyema, but is not effective for prevention, and is typically not recommended as the primary treatment for clotted hemothorax.   Active drainage of the pleural cavity (E) may also be appropriate for the management of clotted hemothorax, but may not be sufficient to prevent the development of acute pleural empyema and may require additional interventions such as antibiotics or surgery.   Therefore, based on the information provided, surgical removal of the clotted hemothorax is the most appropriate treatment tactic for prevention of acute pleural empyema following a traumatic injury. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

186. An aircraft factory processes materials with use of lasers. It is determined that the device radiates in the light spectrum and that levels of laser radiation at the workplaces exceed the alarm level. Specify, what organs will be affected in the first place?

A. Eyes

B. Skin

C. Liver

D. Spleen

E. Kidneys

Answer: Eyes

Explanation

Exposure to laser radiation can cause damage to various organs and tissues in the body, depending on the wavelength, intensity, and duration of the exposure. However, the eyes are particularly vulnerable to laser radiation and are likely to be affected in the first place.   The high energy and concentrated beam of laser radiation can cause damage to the retina, lens, and other structures of the eye, leading to a range of visual impairments, including temporary or permanent blindness, loss of color vision, and visual distortion.   In addition, exposure to laser radiation can cause a range of non-specific symptoms, such as headache, nausea, dizziness, and fatigue, which may worsen with prolonged or repeated exposure.   Skin (B), liver (C), spleen (D), and kidneys (E) may also be affected by laser radiation, particularly with high levels of exposure or prolonged exposure. However, these organs are less likely to be affected in the first place compared to the eyes.   Therefore, based on the information provided, the eyes are the most likely organs to be affected in the first place by exposure to laser radiation in the aircraft factory. It is important to take appropriate safety measures, such as wearing protective eyewear and implementing engineering and administrative controls, to minimize the risk of exposure and prevent potential health effects.

187. At a machine-building plant the casts are cleaned by means of abrasion machines that are a source of local vibration. What are the most efficient preventive measures for preventing harmful effect of vibration on workers’ organisms?

A. Use of gloves that reduce vibration

B. Preliminary and periodical medical examinations

C. Hand massaging

D. Warm hand baths

E. Giving sanitary instructions to the workers

Answer:  Use of gloves that reduce vibration

Explanation

Exposure to local vibration can cause a range of health effects, including musculoskeletal disorders, nerve damage, and circulatory disturbances. To prevent these harmful effects, it is important to implement appropriate preventive measures in the workplace.   The use of gloves that reduce vibration is one of the most efficient preventive measures for reducing the harmful effects of vibration on workers’ organisms. These gloves typically contain vibration-absorbing materials, such as gel or foam, that help to reduce the transmission of vibration to the hands and arms, which can help to prevent musculoskeletal disorders and nerve damage.   Preliminary and periodical medical examinations (B) may also be appropriate for identifying workers who are at increased risk of health effects from vibration exposure, and for monitoring the health status of workers who are exposed to vibration. However, medical examinations alone are not sufficient for preventing the harmful effects of vibration and must be combined with appropriate preventive measures.   Hand massaging (C) and warm hand baths (D) may provide temporary relief for workers who experience symptoms related to vibration exposure, but they are not effective as preventive measures for reducing the risk of health effects from vibration.   Giving sanitary instructions to the workers (E) is also important for promoting good hygiene practices and preventing the spread of infectious diseases in the workplace. However, it is not a specific preventive measure for reducing the harmful effects of vibration.   Therefore, based on the information provided, the most efficient preventive measure for preventing the harmful effects of vibration on workers’ organisms in the context of using abrasion machines is the use of gloves that reduce vibration. It is important to consult with a qualified occupational health and safety professional for an accurate assessment of the risk of vibration exposure and appropriate preventive measures for the specific workplace.

188. 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 finding of a defect in the placental lobe after delivery can indicate that a part of the placenta was not expelled from the uterus and may be retained inside. This can lead to postpartum hemorrhage, infection, and other complications, and requires prompt intervention.   In this case, the general condition of the woman is normal, and the uterus is firm, which suggests that the bleeding is not severe. However, the moderate bloody discharge indicates that there may be retained placental tissue inside the uterus, which can lead to complications if left untreated.   The absence of lacerations or ruptures in the birth canal suggests that the source of bleeding is likely to be inside the uterus. Therefore, the most necessary action in this situation is manual exploration of the uterine cavity to assess for the presence of retained placental tissue and remove it if necessary.   External massage of the uterus (B) and the use of uterine contracting agents (C) may also be appropriate for managing postpartum hemorrhage, but they are not sufficient for addressing the underlying cause of the bleeding in this case.   Urine drainage, cold on the lower abdomen (D), and the use of hemostatic medications (E) are not indicated for the management of retained placental tissue and are unlikely to be effective in preventing complications.   Therefore, based on the information provided, the most necessary action in this situation is manual exploration of the uterine cavity to assess for the presence of retained placental tissue and remove it if necessary. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

