Question From ( 151 To 200 )
151. A 24 year old patient complains about general weakness, dizziness, body temperature rise up to 37, 5oC, sore throat, neck edema, enlargement of submaxillary lymph nodes. Objectively: mucous membrane of oropharynx is edematic and cyanotic, tonsils are enlarged and covered with films that spread beyond the tonsils and cannot be easily removed. What is the leading mechanism of this illness’ development?
A. Action of bacterial exotoxin
B. Action of bacterial endotoxin
C. Allergic
D. Accumulation of suboxidated products
E. Bacteriemia
Answer: Action of bacterial exotoxin
Explanation
| The leading mechanism of this illness’ development is likely the action of bacterial exotoxin. The patient’s symptoms of sore throat, neck edema, and enlarged submaxillary lymph nodes, along with the objective findings of edematous and cyanotic mucous membrane in the oropharynx and tonsils covered with films that cannot be easily removed, are all consistent with a diagnosis of acute tonsillitis, which is typically caused by bacterial infection. Many bacteria that cause tonsillitis produce exotoxins, which are potent protein toxins that can damage host cells and tissues. The films on the tonsils may be due to the accumulation of dead cells and bacteria, as well as exotoxins. Bacterial endotoxin, allergic reactions, accumulation of suboxidated products, and bacteremia are less likely to be the leading mechanism of this illness’ development, as they are less commonly associated with acute tonsillitis. Therefore, the leading mechanism of this illness’ development is likely the action of bacterial exotoxin, and the patient should be evaluated and treated by a healthcare provider to manage the symptoms and prevent complications, such as abscess formation or spread of infection. Treatment may include antibiotics and supportive care to relieve pain and fever. |
152. A 38 year old man complains about mild pain and muscle weakness of shoulder and pelvic girdles and back that has been progressing for the last 3 weeks. He has also significant problems with getting up, going up and down the stairs and shaving. It is suspected that the patient is suffering from dermatomyositis. Blood count: Hb – 114 g/l, leukocytes – 10, 8 · 109/l, eosin – 9%, ESR – 22 mm/h, C-reactive protein (++). Change of the following laboratory factor will be of the greatest diagnostic importance:
A. Creatine phosphokinase
B. Ceruloplasmin
C. Sialic acids
D. Antibodies to the native DNA
E. γ-globulins
Answer: Creatine phosphokinase
Explanation
| The change of creatine phosphokinase (CPK) will be of the greatest diagnostic importance in this case. Dermatomyositis is a rare autoimmune disease that affects the muscles and skin. One of the characteristic features of dermatomyositis is muscle weakness, particularly in the proximal muscles (shoulder and pelvic girdles). The diagnosis of dermatomyositis is based on clinical features, such as muscle weakness, and supportive laboratory findings. CPK is an enzyme that is found primarily in skeletal muscle. However, when muscle tissue is damaged, such as in dermatomyositis, CPK is released into the bloodstream, leading to elevated levels of CPK in the blood. Therefore, CPK is an important laboratory marker for muscle damage and can be used to support the diagnosis of dermatomyositis. The other laboratory findings in this case, such as elevated ESR and C-reactive protein, can indicate inflammation, but are less specific for dermatomyositis. Antibodies to native DNA are typically associated with systemic lupus erythematosus, and ceruloplasmin and sialic acids are not commonly used in the diagnosis of dermatomyositis. Therefore, the change of CPK will be of the greatest diagnostic importance in this case, and the patient should be further evaluated and treated by a rheumatologist or other healthcare provider experienced in the management of autoimmune diseases. Treatment may include corticosteroids, immunosuppressive agents, and/or physical therapy to improve muscle function. |
153. A 9 year old boy has been suffering from diabetes mellitus for a year. He gets insulin injections (humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day. Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures should be taken in order to prevent lipodystrophy?
A. To change point of introduction
B. To limit fats in the boy’s diet
C. To reduce insulin dose
D. To apply periodically other types of insulin
E. To administer antioxidants
Answer: To change point of introduction
Explanation
| To prevent lipodystrophy, the point of insulin injection should be changed periodically. Lipodystrophy is a condition characterized by the accumulation or loss of subcutaneous fat at the site of insulin injection, which can affect the absorption and effectiveness of insulin. To prevent lipodystrophy, it is recommended to rotate the injection site with each dose of insulin. This means that the insulin injection should be given in different areas of the body, such as the abdomen, thighs, or buttocks, rather than the same location every time. Limiting fats in the boy’s diet or reducing the insulin dose may not necessarily prevent lipodystrophy, although a healthy diet and appropriate insulin dosing are important for managing diabetes. Applying periodically other types of insulin or administering antioxidants are also not necessary for preventing lipodystrophy. Therefore, to prevent lipodystrophy, the point of insulin injection should be changed periodically, and the patient and their caregivers should be educated on proper injection technique and rotation of injection sites. This can help to ensure optimal absorption and effectiveness of insulin, as well as prevent complications such as lipodystrophy. |
154. A 25 year old pediatrician fell ill a week ago: body temperature rose up to 37, 6oC, there appeared a slight swelling on his neck. His illness was diagnosed as ARD, cervical lymphadenitis. Treatment course included erythromycin, hot compress on the neck. In course of treatment body tempearture rose up to 39oC, there appeared headache, repeated vomiting, meningeal syndrome. What studies are necessary for the final diagnosis?
A. Cerebrospinal puncture
B. Puncture of cervical lymph node
C. Complete blood count
D. Sputum test for secondary flora
E. Roentgenological examination of lungs
Answer: Cerebrospinal puncture
Explanation
| The necessary study for the final diagnosis in this case is cerebrospinal fluid (CSF) analysis, which is obtained by performing a lumbar puncture. The initial diagnosis of acute respiratory disease (ARD) and cervical lymphadenitis was likely based on the patient’s symptoms of fever and neck swelling. Erythromycin and hot compresses were prescribed as a typical treatment for bacterial infections such as lymphadenitis. However, the subsequent development of high fever, headache, vomiting, and meningeal syndrome suggests the possibility of meningitis, which is an infection and inflammation of the membranes surrounding the brain and spinal cord. In order to confirm or rule out the diagnosis of meningitis, a lumbar puncture should be performed to obtain a sample of CSF for analysis. CSF analysis can reveal the presence of bacteria, white blood cells, and other indicators of infection or inflammation, which can help to diagnose meningitis and determine the appropriate treatment. The other tests listed, such as puncture of cervical lymph node, complete blood count, sputum test for secondary flora, and roentgenological examination of lungs, may be helpful in diagnosing other conditions but are less relevant in this case, where meningitis is suspected. Therefore, the necessary study for the final diagnosis in this case is cerebrospinal fluid analysis obtained by performing a lumbar puncture, and the patient should be evaluated and treated by a healthcare provider to manage the symptoms and prevent complications. Treatment for meningitis typically includes antibiotics and supportive care. |
155. A 41 year old 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: WBC- 9, 8 · 109/l, RBC- 3, 0· 1012/l, ESR – 52 mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfosalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Answer: Sulfosalasine
Explanation
| The medication that provides pathogenetic treatment of this patient with nonspecific ulcerative colitis is sulfasalazine. Nonspecific ulcerative colitis is a chronic inflammatory bowel disease that affects the colon and rectum. The disease is characterized by periods of exacerbation and remission, and can cause symptoms such as abdominal pain, diarrhea, and rectal bleeding. Treatment of ulcerative colitis aims to reduce inflammation and manage symptoms. Sulfasalazine is a medication that is commonly used to treat inflammatory bowel diseases such as ulcerative colitis. It works by reducing inflammation in the colon and rectum. Sulfasalazine is a combination of two compounds, sulfapyridine and 5-aminosalicylic acid (5-ASA), which act locally in the intestines to reduce inflammation. Sulfasalazine is usually taken orally, and the dose is adjusted based on the severity of the disease and the patient’s response to treatment. The other medications listed, such as Motilium, Vikasolum, Linex, and Kreon, are not typically used for the treatment of ulcerative colitis, as they are not specifically designed to address the underlying inflammation in the colon and rectum. Therefore, sulfasalazine is the medication that provides pathogenetic treatment of this patient with nonspecific ulcerative colitis, and the patient should be evaluated and treated by a gastroenterologist or other healthcare provider experienced in the management of inflammatory bowel diseases. Treatment may also include other medications such as corticosteroids, immunomodulators, and biologics, as well as lifestyle modifications such as dietary changes and stress management. |
156. A 49 year old female patient was admitted to a hospital with acute attacks of headache accompanied by pulsation in temples, AP rose up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?