189. 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. Lung cancer

B. Macrofocal pneumonia

C. Bronchoectatic disease

D. Focal pulmonary tuberculosis

E. Exudative pleuritis

Answer: Lung cancer

Explanation

The symptoms and physical examination findings described in the question are consistent with a diagnosis of lung cancer. Dyspnea, chest pain, weakness, and hemoptysis (blood mixed with mucus in sputum) are common symptoms of lung cancer, which can develop gradually over several months.   The vocal tremor over the right lung, dull percussion sound, and absence of breathing sounds on auscultation suggest the presence of a mass or lesion in the lungs that is obstructing the airways and preventing the normal flow of air. This can be caused by a tumor, which can also lead to the development of pleural effusion and exudative pleuritis (E).   Macrofocal pneumonia (B) and focal pulmonary tuberculosis (D) may also present with similar symptoms, such as cough, fever, and hemoptysis, but are less likely to cause the same degree of respiratory obstruction and are less common in older adults.   Bronchoectatic disease (C) is a chronic condition characterized by abnormal dilation of the bronchi and can lead to recurrent respiratory infections, but is unlikely to present with the acute onset and severity of symptoms described in the question.   Therefore, based on the information provided, the most probable diagnosis for this patient is lung cancer. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may include surgical resection of the tumor, chemotherapy, radiation therapy, and supportive care.

190. Poorly refined wastes of an industrial plant are usually thrown into the river that supplies drinking water. It causes perishing of some microorganisms, disturbs processes of water self-purification and worsens its quality that can have negative influence upon people’s health. How is this effect of environmental factors called?

A. Indirect

B. Direct

C. Associated

D. Complex

E. Combined

Answer:  Indirect

Explanation

The effect of poorly refined wastes of an industrial plant on the quality of the river water that supplies drinking water is an example of an indirect effect of environmental factors on human health.   Indirect effects of environmental factors refer to the impact that environmental factors have on intermediate factors, such as air, water, soil, or food, which in turn can affect human health. In this case, the poorly refined wastes of the industrial plant are directly affecting the quality of the river water, which can potentially lead to negative health effects in humans who consume the contaminated water.   Direct effects of environmental factors (B) refer to the impact that environmental factors have directly on human health, such as exposure to air pollutants or radiation.   Associated effects of environmental factors (C) refer to the correlation between environmental factors and health outcomes, but do not necessarily imply causation.   Complex effects of environmental factors (D) refer to the combined impact of multiple environmental factors on human health.   Combined effects of environmental factors (E) refer to the interaction between different environmental factors that can lead to greater health impacts than the sum of their individual effects.   Therefore, based on the information provided, the effect of poorly refined wastes of an industrial plant on the quality of the river water that supplies drinking water is an example of an indirect effect of environmental factors on human health. It is important to implement appropriate environmental controls and regulations to prevent or mitigate the negative impact of industrial waste on the environment and human health.

191. A 22 y.o. patient complains of having boring pain in the right iliac region for one week, morning sickness, taste change. Delay of menstruation is 3 weeks. Objectively: AP- 110/70 mm Hg, Ps- 78/min, t 0- 37, 00. Bimanual examination revealed that uterus is a little enlarged, soft, movable, painless. Appendages palpation: a painful formation 3х4 cm large on the right, it is dense and elastic, moderately movable. What is the most probable diagnosis?

A. Progressing tubal pregnancy

B. Interrupted tubal pregnancy

C. Cyst of the right ovary

D. Uterine pregnancy

E. Acute appendicitis

Answer: Progressing tubal pregnancy

Explanation

The presence of boring pain in the right iliac region, morning sickness, taste change, and a delay of menstruation suggest the possibility of pregnancy. However, the presence of a painful formation on the right appendage, which is dense and elastic and moderately movable, is suggestive of a tubal pregnancy.   The bimanual examination reveals an enlarged, soft, and movable uterus, which is consistent with an early uterine pregnancy. However, the presence of a painful formation on the right appendage suggests that there may be a tubal pregnancy, which can cause the formation of a mass or swelling in the fallopian tube.   Therefore, based on the information provided, the most probable diagnosis is a progressing tubal pregnancy. It is important to confirm the diagnosis with appropriate imaging studies, such as ultrasound, and to provide prompt medical intervention to prevent complications such as rupture of the fallopian tube and hemorrhage.   Cyst of the right ovary (C), uterine pregnancy (D), and acute appendicitis (E) are less likely to be the cause of the symptoms and findings described in this case.   Therefore, a progressing tubal pregnancy should be considered as the most probable diagnosis in this case. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