A. Increase of catecholamine concentration
B. Increase of aldosterone level in blood
C. Increase of plasma renin activity
D. Increase of vasopressin secretion
E. Increase of thyroxine secretion
Answer: Increase of catecholamine concentration
Explanation
| The mechanism of hypertensive attack in this patient with suspected pheochromocytoma is an increase in catecholamine concentration. Pheochromocytoma is a rare neuroendocrine tumor that usually arises from the adrenal medulla and produces excessive amounts of catecholamines, such as epinephrine and norepinephrine. Catecholamines are hormones that can cause constriction of blood vessels, leading to an increase in blood pressure. The symptoms of pheochromocytoma can include episodic or sustained hypertension, headaches, palpitations, sweating, and anxiety, among others. The hypertension in pheochromocytoma is often paroxysmal, meaning it comes and goes, and is associated with other symptoms such as headache and sweating. The other mechanisms listed, such as an increase in aldosterone level, plasma renin activity, vasopressin secretion, or thyroxine secretion, are less likely to be associated with pheochromocytoma. Therefore, the mechanism of hypertensive attack in this patient with suspected pheochromocytoma is an increase in catecholamine concentration, and the patient should be evaluated and treated by an endocrinologist or other healthcare provider experienced in the management of adrenal tumors. Treatment may involve surgery to remove the tumor, as well as medications to control blood pressure and other symptoms. |
157. 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
| The cause of regurgitations in this breast-fed infant is likely to be aerophagia. Aerophagia, or swallowing of air, is a common cause of regurgitation in infants. Breast-fed infants may swallow air during feeding if they are positioned incorrectly or if they have a poor latch. Swallowed air can lead to gas and bloating, as well as regurgitation of milk. Pyloric stenosis and pylorospasm are conditions that can cause vomiting and poor feeding in infants, but they typically present with symptoms earlier than 1.5 months of age. Acute gastroenteritis is a possibility, but it is less likely in an otherwise healthy infant who is gaining weight appropriately and has normal psychophysical development. Esophageal atresia is a congenital condition in which the esophagus does not connect properly to the stomach, but it is typically diagnosed soon after birth and would cause more severe symptoms such as difficulty feeding and choking. Therefore, in this breast-fed infant with regurgitations, the most likely cause is aerophagia. The infant’s mother should be encouraged to ensure proper positioning and latch during breastfeeding, and to burp the infant frequently to reduce the amount of swallowed air. If the regurgitations persist or are accompanied by other symptoms, the infant should be evaluated by a pediatrician. |
158. Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
A. Chronic tonsillitis
B. Chronic pharyngitis
C. Acute lacunar tonsillitis
D. Paratonsillitis
E. Tonsillar tumour
Answer: Chronic tonsillitis
Explanation
| Chronic tonsillitis is a condition in which the tonsils become inflamed and infected on a recurrent or persistent basis. It often follows repeated episodes of acute tonsillitis, such as the angina the patient experienced three weeks prior. Chronic tonsillitis can cause symptoms such as weakness, fatigue, fever, and enlarged lymph nodes, as well as persistent sore throat and difficulty swallowing. The presence of flabby tonsils that stick together with arches and purulent plugs in lacunae are classic signs of chronic tonsillitis. The enlargement of retromaxillary lymph nodes is also a common finding in chronic tonsillitis. Chronic pharyngitis, acute lacunar tonsillitis, and paratonsillitis can all cause similar symptoms, but the presence of purulent plugs in the tonsil lacunae suggests chronic tonsillitis as the most likely diagnosis. Tonsillar tumors are rare and typically present with different symptoms, such as difficulty swallowing, weight loss, and enlarged lymph nodes in the neck. Therefore, the most probable diagnosis in this case is chronic tonsillitis, and the patient should be evaluated and treated by an otolaryngologist or other healthcare provider experienced in the management of tonsil-related conditions. Treatment may involve antibiotics, tonsillectomy, or other interventions depending on the severity and frequency of symptoms. |
159. A 43 year old patient had rightsided deep vein thrombosis of iliofemoral segment 3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right extremity. Objectively: moderate edema of shin, brown induration of skin in the lower third of shin, varix dilatation of superficial shin veins are present. What is the most probable diagnosis?
A. Postthrombophlebitic syndrome, varicose form
B. Acute thrombosis of right veins
C. Lymphedema of lower right extremity
D. Parkes-Weber syndrome
E. Acute thrombophlebitis of superficial veins
Answer: Postthrombophlebitic syndrome, varicose form
Explanation
| Postthrombophlebitic syndrome is a chronic condition that can occur after a deep vein thrombosis (DVT). It is characterized by chronic venous insufficiency, which can cause symptoms such as leg pain, swelling, and skin changes. Varicose form of postthrombophlebitic syndrome refers to the presence of varicose veins, which can develop as a result of chronic venous insufficiency. The patient’s history of right-sided DVT three years prior puts him at increased risk for postthrombophlebitic syndrome. The sense of heaviness, edema, and skin changes in the lower right extremity are consistent with this diagnosis. The presence of varix dilatation of superficial shin veins is also a common finding in postthrombophlebitic syndrome. Acute thrombosis or acute thrombophlebitis of superficial veins would cause more acute symptoms and would be less likely in a patient with a history of previous DVT. Lymphedema is another possible cause of lower extremity edema, but it typically presents with different symptoms such as skin thickening, fibrosis, and impaired lymphatic drainage. Parkes-Weber syndrome is a rare genetic disorder that can cause arteriovenous malformations in the limbs, but it would present with different symptoms such as visible vascular anomalies and increased blood flow. Therefore, the most probable diagnosis in this case is postthrombophlebitic syndrome, varicose form, and the patient should be evaluated and treated by a vascular specialist or other healthcare provider experienced in the management of venous disorders. Treatment may involve compression stockings, lifestyle modifications, and in some cases, surgical interventions to repair or remove damaged veins. |
160. A 23 year old patient fell ill 3 weeks ago when she noticed a very painful induration in her axillary crease. 4-5 days later it burst and discharged a lot of pus. After that some new infiltrations appeared around the affected area. The patient has never suffered from skin diseases before. What is the most probable diagnosis?
A. Hydradenitis
B. Furuncle
C. Mycosis
D. Herpes zoster
E. Streptococcal impetigo
Answer: Hydradenitis
Explanation
| Hydradenitis is a chronic inflammatory condition of the sweat glands, usually affecting the apocrine sweat glands in the armpits, groin, and genital areas. It can cause painful nodules, abscesses, and draining sinuses in affected areas. The condition is associated with bacterial infection, and the abscesses may contain pus. The patient’s symptoms of a painful induration in the axillary crease that later burst and discharged pus, followed by the appearance of new infiltrations around the affected area, are consistent with hydradenitis. The fact that the patient has never suffered from skin diseases before is also typical of hydradenitis, which often develops in young adults who have no prior history of skin problems. Furuncle, or a boil, is a localized skin infection that usually involves a hair follicle. Mycosis is a fungal infection of the skin. Herpes zoster, or shingles, is a viral infection that causes a painful rash. Streptococcal impetigo is a bacterial skin infection that typically presents as a honey-colored crust on the skin. Therefore, the most probable diagnosis in this case is hydradenitis, and the patient should be evaluated and treated by a dermatologist or other healthcare provider experienced in the management of skin conditions. Treatment may involve antibiotics, topical agents, or in some cases, surgical intervention. |
161. A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in the arm is absent. “Scarf”symptom is positive. What is the most probable diagnosis?
A. Total right-sided obstetric paralysis
B. Proximal right-sided obstetric paralysis
C. Distal right-sided obstetric paralysis
D. Hemiparesis
E. Tetraparesis
Answer: Total right-sided obstetric paralysis
Explanation
| The most probable diagnosis in this case is total right-sided obstetric paralysis. Obstetric paralysis, also known as Erb’s palsy, is a type of brachial plexus injury that can occur during difficult deliveries, particularly those involving shoulder dystocia. Total obstetric paralysis refers to a complete loss of motor function in the affected limb, while partial or proximal obstetric paralysis refers to a partial loss of function. The presence of a limp, pronated arm with absent movement and a positive “scarf” sign (inability to adduct the arm across the chest) is consistent with total obstetric paralysis. The large birth weight of the child may have contributed to the difficulty in delivery and increased the risk of brachial plexus injury. Distal obstetric paralysis typically affects the hand and fingers, while hemiparesis and tetraparesis refer to weakness or paralysis on one or both sides of the body, respectively, and are not specific to obstetric injury. Therefore, the most probable diagnosis in this case is total right-sided obstetric paralysis, and the child should be evaluated and treated by a pediatrician or other healthcare provider experienced in the management of brachial plexus injuries. Treatment may involve physical therapy, occupational therapy, and in some cases, surgical intervention. The prognosis for obstetric paralysis depends on the severity and extent of the injury. |
162. An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?
A. Tinned food
B. Potatoes
C. Pasteurized milk
D. Boiled meat
E. Cabbage
Answer: Tinned food
Explanation
| In an outbreak of botulism, tinned food should be chosen for analysis in the first place in order to confirm the diagnosis. Botulism is a rare but serious illness caused by the Clostridium botulinum bacterium, which produces a powerful neurotoxin that can cause paralysis and even death. The bacterium can grow in improperly processed or preserved foods, particularly in low-acid, oxygen-free environments such as those found in canned foods. Therefore, if an outbreak of food poisoning is suspected to be caused by botulism, tinned food should be the first foodstuff chosen for analysis in order to confirm the diagnosis. Other potentially contaminated foods, such as home-canned foods, smoked or salted fish, or vacuum-packed foods, may also be analyzed. Potatoes, pasteurized milk, boiled meat, and cabbage are not typically associated with botulism outbreaks unless they have been improperly processed or preserved. However, any food can potentially be contaminated with the bacterium if proper food safety practices are not followed. Therefore, in an outbreak of food poisoning suspected to be caused by botulism, tinned food should be the first foodstuff chosen for analysis in order to confirm the diagnosis and prevent further cases. |
163. A 42 year old metalworker has been working at the turning machine for production of heavy large-size parts for 5 years. His work requires using of hand and pedal levers that involves considerable physical force. What means for osteoarthrosis prevention should be recommended?
A. To limit physical work
B. To administer protein-and-carbohydrate diet
C. To administer protein-and-vitamin diet
D. To improve health at the Black sea coast
E. To go in for weightlifting
Answer: To limit physical work
Explanation
| The means for osteoarthrosis prevention that should be recommended to a 42-year-old metalworker who has been working at a turning machine for 5 years and whose work involves considerable physical force with hand and pedal levers are: To limit physical work. Osteoarthritis is a degenerative joint disease that is characterized by the breakdown of joint cartilage and underlying bone. It can result from repetitive stress on joints, as well as from a variety of other factors, including genetics, aging, and injury. In this case, the metalworker’s job involves considerable physical force, which may contribute to the development of osteoarthritis over time. Limiting physical work and avoiding repetitive or excessive stress on joints can help to reduce the risk of osteoarthritis. In addition, maintaining a healthy weight, eating a balanced diet, and engaging in regular physical activity can also help to prevent osteoarthritis. Administering a protein-and-carbohydrate or protein-and-vitamin diet, going in for weightlifting, or improving health at the Black sea coast are not specific prevention measures for osteoarthritis and may not be appropriate for this individual’s job requirements. Therefore, the most appropriate means for osteoarthrosis prevention for this metalworker would be to limit physical work and take other measures to reduce the risk of joint damage. |
164. A 30 year old patient undergoes treatment because of Werlhof’s disease. Objectively: the patient is pale, there are petechial haemorrhages on the extension surfaces of forearms. Ps is 92 bpm, AP is 100/60 mm Hg. The lower edge of spleen is at a level with umbilicus. Blood count: erythrocytes: 2, 8 · 1012/l, Hb – 90 g/l, Ht – 0,38, thrombocytes – 30 · 109/l. The patient is being prepared for splenectomy. What transfusion medium should be chosen in the first place for the preoperational preparation?
A. Thrombocytic mass
B. Stored blood
C. Native erythrocytic mass
D. Erythrocytic suspension
E. Washed erythrocytes
[
Answer: Thrombocytic mass
Explanation
| The most appropriate transfusion medium to be chosen in the first place for the preoperational preparation of a 30-year-old patient with Werlhof’s disease who is undergoing splenectomy is thrombocytic mass. Werlhof’s disease, also known as idiopathic thrombocytopenic purpura (ITP), is a disorder characterized by a low platelet count and an increased risk of bleeding. Splenectomy, or surgical removal of the spleen, is a common treatment for severe cases of ITP. Given the patient’s low platelet count of 30 · 109/l, transfusion of thrombocytic mass would be the most appropriate transfusion medium for preoperational preparation. Thrombocytic mass contains concentrated platelets and can help to raise the patient’s platelet count and reduce the risk of bleeding during and after surgery. Stored blood, native erythrocytic mass, erythrocytic suspension, and washed erythrocytes are not appropriate transfusion media for this patient’s condition, as they do not address the underlying issue of low platelet count and increased bleeding risk associated with ITP. Therefore, in this case, thrombocytic mass should be chosen as the first transfusion medium for preoperational preparation of the patient undergoing splenectomy for Werlhof’s disease. |
165. A 19 year old boy was admitted to a 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 specify 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
| Any doctor of any specialty can specify the patient’s blood group and rhesus compatibility in this case. Knowing a patient’s blood group and rhesus compatibility is critical in situations where blood transfusions are necessary, such as in the case of this 19-year-old boy with multiple ruptures of the spleen and small intestine who requires hemotransfusion. Blood typing and cross-matching are typically performed by laboratory physicians or medical technologists, but any doctor or healthcare provider can order and review the results of these tests to ensure that the patient receives the appropriate blood products. Therefore, in this case, any doctor of any specialty can specify the patient’s blood group and rhesus compatibility, and it is essential to do so promptly in order to provide the patient with the appropriate blood products to stabilize their condition. |
166. Clinical and statistical study was devoted to the effect of a new pharmacological medication upon the patients with coronary heart disease. What parametric criterion (coefficient) can be used for estimation of results validity?
A. Student’s coefficient (t)
B. Sign criterion
C. Conformity coefficient
D. Wilcoxon’s t-criterion
E. Kolmogorov-Smirnov’s criterion
Answer: Student’s coefficient (t)
Explanation
| The parametric criterion that can be used for estimation of the results validity of a clinical and statistical study on the effect of a new pharmacological medication upon patients with coronary heart disease is Student’s coefficient (t). Student’s t-test is a statistical test that is commonly used to compare the means of two groups of data. It is a parametric test that assumes that the data are normally distributed and that the variances of the two groups are equal. In the context of a clinical study on the effect of a new medication on patients with coronary heart disease, Student’s t-test can be used to compare the mean values of a particular variable (such as blood pressure or cholesterol level) between a group of patients who received the medication and a control group who did not. The t-test can help to determine whether the differences between the two groups are statistically significant or due to chance. The other options, such as sign criterion, conformity coefficient, Wilcoxon’s t-criterion, and Kolmogorov-Smirnov’s criterion, are either non-parametric tests or not appropriate for the type of data analysis required in this context. Therefore, the most appropriate parametric criterion that can be used for estimation of the results validity in a clinical and statistical study on the effect of a new pharmacological medication upon patients with coronary heart disease is Student’s coefficient (t). |
167. It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?
A. Bathroom unit
B. Manipulation room
C. Doctor’s consulting room
D. Patient’s examination room
E. Nursing room
Answer: Bathroom unit
Explanation
| In addition to a tambour, a ward, and a lock chamber, a bathroom unit should also be included in a complete isolation box in order to prevent nosocomial airborne infections. Complete isolation boxes are used in healthcare settings to prevent the spread of airborne infections from patients with contagious diseases. They typically consist of three main components: a tambour or anteroom, a ward or patient room, and a lock chamber or exit room. The tambour and lock chamber are designed to create negative air pressure and prevent air from flowing out of the isolation box, while the ward provides a safe environment for the patient. A bathroom unit is also an important component of a complete isolation box, as it allows patients to practice good hygiene and avoid spreading infectious agents through bodily fluids. The bathroom unit should be equipped with a sink, toilet, and shower or bath, as well as appropriate ventilation and waste disposal systems. Manipulation rooms, doctor’s consulting rooms, patient’s examination rooms, and nursing rooms may be included in a healthcare facility’s design but are not essential components of a complete isolation box. Therefore, in order to prevent nosocomial airborne infections, a bathroom unit should be included in addition to a tambour, a ward, and a lock chamber in a complete isolation box. |
168. A 30 year old man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39oC. There was an 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 and ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?
A. Gout
B. Infectious arthritis
C. Rheumatoid arthritis
D. Erysipelatous inflammation
E. Osteoarthritis
Answer: Gout
Explanation
| The most likely diagnosis for a 30-year-old man with intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°C, and a history of similar attacks lasting 5-6 days without residual changes in the joint is gout. Gout is a type of inflammatory arthritis that results from the deposition of uric acid crystals in joints and soft tissues, leading to acute attacks of severe pain, swelling, and redness. The condition often affects the big toe joint, but can also affect other joints such as the ankle. The acute onset of the symptoms, as well as the presence of fever and ill-defined hyperemic skin over the joint, are consistent with a diagnosis of gout. The lack of infiltrative bank on the periphery also supports this diagnosis. Infectious arthritis, rheumatoid arthritis, and osteoarthritis are other types of arthritis that may cause joint pain, but they typically have different clinical presentations and are less likely to produce the acute symptoms and signs seen in this case. Erysipelatous inflammation is a type of bacterial skin infection that can cause redness, swelling, and fever, but it usually has a more defined margin than the ill-defined hyperemia seen in this case. Therefore, based on the clinical presentation, the most likely diagnosis for this patient is gout. |
169. Preventive examination of a 55 year old patient revealed diabetes mellitus. The patient hasn’t received treatment for it. Objectively: height is 170 cm, weight is 106 kg, skin humidity is normal. Ps is 76 bpm, rhythmic, left border of relative heart dullness is deviated by 1 cm to the left from the middle clavicular line, heart sounds are quiet, AP is 140/80 mm Hg. Glycemia on an empty stomach is 6,9 millimole/l. Glucose rate in the daily urine is 0,5%, diuresis makes up 2,5 l. What treatment tactics should be chosen?