192. A 15 y.o. patient has developmental lag, periodical skin yellowing. Objectively: spleen is 16х12х10 cm large, holecistolithiasis, skin ulcer on the lower third of his left crus. Blood count: erythrocytes – 3, 0 · 1012/L, Hb- 90 g/L, C.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin – 56 mmole/L, indirect bilirubin – 38 mmole/L. Choose the way of treatment:

A. Splenectomy

B. Spleen transplantation

C. Portocaval anastomosis

D. Omentosplenopexy

E. Omentohepatopexy

Answer: Splenectomy

Explanation

The patient’s symptoms and findings suggest a diagnosis of hereditary spherocytosis, which is a genetic disorder that causes the red blood cells to be more fragile and prone to destruction, leading to anemia, jaundice, and an enlarged spleen. The presence of holecistolithiasis and a skin ulcer on the lower third of the left crus may also be associated with this condition.   Splenectomy (surgical removal of the spleen) is the most effective treatment for hereditary spherocytosis, as it eliminates the site of red blood cell destruction and improves anemia and jaundice. In some cases, splenectomy may also improve or resolve other associated symptoms and complications, such as gallstones and leg ulcers.   Spleen transplantation (B), portocaval anastomosis (C), omentosplenopexy (D), and omentohepatopexy (E) are not indicated for the treatment of hereditary spherocytosis.   Therefore, based on the information provided, the most appropriate treatment for the patient with hereditary spherocytosis is splenectomy. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

193. A 30 y.o. parturient woman was taken to the maternity house with complaints of having acute, regular labour pains that last 25-30 seconds every 1,5-2 minutes. Labour activity began 6 hours ago. Uterus is in higher tonus, head of the fetus is above the opening into the small pelvis. Fetal heartbeat is 136/min. P.V: cervical dilatation is 4 cm, uterine fauces is spasming at a height of parodynia. Head is level with opening into the small pelvis, it is being pushed off. What is the most probable diagnosis?

A. Discoordinated labour activity

B. Secondary powerless labour activity

C. Pathological preliminary period

D. Primary powerless labour activity

E. Normal labour activity

Answer: Discoordinated labour activity

Explanation

The symptoms and findings described suggest that the woman is in active labor with regular contractions and cervical dilation of 4 cm. However, the spasm of the uterine fauces at the height of parodynia and the lack of progress in fetal descent suggest the possibility of discoordinated labor activity.   Discoordinated labor activity is a condition in which the contractions of the uterus are not synchronized, leading to ineffective uterine contractions that do not result in adequate cervical dilation or fetal descent. This can be caused by various factors, such as maternal exhaustion, fetal malpresentation, or uterine dysfunction.   Secondary powerless labor activity (B) refers to a condition in which the labor process has started but has subsequently stalled, typically due to maternal exhaustion, ineffective uterine contractions, or fetal malpresentation.   Pathological preliminary period (C) refers to a condition in which the early stage of labor (before cervical dilation of 4 cm) is prolonged or difficult, typically due to cervical insufficiency, premature rupture of membranes, or fetal malpresentation.   Primary powerless labor activity (D) refers to a condition in which the labor process fails to start or progress due to inadequate uterine contractions or fetal malpresentation.   Normal labor activity (E) would not typically present with the spasm of the uterine fauces at the height of parodynia and the lack of progress in fetal descent observed in this case.   Therefore, based on the information provided, the most probable diagnosis is discoordinated labor activity. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate management plan, which may include monitoring of fetal well-being, augmentation of labor with oxytocin, or cesarean delivery if necessary.

194. A primigravida woman appealed to the antenatal clinic on the 22.03.03 with complaints of boring pain in the lower part of abdomen. Anamnesis registered that her last menstruation was on the 4.01.03. Bimanual examination revealed that uterine servix is intact, external fauces is closed, uterus is enlarged up to the 9-th week of pregnancy, movable, painless. What complication can be suspected?