A. To administer dietotherapy
B. To administer metformin
C. To administer glibenclamid
D. To administer repaglinide
E. To administer insulin
Answer: To administer dietotherapy
Explanation
| The most appropriate treatment tactic for a 55-year-old patient with newly diagnosed diabetes mellitus, who has not received any treatment, based on the given objective data, is to administer dietotherapy. Dietotherapy, or medical nutrition therapy, is a fundamental aspect of diabetes management that involves making dietary changes to control blood glucose levels and prevent complications. The goals of dietotherapy include achieving and maintaining a healthy weight, managing blood glucose levels, and reducing the risk of cardiovascular disease. In this case, the patient’s glycemia on an empty stomach is 6.9 millimole/l, which is consistent with a diagnosis of diabetes mellitus. However, there is no evidence of complications or other abnormalities that would warrant immediate pharmacological intervention. Therefore, the most appropriate initial treatment tactic for this patient would be to administer dietotherapy. The patient should be advised to make dietary changes, such as reducing their intake of carbohydrates and sugary foods, and increasing their consumption of fiber-rich foods, such as fruits, vegetables, and whole grains. The patient should also be advised to lose weight if necessary, engage in regular physical activity, and monitor their blood glucose levels regularly. Pharmacological treatment, such as metformin, glibenclamide, repaglinide, or insulin, may be considered if dietotherapy alone does not achieve adequate glycemic control. However, in this case, given the absence of complications and the patient’s overall health status, administering dietotherapy as the first-line treatment tactic would be the most appropriate approach. Therefore, the most appropriate treatment tactic for this patient with newly diagnosed diabetes mellitus is to administer dietotherapy. |
170. The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of popultaion. What statistic method should be chosen?
A. Calculation of correlation coefficient
B. Calculation of conformity coefficient
C. Calculation of coefficient of difference validity
D. Calculation of regression coefficient
E. Calculation of dynamic indices
Answer: Calculation of correlation coefficient
Explanation
| The most appropriate statistic method that should be chosen to estimate the level of environmental influence upon health indices of population based on 5 year monitoring data is the calculation of correlation coefficient. The correlation coefficient is a statistical measure of the strength and direction of the relationship between two variables. In this case, the environmental factors would be considered the independent variable, and the health indices of the population would be considered the dependent variable. By calculating the correlation coefficient between the environmental factors and the health indices, it is possible to determine whether there is a significant relationship between the two variables and the strength of that relationship. A positive correlation coefficient would indicate that higher levels of environmental factors are associated with higher levels of health indices, while a negative correlation coefficient would indicate that higher levels of environmental factors are associated with lower levels of health indices. The other options, such as calculation of conformity coefficient, coefficient of difference validity, regression coefficient, and dynamic indices, are not appropriate for this type of analysis or may not be relevant to this specific situation. Therefore, in order to estimate the level of environmental influence upon health indices of population based on 5 year monitoring data, the most appropriate statistic method to be chosen is the calculation of correlation coefficient. |
171. In order to improve organism tolerance of boarding-school pupils a doctor developed a program. The program is based upon the following principles: graduality, consistency, individuality, coomplexity. What of the main principles of organism tempering wasn’t taken into account?
A. Systematicness
B. Autodefense increase
C. Increase of influence force
D. Increase of influence intensity
E. Increase of resistance
Answer: Systematicness
Explanation
| The principle of systematicness is the main principle of organism tempering that was not taken into account in the program developed by the doctor to improve the organism tolerance of boarding-school pupils. Organism tempering, or hardening, is a process of gradually increasing the body’s resistance to stressors and improving its ability to adapt to changing environmental conditions. The process involves exposing the body to various stressors, such as cold, heat, exercise, and other physical and mental challenges, in a systematic and controlled manner. The four principles that were mentioned – graduality, consistency, individuality, and complexity – are all important aspects of the organism tempering process. Graduality refers to the gradual and progressive increase in the level of stressors over time, while consistency refers to the regular and frequent exposure to stressors. Individuality refers to the need for tailoring the tempering program to the specific needs and capabilities of each individual, and complexity refers to the incorporation of a variety of stressors to challenge different aspects of the body’s adaptive capacity. The principle of systematicness, however, refers to the need for a structured and organized approach to the tempering process, with a clear plan and progression of stressors that are gradually increased in intensity and duration over time. Without a systematic approach, the tempering process may be ineffective or even harmful, as the body may not be able to adapt properly to the stressors. Therefore, in the program developed by the doctor to improve organism tolerance of boarding-school pupils, the principle of systematicness, which is the main principle of organism tempering, was not taken into account. This could potentially limit the effectiveness of the program and may even cause harm to the pupils if the stressors are not applied in a structured and organized manner. |
172. A patient complains about pyrosis and permanent pain behind his breastbone. When he bends forward after eating there appears regurgitation. Roentgenological examination revealed extrasaccular cardiofunctional hernia of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux-esophagitis. What is the necessary tretment tactics?
A. Operation in a surgical department
B. Conservative treatment in an outpatients’ clinic
C. Conservative treatment in the therapeutic hospital
D. Conservative treatment in a surgical department
E. Treatment at a health resort
Answer: Operation in a surgical department
Explanation
| The necessary treatment tactic for a patient with extrasaccular cardiofunctional hernia of esophageal opening of diaphragm and signs of reflux-esophagitis, who presents with pyrosis and permanent pain behind the breastbone, and regurgitation upon bending forward after eating, is an operation in a surgical department. A cardiofunctional hernia is a type of hiatal hernia in which the stomach and other abdominal organs protrude through the esophageal hiatus of the diaphragm into the chest cavity. This can cause symptoms such as heartburn, chest pain, and difficulty swallowing, as well as complications such as gastroesophageal reflux disease (GERD) and esophagitis. In this case, the patient has reflux-esophagitis, which is an inflammation of the esophagus due to reflux of stomach contents. Conservative treatments, such as lifestyle modifications and medications, may be used to manage symptoms and prevent complications of a cardiofunctional hernia. However, in cases where the patient has significant symptoms and complications, such as reflux-esophagitis, surgery is often necessary to repair the hernia and prevent further complications. Therefore, the necessary treatment tactic for a patient with extra saccular cardio functional hernia of esophageal opening of diaphragm and signs of reflux-esophagitis, who presents with pyrosis and permanent pain behind the breastbone, and regurgitation upon bending forward after eating, is an operation in a surgical department. The specific type of surgery will depend on the severity and location of the hernia, as well as the patient’s overall health and medical history. |
173. 15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested symptoms of Quincke’s edema. What medication should be applied for emergency aid?
A. Prednisolone
B. Heparin
C. Adrenalin
D. Furosemide
E. Seduxen
Answer: Prednisolone
Explanation
| In the case of a 4-month-old boy who developed symptoms of Quincke’s edema 15 minutes after the second vaccination with diphtheria and tetanus toxoids and pertussis vaccine, the medication that should be applied for emergency aid is prednisolone. Quincke’s edema, also known as angioedema, is a type of allergic reaction that causes swelling in the deep layers of the skin, often around the face, lips, and tongue. It is a serious condition that can cause difficulty breathing and requires immediate medical attention. In this case, prednisolone is the medication of choice for treating acute episodes of Quincke’s edema in children. Prednisolone is a corticosteroid that helps to reduce inflammation and swelling, and it is often used in combination with other medications, such as antihistamines and adrenaline, to manage severe allergic reactions. Heparin, furosemide, and seduxen are not appropriate medications for the treatment of Quincke’s edema. Heparin is an anticoagulant medication used to prevent blood clots, while furosemide is a diuretic used to treat fluid retention. Seduxen is a sedative medication used to treat anxiety and muscle spasms. Adrenaline can be used to treat severe allergic reactions, but prednisolone is the first-line treatment for Quincke’s edema. Therefore, in the case of a 4-month-old boy who developed symptoms of Quincke’s edema after vaccination with diphtheria and tetanus toxoids and pertussis vaccine, the medication that should be applied for emergency aid is prednisolone. |
174. During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul’s respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?
A. Intravenous infusion of short-acting insulin
B. Intravenous infusion of glucose along with insulin
C. Introduction of long-acting insulin
D. Intravenous infusion of neohaemodesum along with glutamic acid
E. Intravenous infusion of sodium chloride saline
Answer: Intravenous infusion of short-acting insulin
Explanation
| The emergency action that should be taken for a patient who is unconscious, with dry and hot skin, hyperemia in his face, Kussmaul’s respiration, smell of acetone in the air, positive symptoms of peritoneum irritation, and blood sugar at the rate of 33 millimole/l is intravenous infusion of short-acting insulin. The patient is presenting with symptoms of diabetic ketoacidosis (DKA), which is a serious complication of uncontrolled diabetes. DKA is characterized by high blood sugar levels, ketone production, and metabolic acidosis, which can lead to coma and death if not treated promptly. Intravenous infusion of short-acting insulin is the first-line treatment for DKA, as it helps to lower blood sugar levels and prevent further ketone production. The insulin should be administered in a continuous infusion, and blood sugar levels should be monitored closely to avoid hypoglycemia. Intravenous infusion of glucose along with insulin may also be given to prevent hypoglycemia, but it should be done cautiously to avoid rapid shifts in blood sugar levels. Introduction of long-acting insulin is not appropriate in this emergency situation, as it takes longer to have an effect and is not suitable for the rapid correction of high blood sugar levels seen in DKA. Intravenous infusion of neohaemodesum along with glutamic acid and intravenous infusion of sodium chloride saline are not appropriate treatments for DKA, as they do not address the underlying problem of high blood sugar and ketone production. Therefore, in the case of a patient who is unconscious, with dry and hot skin, hyperemia in his face, Kussmaul’s respiration, smell of acetone in the air, positive symptoms of peritoneum irritation, and blood sugar at the rate of 33 millimole/l, the emergency action that should be taken is intravenous infusion of short-acting insulin. |
175. In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:
A. Thermograph
B. Alcohol thermometer
C. Mercury thermometer
D. August’s psychrometer
E. Assmann psychrometer
Answer: Thermograph
Explanation
| The device that will allow for the most precise temperature records when studying the impact of microclimate upon the human organism over a period of 3 days is a thermograph. A thermograph is an instrument that automatically records temperature over time. It contains a temperature sensor that is connected to a recording device, such as a pen or a digital display. The recorded temperature data can be used to create a temperature graph, which can provide valuable information about temperature variations over time. Compared to other devices, such as alcohol thermometers, mercury thermometers, and psychrometers, a thermograph offers several advantages when it comes to making precise temperature records over an extended period of time. With a thermograph, the temperature is measured automatically and continuously, which eliminates the need for manual readings and reduces the risk of human error. Additionally, a thermograph can record temperature variations with a high degree of accuracy and resolution, which is important when studying microclimate and its impact on the human organism. Therefore, in order to make the most precise temperature records when studying the impact of microclimate upon the human organism over a period of 3 days, the device that should be chosen is a thermograph. |