A. Risk of abortion in the 9-th week of pregnancy

B. Abortion that started in the 9-th week of pregnancy

C. Hysteromyoma

D. Vesicular mole

E. –

Answer: Risk of abortion in the 9-th week of pregnancy

Explanation

The woman’s symptoms of boring pain in the lower part of the abdomen and the gestational age of 9 weeks indicate that she may be at risk of abortion, which is the loss of pregnancy before the fetus is viable.   The fact that the cervix is intact, the external os is closed, and the uterus is enlarged and painless is suggestive of a threatened abortion, which is a condition in which there is vaginal bleeding in the first 20 weeks of pregnancy and the cervix is closed. The uterus may be enlarged or the size of the gestational sac may be smaller than expected.   Hysteromyoma (C) is a benign tumor of the uterus that may cause pain or abnormal uterine bleeding, but is less likely to present with the symptoms and findings described in this case.   Vesicular mole (D) is a rare type of gestational trophoblastic disease that presents with vaginal bleeding, uterine enlargement, and the presence of grape-like vesicles in the uterus on ultrasound. It is less likely to be the cause of the symptoms and findings described in this case.   Therefore, based on the information provided, the most probable complication is a risk of abortion in the 9th week of pregnancy. It is important to monitor the woman closely for any signs of bleeding or other complications, and to provide appropriate management and support as needed.

195. On the 15-th day after a minor trauma of the right foot a patient felt malaise, fatigability, irritability, headache, high body temperature, feeling of compression, tension and muscular twitching of his right crus. What disease can it be?

A. Tetanus

B. Anaerobic gas gangrene

C. Erysipelas

D. Acute thrombophlebitis

E. Thromboembolism of popliteal artery

Answer: Tetanus

Explanation

Tetanus is a bacterial infection caused by Clostridium tetani, which enters the body through a wound or injury and produces a neurotoxin that affects the nervous system. The symptoms of tetanus can appear anywhere from a few days to several weeks after the initial injury, and can include malaise, fatigue, irritability, headache, high body temperature, muscle stiffness and spasms, and a feeling of compression or tension in the affected area.   In this case, the symptoms of malaise, fatigue, irritability, headache, and high body temperature, as well as the feeling of compression, tension, and muscular twitching in the right crus, suggest the possibility of tetanus. The history of a minor trauma to the right foot also increases the likelihood of tetanus, as this is a common route of entry for the bacteria.   Anaerobic gas gangrene (B), erysipelas (C), acute thrombophlebitis (D), and thromboembolism of popliteal artery (E) are less likely to be the cause of the symptoms and history described in this case.   Therefore, based on the information provided, the most probable disease is tetanus. It is important to seek immediate medical attention and treatment for tetanus, which may include wound care, antibiotics, and tetanus immunoglobulin to neutralize the tetanus toxin.

196. 10 years ago a patient had a fracture in the middle one-third of his left femoral bone, and during the last 7 years he has been having acute inflammation in the area of old fracture accompanied by formation of a fistula through which some pus with small fragments of bone tissue is discharged. After a time the fistula closes. What complication of the fracture is it?

A. Chronic osteomyelitis

B. Bone tuberculosis

C. Soft tissue phlegmon

D. False joint

E. Trophic ulcer

Answer: Chronic osteomyelitis

Explanation

Chronic osteomyelitis is a bone infection that can occur after a fracture, especially if there is an open wound or if the fracture is not properly treated. The symptoms of chronic osteomyelitis can include recurrent acute inflammation in the affected area, formation of a fistula through which pus and fragments of bone tissue are discharged, and periods of remission when the fistula closes.   In this case, the history of a fracture in the middle one-third of the left femoral bone, followed by recurrent acute inflammation in the same area and the formation of a fistula through which pus and bone fragments are discharged, suggests the possibility of chronic osteomyelitis. The fact that the fistula periodically closes and then reopens further supports this diagnosis.   Bone tuberculosis (B), soft tissue phlegmon (C), false joint (D), and trophic ulcer (E) are less likely to be the cause of the symptoms and history described in this case.   Therefore, based on the information provided, the most probable complication of the fracture is chronic osteomyelitis. It is important to seek prompt medical attention and treatment for chronic osteomyelitis, which may include antibiotics, surgical debridement of infected tissue, and bone grafting if necessary.

197. Medical examination of a 43 y.o. man revealed objectively pailness of skin and mucous membranes, smoothness of lingual papillas, transverse striation of nails, fissures in the mouth corners, tachycardia. Hemoglobin content amounts 90 g/l; there are anisocytosis, poikilocytosis. The most probable causative agent of this condition is deficiency of the following microelement:

A. Iron

B. Copper

C. Zinc

D. Magnesium

E. Selenium

Answer: Iron

Explanation

Iron deficiency is a common cause of anemia, which can present with symptoms such as pallor of the skin and mucous membranes, smoothness of lingual papillae, transverse striation of nails, fissures in the mouth corners, and tachycardia. The presence of anisocytosis and poikilocytosis on the blood test also suggests a possible diagnosis of iron deficiency anemia.   Copper (B), zinc (C), magnesium (D), and selenium (E) deficiencies are less likely to be the cause of the symptoms and findings described in this case.   Therefore, based on the information provided, the most probable causative agent of this condition is iron deficiency. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan, which may include iron supplements and dietary changes to increase iron intake.