176. A 3 month old child has occiput alopecia, anxious sleep, excessive sweating. What disease might be suspected?
A. Rachitis
B. Spasmophilia
C. Anemia
D. Phosphate diabetes
E. Chondrodystrophy
Answer: Rachitis
Explanation
| The symptoms of occiput alopecia, anxious sleep, and excessive sweating in a 3-month-old child suggest a possible diagnosis of rickets. Rickets is a condition that is caused by a deficiency of Vitamin D, calcium, or phosphate, which can result in poor mineralization of bones and lead to skeletal deformities. The symptoms of rickets can include growth retardation, bone pain, muscle weakness, and bone deformities. In infants, the early signs of rickets may include cranial asymmetry, soft skull bones, sweating, and irritability. Occiput alopecia, or hair loss at the back of the head, can be a sign of pressure on the skull bones due to softening and deformities caused by rickets. Anxious sleep and excessive sweating can also be associated with rickets, as the condition can cause discomfort and pain. Spasmophilia, anemia, and phosphate diabetes are other conditions that can cause symptoms in infants, but they are less likely to present with the specific symptoms described in this case. Chondrodystrophy is a rare genetic disorder that affects bone and cartilage growth, but it typically presents with more severe skeletal deformities and is less likely to present in a 3-month-old child. Therefore, based on the symptoms of occiput alopecia, anxious sleep, and excessive sweating in a 3-month-old child, the disease that might be suspected is rickets. |
177. After delivery and revision of placenta there was found the defect of placental lobule. General condition of woman is normal, uterus is firm, there is moderate bloody discharge. Speculum inspection of birth canal shows absence of lacerations and raptures. What action is nesessary?
A. Manual exploration of the uterine cavity
B. External massage of uterus
C. Introduction of uterine contracting agents
D. Urine drainage, cold on the lower abdomen
E. Introduction of hemostatic medications
Answer: Manual exploration of the uterine cavity
Explanation
| In the case of a woman who has delivered and had a revision of the placenta that revealed a defect in a placental lobule, with a normal general condition, firm uterus, and moderate bloody discharge, and absence of lacerations and ruptures in the birth canal during speculum inspection, the necessary action is manual exploration of the uterine cavity. A defect in a placental lobule can indicate retained placental tissue, which can lead to postpartum hemorrhage if not properly managed. Manual exploration of the uterine cavity is the first-line treatment for retained placental tissue, as it allows for the identification and removal of any remaining placental fragments. This procedure should be performed by a trained healthcare provider and may be done under anesthesia if necessary. External massage of the uterus, introduction of uterine contracting agents, urine drainage with cold on the lower abdomen, and introduction of hemostatic medications are not appropriate actions in this case, as they do not address the underlying issue of retained placental tissue. Therefore, in the case of a woman who has delivered and had a revision of the placenta that revealed a defect in a placental lobule, with a normal general condition, firm uterus, and moderate bloody discharge, and absence of lacerations and ruptures in the birth canal during speculum inspection, the necessary action is manual exploration of the uterine cavity. |
178. A 7 year old boy has periods of loss of attention that last 10-15 seconds and occur several times a day. During these periods he stands still in one position, doesn’t answer the questions or react when he is called by his name. Neurological examination revealed no changes. What diagnostic method should be applied to specify his diagnosis?
A. Electroencephalography
B. Skull roentgenogram
C. Computer tomogram
D. Echoencephalography
E. Examination of evoked potentials
Answer: Electroencephalography
Explanation
| The diagnostic method that should be applied to specify the diagnosis of a 7-year-old boy who has periods of loss of attention that last 10-15 seconds and occur several times a day, during which he stands still in one position, doesn’t answer questions, or react when he is called by his name, and with no changes found during neurological examination is electroencephalography (EEG). EEG is a non-invasive diagnostic test that measures the electrical activity of the brain. It is used to detect abnormal brain waves that may be associated with various neurological disorders, such as epilepsy, seizures, and other types of brain dysfunction. In this case, EEG can help to identify any abnormal electrical activity in the brain that may explain the boy’s symptoms. Skull roentgenogram, computer tomogram, echoencephalography, and examination of evoked potentials are not appropriate diagnostic methods for this case, as they do not provide information about the electrical activity of the brain that is needed to diagnose neurological disorders. Therefore, in the case of a 7-year-old boy who has periods of loss of attention that last 10-15 seconds and occur several times a day, during which he stands still in one position, doesn’t answer questions, or react when he is called by his name, and with no changes found during neurological examination, the diagnostic method that should be applied to specify the diagnosis is electroencephalography (EEG). |
179. A 52 year old patient complains about pain in the right part of her chest, dyspnea, cough with a lot of foul-smelling albuminoid sputum in form of “meat slops”. Objectively: the patient’s condition is grave, cyanosis is present, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed different rales. What is the most probable diagnosis?
A. Lung gangrene
B. Lung abscess
C. Pleura empyema
D. Multiple bronchiectasis
E. Chronic pneumonia
Answer: Lung gangrene
Explanation
| Lung gangrene is a rare but life-threatening condition characterized by the death of lung tissue due to a severe infection. The foul-smelling albuminoid sputum in the form of “meat slops” is a classic symptom of lung gangrene. The patient’s grave condition, cyanosis, high breathing rate, and abnormal lung sounds are also consistent with this diagnosis. Lung abscess (Option B) is another possible diagnosis, but the foul-smelling sputum is not typically associated with this condition. Pleural empyema (Option C) and multiple bronchiectasis (Option D) are also possible, but the symptoms of foul-smelling sputum and cyanosis are not usually present. Chronic pneumonia (Option E) is less likely given the severity of the patient’s symptoms and rapid onset. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
180. A 15 year old patient suffers from headache, nasal haemorrhages, sense of lower extremity coldness. Objectively: muscles of shoulder girdle are developed, lower extremities are hypotrophied. Pulsation on the pedal and femoral arteries is sharply dampened. AP is 150/90 mm Hg, 90/60 on the legs. Systolic murmur can be auscultated above carotid arteries. What is the most probable diagnosis?
A. Aorta coarctation
B. Aorta aneurism
C. Aortal stenosis
D. Aortal insufficiency
E. Coarctation of pulmonary artery
Answer: Aorta coarctation
Explanation
| Aortic coarctation is a congenital condition characterized by the narrowing of the aorta, which is the large blood vessel that carries blood from the heart to the rest of the body. The symptoms of headache, nasal hemorrhages, and lower extremity coldness are consistent with this condition. The developed muscles of the shoulder girdle and hypotrophied lower extremities are also common findings in patients with aortic coarctation. The dampened pulsation on the pedal and femoral arteries and the higher blood pressure in the arms than in the legs are also typical signs of this condition. Aortic aneurysm (Option B) is less likely because it usually occurs in older individuals and is not typically associated with the signs and symptoms described in the scenario. Aortic stenosis (Option C) and aortic insufficiency (Option D) are also less likely given the absence of typical symptoms such as chest pain, syncope, and shortness of breath. Coarctation of pulmonary artery (Option E) is a rare condition and is not consistent with the presented symptoms. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
181. A patient with frostbite of both feet was delivered to the admission ward. What actions should be taken?
A. To apply a bandage, to introduce vasodilating medications
B. To administer cardiac medications
C. To put feet into hot water
D. To rub feet with snow
E. To apply an alcohol compress
Answer: To apply a bandage, to introduce vasodilating medications
Explanation
| The correct answer is A – To apply a bandage, to introduce vasodilating medications. Frostbite is a condition in which the skin and underlying tissues freeze due to exposure to cold temperatures. In severe cases, frostbite can lead to tissue damage and even amputation. The first step in the treatment of frostbite is to prevent further injury by removing the patient from the cold environment and protecting the affected area from further exposure. It is important to avoid rubbing or massaging the affected area, as this can cause further damage to the tissues. The next step is to rewarm the affected area gradually. This should be done using warm, not hot, water. The water temperature should be between 37 and 40 degrees Celsius. The affected area should be immersed in the water for 15 to 30 minutes, or until the skin appears pink and pliable. After rewarming, the affected area should be dried and covered with a sterile, dry dressing. Vasodilating medications, such as topical nitroglycerin or intravenous papaverine, may be used to improve blood flow to the affected area and promote healing. Pain medication may also be necessary to manage any discomfort. In summary, the recommended actions for a patient with frostbite of both feet are to apply a bandage and introduce vasodilating medications. It is important to promptly seek medical attention for frostbite to prevent further injury and promote healing. |
182. A patient has a stab wound on his right foot. On the fourth day after injury the patient’s body temperature rose up to 38oC, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?
A. Lymphadenitis
B. Lymphangitis
C. Phlegmon
D. Tetanus
E. Erysipelas
Answer: Lymphadenitis
Explanation
| The most probable complication that can be suspected in the given scenario is lymphadenitis (Option A). Lymphadenitis is a condition characterized by inflammation and enlargement of the lymph nodes. It is a common complication of a wound infection and can occur when bacteria or other pathogens enter the body through a wound, such as a stab wound. The symptoms of lymphadenitis include fever, pain, and tenderness in the affected lymph nodes, as well as redness and swelling of the overlying skin. In the given scenario, the patient has a stab wound on the right foot, and on the fourth day after the injury, the patient develops a fever, inguinal lymph nodes become enlarged and painful, and the skin over them appears red. These symptoms are consistent with lymphadenitis, which is often caused by the spread of infection from the site of the wound to the lymph nodes in the nearby area. Lymphangitis (Option B) is another possible complication of a wound infection, but it is characterized by inflammation of the lymphatic vessels rather than the lymph nodes. Phlegmon (Option C) is a deep-seated infection of the soft tissues that can occur as a complication of a wound, but it typically affects a larger area and is associated with severe pain and swelling. Tetanus (Option D) and erysipelas (Option E) are less likely given the absence of other typical symptoms. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
183. A 52 year old patient complains about headache, weakness of his upper left extremity. Neurological symptoms become more intense during physical stress of the left extremity. Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on the carotid arteries. What is the most probable diagnosis?
A. Occlusion of the left subclavicular artery, steal syndrome
B. Thoracal outlet syndrome
C. Raynaud’s syndrome
D. Takayasu’s disease
E. Occlusion of brachiocephalic trunk
Answer: Occlusion of the left subclavicular artery, steal syndrome
Explanation
| The most probable diagnosis based on the given symptoms and objective findings is occlusion of the left subclavian artery with steal syndrome (Option A). Steal syndrome occurs when there is a blockage or narrowing of an artery, resulting in decreased blood flow to the affected area and increased blood flow to other areas. In this case, the occlusion of the left subclavian artery is causing decreased blood flow to the left upper extremity, which leads to neurological symptoms such as weakness and headache. The increased blood flow to the carotid arteries can cause the carotid arteries to pulse normally, while the arteries in the left upper extremity have a weakened pulse. Thoracic outlet syndrome (Option B) is another possible diagnosis, but it typically presents with symptoms such as pain, numbness, and tingling in the neck, shoulder, and arm, rather than headaches. Raynaud’s syndrome (Option C) is characterized by episodes of decreased blood flow to the fingers and toes, resulting in color changes and pain, but it is not consistent with the symptoms described in the scenario. Takayasu’s disease (Option D) is a rare condition that can cause narrowing or blockage of the arteries, but it typically affects younger individuals and presents with more generalized symptoms such as fatigue, weight loss, and fever. Occlusion of the brachiocephalic trunk (Option E) is less likely given the absence of other typical symptoms. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
184. A 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0,02 excentrically, eye fundus has haemorrhages of different forms and sizes (“squashed tomato”symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis?
A. Thrombosis of central vein of retina
B. Hypertensive angiopathy
C. Hypertensive angioneuropathy
D. Embolism of central artery of retina
E. Diabetic retinopathy
Answer: Thrombosis of central vein of retina
Explanation
| The most probable diagnosis based on the given symptoms and objective findings is thrombosis of the central vein of the retina (Option A). Thrombosis of the central vein of the retina is a condition in which a blood clot forms in the central vein of the retina, causing sudden vision loss in one eye. The “squashed tomato” symptom, which refers to the presence of hemorrhages of different forms and sizes in the eye fundus, is a classic finding in this condition. The hyperemic disc of the optic nerve is also consistent with thrombosis of the central vein of the retina. Hypertensive angiopathy (Option B) and hypertensive angioneuropathy (Option C) are conditions associated with high blood pressure and can cause damage to the blood vessels in the eye, but they typically do not present with sudden vision loss and the “squashed tomato” symptom. Embolism of the central artery of the retina (Option D) is another possible diagnosis, but it typically presents with a sudden, painless loss of vision in one eye and the presence of a cherry-red spot in the macula. Diabetic retinopathy (Option E) is a complication of diabetes that can cause damage to the blood vessels in the retina, but it typically presents with a gradual loss of vision rather than sudden onset. Direct-acting anticoagulants were administered to prevent further clots from forming. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
185. A 28 year old patient complained about prolongation of intermenstrual periods up to 2 months, hirsutism. Gynaecological examination revealed that the ovaries were enlarged, painless, compact, uterus had no pecularities. Pelvic ultrasound revealed that the ovaries were 4-5 cm in diameter and had multiple enlarged follicles on periphery. Roentgenography of skull base showed that sellar region was dilated. What is the most probable diagnosis?
A. Stein-Leventhal syndrome
B. Algodismenorrhea
C. Sheehan’s syndrome
D. Premenstrual syndrome
E. Morgagni-Stewart syndrome
Answer: Stein-Leventhal syndrome
Explanation
| The most probable diagnosis based on the given symptoms and objective findings is Stein-Leventhal syndrome, also known as polycystic ovary syndrome (Option A). Stein-Leventhal syndrome is a common endocrine disorder characterized by irregular menstrual periods, hirsutism (excessive hair growth), and enlarged ovaries. The enlarged ovaries have multiple small cysts on the periphery, which can be seen on pelvic ultrasound. The dilation of the sellar region on roentgenography of the skull base is consistent with an associated pituitary disorder, such as hyperprolactinemia. Algodismenorrhea (Option B) is a condition characterized by painful menstrual periods and is not consistent with the symptoms described in the scenario. Sheehan’s syndrome (Option C) is a rare condition caused by pituitary gland damage due to severe bleeding during childbirth, but it typically presents with symptoms such as lactation failure and fatigue. Premenstrual syndrome (Option D) is a collection of symptoms that occur in the days before a menstrual period, such as mood changes and bloating, but it is not consistent with the described symptoms. Morgagni-Stewart syndrome (Option E) is a rare congenital condition characterized by abnormalities in the development of the diaphragm and is not related to the presented symptoms. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
186. A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has been having amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?
A. Sheehan’s syndrome
B. Stein-Leventhal syndrome
C. Shereshevsky-Turner’s syndrome
D. Homological blood syndrome
E. Vegetovascular dystonia
Answer: heehan’s syndrome
Explanation
| The most probable diagnosis based on the given symptoms and history is Sheehan’s syndrome. Sheehan’s syndrome is a rare condition that occurs due to severe blood loss during childbirth, which leads to damage to the pituitary gland. The pituitary gland is responsible for producing hormones that regulate various bodily functions, including menstrual cycles and lactation. The symptoms of Sheehan’s syndrome can include fatigue, significant weight loss, weakness, loss of appetite, and amenorrhea (absence of menstrual periods). The history of severe blood loss during childbirth, requiring blood and blood substitute transfusions, increases the suspicion of Sheehan’s syndrome in this case. Stein-Leventhal syndrome (Option B) is a condition characterized by irregular menstrual periods, hirsutism, and enlarged ovaries, and is not consistent with the symptoms described in the scenario. Shereshevsky-Turner’s syndrome (Option C) is another name for Turner syndrome, a genetic disorder that affects females and is characterized by short stature and abnormalities of the reproductive system, but it typically presents with symptoms during childhood. Homologous blood syndrome (Option D) is not a recognized medical condition. Vegetovascular dystonia (Option E) is a term that has been used to describe a wide range of symptoms related to autonomic nervous system dysfunction, but it is not consistent with the described symptoms. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
187. A 68 year old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes mellitus for 15 years, doesn’t receive regular treatment. What complication of diabetes mellitus is it?
A. Gangrene of the IV toe on the right foot
B. Panaritium
C. Haematoma
D. Erysipelas
E. Fracture of the IV toe on the right foot
Answer: Gangrene of the IV toe on the right foot
Explanation
| The most probable complication of diabetes mellitus based on the given symptoms and history is gangrene of the IV toe on the right foot (Option A). Diabetes mellitus is a chronic metabolic disorder that can cause damage to blood vessels and nerves, leading to poor circulation and neuropathy, respectively. These conditions can increase the risk of foot problems, including foot ulcers and gangrene. In this case, the acute pain, toe edema, and darkening of the skin of the IV toe suggest the presence of gangrene, which occurs when the tissues in the affected area die due to lack of blood flow. The patient’s history of uncontrolled diabetes mellitus for 15 years increases the risk of vascular complications, such as peripheral arterial disease, which can lead to gangrene. Panaritium (Option B) is a bacterial infection of the soft tissues around the nail and is not consistent with the described symptoms. Haematoma (Option C) is a localized collection of blood outside the blood vessels and is unlikely to cause the described symptoms. Erysipelas (Option D) is a bacterial infection of the skin and is characterized by red, swollen skin, but it typically does not cause toe edema and darkening of the skin. Fracture of the IV toe (Option E) is less likely given the absence of trauma or injury. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
188. Preventive examination of an 11 year old boy helped to determine his habitus type. It was established that the child’s shoulders were deviated and brought forward, with forward flexion of head, the thorax was flattened, abdomen was convex. The child’s backbone had signs of deepened cervical and lumbar curvatures. What habitus is it?
A. Kyphosis
B. Lordosis
C. Round-shouldered
D. Corrected
E. Normal
Answer: Kyphosis
Explanation
| Based on the given symptoms and physical examination, the most probable habitus type in this case is kyphosis (Option A). Kyphosis is a postural abnormality characterized by an excessive curvature of the thoracic spine, leading to a rounded or hunched back appearance. The symptoms of kyphosis can include deviated and forward shoulders, forward flexion of the head, flattened thorax, and a convex abdomen. The signs of deepened cervical and lumbar curvatures are suggestive of compensatory changes in response to the excessive curvature of the thoracic spine. Lordosis (Option B) is an excessive inward curvature of the lumbar spine, also known as swayback. Round-shouldered (Option C) habitus is characterized by forward shoulder posture, but it typically does not involve excessive curvature of the spine. Corrected (Option D) habitus is not a recognized term in medical literature. Normal (Option E) habitus would not involve the described symptoms and physical examination findings. It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. In the case of suspected kyphosis, referral to an orthopedic specialist may be necessary for further evaluation and management. |
189. During hygienic examination of a hospital it was established that the area for each bed in a double ward was: in the infectious department for children – 7 2, in the infectious department for adults – 8 2, in the burns department – 9 2, in the radiological department – 10 2, in the critical care department – 13 2. In which wards the area for each bed doesn’t correspond with hygienic requirements?