198. The total area of ground intended for building of a regional hospital is 2,0 hectare. What is the highest possible capacity of the in-patient hospital that can be built upon this ground?

A. 100 beds

B. 200 beds

C. 400 beds

D. 800 beds

E. Over 1000 beds

Answer: 100 beds

Explanation

The highest possible capacity of the in-patient hospital that can be built upon a 2.0-hectare ground will depend on a number of factors, such as the size and layout of the hospital buildings, the availability of space for parking, and the need for open spaces and green areas.   However, as a general rule of thumb, a hospital typically requires about 10,000 to 20,000 square meters of land area per 100 beds, depending on the level of complexity and specialization of the hospital. Based on this estimate, a 2.0-hectare (20,000 square meters) ground may be able to accommodate a hospital with a capacity of approximately 100 beds.   Therefore, the highest possible capacity of the in-patient hospital that can be built upon a 2.0-hectare ground is likely to be around 100 beds. However, it is important to consult with a qualified architect or hospital planner to determine the optimal capacity and layout of a hospital based on specific needs and requirements.

199. A 33 y.o. woman survived two operations on account of extrauterine pregnancy, both uterine tubes were removed. She consulted a doctor with a question about possibility of having a chi-ld. What can be advised in this case?

A. Extracorporal fertilization

B. Insemination with her husband’s semen

C. Substitutional maternity

D. Artifical fertilization with donor’s semen

E. Induction of ovulation

Answer: Extracorporal fertilization

Explanation

In this case, since both uterine tubes have been removed due to extrauterine pregnancy, the woman may experience difficulty in conceiving naturally. Therefore, the most appropriate option to advise in this case is A) Extracorporeal fertilization.   Extracorporeal fertilization, also known as in vitro fertilization (IVF), is a method of assisted reproductive technology that involves fertilizing an egg with sperm outside the body and then implanting the resulting embryo into the uterus. This method can be used to help women who have difficulty conceiving due to various reasons, including the absence of uterine tubes.   Insemination with her husband’s semen (B) is a method of assisted reproductive technology that involves placing sperm directly into the uterus, but it may not be effective in this case since the absence of uterine tubes makes it difficult for the sperm to reach the egg.   Substitutional maternity (C) is a method of having a child through a surrogate mother who carries the pregnancy to term, but this may not be a preferred option for all couples due to ethical or legal concerns.   Artificial fertilization with donor’s semen (D) is a method of assisted reproductive technology that involves using sperm from a donor to fertilize the egg, but this may not be a preferred option for all couples due to personal or religious beliefs.   Induction of ovulation (E) is a method of stimulating the ovaries to produce eggs, but it may not be effective in this case since the absence of uterine tubes makes it difficult for the fertilized egg to reach the uterus.   Therefore, based on the information provided, the most appropriate option to advise in this case is extracorporeal fertilization (IVF), which can help the woman conceive despite the absence of uterine tubes. It is important to consult with a qualified fertility specialist for an accurate diagnosis and appropriate treatment plan.

200. A worker diagnosed with “acute dysentery”was sent to the infectious department by a doctor of aid post. What document should be used for registration of this disease?

A. Urgent report on infectious disease

B. Statistic coupon for registration of final diagnoses

C. Outpatient’s card

D. Inpatient’s card

E. Statistic card of the patient who left in-patient hospital

Answer: Urgent report on infectious disease

Explanation

An urgent report on infectious disease is a document used for reporting and registering cases of infectious diseases to the relevant authorities. It is typically used by healthcare providers, such as doctors or nurses, to report suspected or confirmed cases of infectious diseases to local health departments or other public health agencies.   In this case, since the worker was diagnosed with acute dysentery and was sent to the infectious department, an urgent report on infectious disease should be used to report and register the case with the relevant authorities. This is important for disease surveillance and control, as well as for monitoring and responding to outbreaks of infectious diseases.   Statistic coupon for registration of final diagnoses (B), outpatient’s card (C), inpatient’s card (D), and statistic card of the patient who left in-patient hospital (E) are not appropriate documents for registering and reporting cases of infectious diseases.   Therefore, based on the information provided, the appropriate document for registration of acute dysentery as an infectious disease is an urgent report on infectious disease.
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