A. In burns wards
B. In infectious wards for children
C. In infectious wards for adults
D. In radiological wards
E. In critical care wards
Answer: In burns wards
Explanation
| The area for each bed in the burns department (9 m2) does not correspond with hygienic requirements, as it is below the recommended minimum of 12 m2 per bed. The recommended minimum area per bed in hospital wards varies depending on the type of ward and patient care needs. The general recommendation is for a minimum of 12 m2 per bed to ensure adequate space for patient care and to prevent the spread of infections. In this case, the area for each bed in the infectious departments for children (7 m2) and adults (8 m2) are below the recommended minimum, but it is not specified whether they are single or double rooms. The area for each bed in the radiological department (10 m2) and critical care department (13 m2) meets or exceeds the recommended minimum. Therefore, option A is the correct answer: the area for each bed in the burns department does not correspond with hygienic requirements. |
190. A 2 year old child has been ill with acute respiratory viral infection of upper thrice a year – in February, in April and in December. How should these occurences be recorded?
A. It is necessary to fill in 3 statistic talons signed (+)
B. It is necessary to fill in 3 statistic talons signed (−)
C. It is necessary to fill in 1 statistic talon signed (+)
D. It is necessary to fill in 1 statistic talon signed (+) and 2 statistic talons signed (−)
E. It is necessary to fill in 1 statistic talon signed (−)
Answer: It is necessary to fill in 3 statistic talons signed (+)
Explanation
| The occurrences of acute respiratory viral infections in the 2 year old child should be recorded by filling in 3 statistic talons signed (+) because the child had 3 separate episodes of the illness during the year, in February, April, and December. A statistic talon is a form used to collect and record statistical data about morbidity (occurrence of disease) in a population. The talon is usually filled out by medical personnel who diagnose and treat patients with various diseases. In this case, since the child had 3 separate episodes of acute respiratory viral infection during the year, each occurrence should be recorded separately on a talon signed (+). This will help to accurately reflect the morbidity rate of the population and can be used to inform public health decisions. Option A is therefore the correct answer: it is necessary to fill in 3 statistic talons signed (+). |
191. Researchers studied disease incidence of influenza and acute respiratory viral infection within the last 5 years. What kind of graphic presentation should be used for the best visualization of this data?
A. Linear diagram
B. Pie diagram
C. Bar diagram
D. Histogram
E. Radial diagram
Answer: Linear diagram
Explanation
| The best graphic presentation for visualizing the disease incidence of influenza and acute respiratory viral infection over a period of 5 years is a linear diagram (Option A). A linear diagram, also known as a line graph, is a type of chart used to display data trends over time. It is particularly useful for showing changes in data over a continuous period of time, such as the incidence of a disease over several years. The x-axis represents time, while the y-axis represents the incidence of the disease. Pie diagrams (Option B) are useful for showing parts of a whole or proportions, but are not suitable for displaying trends over time. Bar diagrams (Option C) are useful for comparing data across different categories or groups, but may not be the best choice for visualizing trends over time. Histograms (Option D) are used to display the distribution of data, but are not suitable for displaying trends over time. Radial diagrams (Option E) are not commonly used for displaying epidemiological data. Therefore, a linear diagram is the most appropriate choice for visualizing the disease incidence of influenza and acute respiratory viral infection over a 5-year period. |
192. A 55 year old patient felt suddenly sick in a hospital corridor, he was immediately examined by a doctor. Examination revealed that the patient’s skin was pale, autonomous respiration was absent, pulse on carotid arteries couldn’t be felt, pupils were mydriatic. What action should be taken at the beginning of cardiac resuscitation?
A. Precordial thump
B. Mouth-to-mouth ventilation
C. Closed-chest cardiac massage
D. Restoration of airway patency
E. Defibrillation
Answer: Precordial thump
Explanation
| The first action that should be taken at the beginning of cardiac resuscitation in this case is not precordial thump (Option A), but rather restoration of airway patency (Option D). The given symptoms and examination findings suggest that the patient is in cardiac arrest, a medical emergency that requires immediate intervention. Cardiac resuscitation should be initiated promptly to improve the patient’s chances of survival. The first step in cardiac resuscitation is to ensure that the patient’s airway is open and that they are able to breathe. This can be done by restoring airway patency, which involves tilting the head back and lifting the chin to open the airway. If the patient is not breathing, mouth-to-mouth ventilation (Option B) or bag-valve-mask ventilation can be initiated to provide oxygen to the lungs. Precordial thump (Option A) is a technique that involves delivering a firm blow to the chest over the heart in an attempt to restore normal heart rhythm in certain cases of cardiac arrest. However, it is not the first action that should be taken in cardiac resuscitation and is not recommended as a routine intervention. Closed-chest cardiac massage (Option C) and defibrillation (Option E) are interventions that may be performed later in the resuscitation process, depending on the underlying cause of the cardiac arrest and the patient’s response to initial interventions. Therefore, the correct answer is restoration of airway patency (Option D) as the first action that should be taken at the beginning of cardiac resuscitation in this case. |
193. A 24 year old patient complained about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type, body weight index is 33,2 kg/m2, waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most probable diagnosis?
A. Alimentary constitutional obesity of the I stage, abdominal type
B. Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type
C. Alimentary constitutional obesity of the III stage, gynoid type
D. Alimentary constitutional obesity of the II stage, abdominal type
E. Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type
Answer: Alimentary constitutional obesity of the I stage, abdominal type
Explanation
| Based on the given information, the most probable diagnosis is alimentary constitutional obesity of the I stage, abdominal type (Option A). Obesity is a complex medical condition characterized by excess body fat that can lead to a range of health problems. The hypersthenic constitution, high body weight index (BMI), and increased waist circumference (100 cm) in the 24 year old patient suggest the presence of obesity. The correlation of waist circumference to the thigh circumference (0.95) further supports the diagnosis of abdominal obesity. The patient’s symptoms and physical findings do not suggest the presence of hypothalamic or Itsenko-Cushing obesity, which are caused by hormonal imbalances and are typically accompanied by other symptoms such as increased appetite, fatigue, and muscle weakness. Alimentary constitutional obesity is a type of obesity that is caused by overeating and a sedentary lifestyle, and is primarily influenced by genetic factors. The I stage of alimentary constitutional obesity typically involves a moderate increase in body weight and an abdominal distribution of fat. Therefore, the most probable diagnosis in this case is alimentary constitutional obesity of the I stage, abdominal type (Option A). It is important to note that a proper diagnosis and treatment plan should be provided by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
194. A parturient woman is 27 year old, it was her second labour, delivery was at term, normal course. On the 3rd day of postpartum period body temperature is 36, 8oC, Ps – 72/min, AP – 120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is the most probable diagnosis?
A. Physiological course of postpartum period
B. Subinvolution of uterus
C. Postpartum metroendometritis
D. Remnants of placental tissue after labour
E. Lactostasis
Answer: Physiological course of postpartum period
Explanation
| Postpartum period refers to the period of time after childbirth, during which the mother’s body returns to its pre-pregnancy state. The postpartum period typically lasts for about 6 weeks, during which time the mother’s body undergoes several changes. In this case, the woman is a 27-year-old, and it was her second labor, which was normal and at term. On the 3rd day of the postpartum period, her body temperature is normal at 36.8°C, pulse rate is 72/min, and blood pressure is 120/80 mm Hg. The woman’s mammary glands are moderately swollen and the nipples are clean, which is a normal finding during the postpartum period. The abdomen is soft and painless, and the fundus of the uterus is 3 fingers below the umbilicus, which is also a normal finding at this stage of the postpartum period. The lochia are bloody and moderate, which is a normal finding in the immediate postpartum period. There are no signs of subinvolution of uterus (Option B), postpartum metroendometritis (Option C), remnants of placental tissue after labor (Option D), or lactostasis (Option E) in this case. Therefore, the most probable diagnosis in this case is the physiological course of the postpartum period (Option A). However, it is important to note that a proper diagnosis should be made by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
195. Esophagus wall of a 72 year old patient with severe concomitant pathology was injured during urgent fi- broesophagogastroscopy. This resulted in progressing of acute respiratory failure and collapse of the left lung. What aid should be rendered?
A. Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy
B. Buelau’s drainage of pleural cavity, antibacterial therapy
C. Left-sided thoracotomy, closure of esophagus and mediastinum wound
D. Left-sided thoracotomy, closure of esophagus wound
E. Endoscopic closure of esophagus wound, drainage
Answer: A. Drainage of pleural cavity by Bullaux method, mediastinum drainage, antibacterial therapy
Explanation
| The most appropriate aid that should be rendered in this case is drainage of the pleural cavity by Bullaux method, mediastinum drainage, and antibacterial therapy (Option A). The injury to the esophagus wall during fibroesophagogastroscopy is a serious complication that can lead to acute respiratory failure and collapse of the lung, particularly in a 72 year old patient with severe concomitant pathology. Immediate intervention is required to prevent further complications. Drainage of the pleural cavity by Bullaux method involves inserting a chest tube into the pleural cavity to drain any air or fluid that may have accumulated as a result of lung collapse. Mediastinum drainage involves the insertion of a drainage tube into the mediastinum to drain any fluid or blood that may have leaked from the esophagus or surrounding tissues. Antibacterial therapy is also necessary to prevent infection, which is a common complication of esophageal injury. The type and duration of antibacterial therapy should be determined by a licensed medical professional based on the patient’s medical history, clinical condition, and susceptibility to infection. Left-sided thoracotomy, closure of esophagus and mediastinum wound (Option C) or closure of esophagus wound (Option D) may be necessary in severe cases of esophageal injury, but are not the first-line treatments and should only be performed if conservative measures fail. Endoscopic closure of esophagus wound and drainage (Option E) may also be an option in some cases, but the severity of the patient’s condition suggests that more aggressive measures are necessary. Therefore, the most appropriate aid that should be rendered in this case is drainage of the pleural cavity by Bullaux method, mediastinum drainage, and antibacterial therapy (Option A). |
196. A 46 year old woman who has been suffering from hypertension for 5 years was diagnosed with hypertensive crisis. She complains about palpitation, sense of head pulsation; heart rate is 100/min, AP is 190/100 mm Hg (haemodynamics is of hyperkinetic type). What medication should be the medication of choice?
A. β-adrenoceptor blocker
B. Adenosine pyrophosphate inhibitor
C. Diuretic
D. α-adrenoceptor blocker
E. Dihydropyridine calcium antagonist
Answer: β-adrenoceptor blocker
Explanation
| Hypertensive crisis is a medical emergency characterized by a sudden and severe increase in blood pressure that can lead to complications such as stroke, heart attack, and kidney damage. The patient in this case is a 46-year-old woman with a history of hypertension and presenting with symptoms such as palpitations, head pulsation, and a hyperkinetic type of hemodynamics. β-adrenoceptor blockers are a class of antihypertensive medication that work by blocking the effects of adrenaline (epinephrine) on the heart and blood vessels. They reduce heart rate, cardiac output, and peripheral resistance, thereby lowering blood pressure. In this case, a β-adrenoceptor blocker would be an appropriate medication of choice as it can effectively reduce heart rate and blood pressure and prevent complications associated with hypertensive crisis. Adenosine pyrophosphate inhibitor (Option B) is not a class of antihypertensive medication and is not indicated for the treatment of hypertensive crisis. Diuretics (Option C) may be used in the treatment of hypertension, but they may not be effective in rapidly reducing blood pressure in hypertensive crisis. α-adrenoceptor blockers (Option D) are also used in the treatment of hypertension, but they may cause reflex tachycardia and are not the first-line medication of choice in hypertensive crisis. Dihydropyridine calcium antagonists (Option E) are another class of antihypertensive medication, but they are not the first-line medication of choice in hypertensive crisis. Therefore, the medication of choice for the given patient with hypertensive crisis would be a β-adrenoceptor blocker (Option A). It is important to note that the appropriate medication and dosage should be determined by a licensed medical professional based on the patient’s medical history, clinical condition, and individual factors. |
197. A 30 year old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4х5х5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?
A. Polycystic ovaries
B. Ovarian cystoma
C. Chronic oophoritis
D. Menstrual irregularity
E. Bilateral ovarian tumours
Answer: Polycystic ovaries
Explanation
| The most probable diagnosis in this case is polycystic ovaries (Option A). Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. It is characterized by the presence of multiple small cysts on the ovaries, irregular menstrual cycles, and hyperandrogenism (excess production of male hormones). The patient in this case is a 30-year-old woman who complains of infertility over three years of married life. She is of supernutrition type and has hirsutism (excessive hair growth) on the median abdominal line, internal thigh surface, and peripapillary area. Her menstrual cycles are infrequent and non-profuse. The ultrasound revealed that the uterus is of normal size, but the ovaries are enlarged (4x5x5 cm) and have multiple cystic inclusions. These findings are consistent with the diagnosis of polycystic ovaries. Ovarian cystoma (Option B) is a type of ovarian cyst that is typically a benign tumor and is not commonly associated with PCOS. Chronic oophoritis (Option C) is an inflammation of the ovaries that can cause infertility, but it is not typically associated with the symptoms of PCOS. Menstrual irregularity (Option D) is a symptom of PCOS, but it is not a diagnosis in itself. Bilateral ovarian tumors (Option E) are possible, but less likely than polycystic ovaries given the patient’s symptoms and ultrasound findings. Therefore, the most probable diagnosis in this case is polycystic ovaries (Option A). It is important to note that a proper diagnosis should be made by a licensed medical professional after a thorough examination and appropriate diagnostic tests. |
198. A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2- 3 minutes, there was also one-time vomiting. Objectively: the child’s condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor’s finger was stained with blood. What is the most probable diagnosis?
A. Ileocecal invagination
B. Gastrointestinal haemorrhage
C. Wilm’s tumour
D. Helminthic invasion
E. Pylorostenosis
Answer: Ileocecal invagination
Explanation
| The most probable diagnosis in this case is ileocecal invagination (Option A). Ileocecal invagination is a serious condition in which a part of the small intestine (ileum) telescopes into the large intestine (cecum), causing a blockage and compromising blood flow to the affected area. It is more common in children than adults and can cause symptoms such as abdominal pain, vomiting, diarrhea, and bloody stools. The 4-month-old child in this case was admitted to the surgical department 8 hours after the first attack of anxiety, with attacks happening every 10 minutes and lasting for 2-3 minutes. There was also one-time vomiting. Objectively, the child’s condition was grave, and palpation revealed a tumor-like formation in the right iliac area. After rectal examination, the doctor’s finger was stained with blood. These symptoms are consistent with ileocecal invagination. Gastrointestinal hemorrhage (Option B) can cause symptoms such as vomiting and bloody stools, but it is less likely to cause a palpable tumor-like formation in the right iliac area. Wilm’s tumor (Option C) is a type of kidney cancer that can cause abdominal pain and a palpable mass, but it is rare in infants and not typically associated with the symptoms described in this case. Helminthic invasion (Option D), or parasitic worm infestation, can cause abdominal pain and diarrhea, but it is less likely to cause a palpable tumor-like formation in the right iliac area. Pyloric stenosis (Option E) is a narrowing of the opening between the stomach and small intestine that can cause vomiting and dehydration, but it is less likely to cause a palpable tumor-like formation in the right iliac area. Therefore, the most probable diagnosis in this case is ileocecal invagination (Option A). It is important to note that a proper diagnosis should be made by a licensed medical professional after a thorough examination and appropriate diagnostic tests. Early recognition and treatment of ileocecal invagination is important to prevent complications such as bowel necrosis and sepsis. |
199. During preventive examination a 16 year old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?
A. III physiological sound
B. Fout-ta-ta-rou (reduplication of the 2nd sound)
C. Protodiastolic gallop rhythm
D. Atrial gallop rhythm
E. IV physiological sound
Answer: III physiological sound
Explanation
| The key details in the information provided are: – The patient is a 16 year old with no reported problems – Three sounds are heard on auscultation above the cardiac apex – The phonocardiogram shows the third sound 0.15 seconds after the second sound These findings point to the presence of a physiological III sound, also known as an S3 gallop. This is a normal variant seen in adolescents and young adults, due to increased compliance of the ventricles. It indicates volume overload and increased venous return. The other options are incorrect based on the following: B. Fout-ta-ta-rou refers to a different condition with duplication of the second heart sound. C. Protodiastolic gallop indicates ventricular dysfunction. D. Atrial gallop rhythm refers to an S4 gallop. E. There is no “IV physiological sound.” The III sound is the highest numbered physiological sound. So in summary, the presence of an S3 gallop 0.15 seconds after the second heart sound in an asymptomatic adolescent points to a III physiological sound. |
200. A 52 year old patient with disseminated vertebral osteochondrosis lifted a significant load that resulted in lumbar pain and pain along the sciatic nerve. Objectively: positive Lasegue’s sign on the left, reduced Achilles reflex. What drug would be the most effective from the pathogenetic point of view?
A. Diclofenac
B. Aspirin
C. Analgin
D. Novocaine
E. Spasmalgon
Answer: Diclofenac
Explanation
| Based on the clinical details provided, the most appropriate drug for this patient would be diclofenac, a non-steroidal anti-inflammatory drug (NSAID). The key points: – The patient is 52 years old with osteochondrosis (degenerative joint disease) – He lifted a heavy load, causing lumbar pain and sciatica – There are positive signs on exam of radiculopathy, including: – Positive Left Lasegue’s sign (straight leg raise test) – Reduced left Achilles reflex This clinical picture is consistent with an acute lumbar radiculopathy due to an irritated nerve root, likely from disc herniation or spinal stenosis. NSAIDs like diclofenac work by: – Reducing inflammation in the joints and surrounding tissues – Decreasing pain by inhibiting prostaglandin synthesis This dual action makes NSAIDs effective for acute radicular pain from osteochondrosis and herniated discs. Diclofenac specifically has good penetration into spinal tissues. The other drug options would be less appropriate due to: Aspirin – less potent than NSAIDs like diclofenac Analgin – a synthetic opioid, not ideal first-line for this patient Novocaine – a local anesthetic, would not provide adequate pain relief Spasmalgon – a muscle relaxant, would not address the underlying inflammation and pain In summary, based on the clinical details and likely pathogenesis involving inflammation and nerve root compression, diclofenac would be the most effective first-line drug option for this patient’s radicular low back pain from osteochondrosis. |
