Question From ( 151 To 200 )
151. 1 day ago a 19-year old male patient got a trauma after a fall from 1,5 m height when he “bestrode”a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?
A. Epicystostomy
B. Urine bladder catheterization for urine diversion
C. Urethra bougienage
D. Cold to the perineum, hemostatic therapy
E. Primary suturing of urethra
Answer: Epicystostomy
Explanation
| The patient’s symptoms and urethrography findings suggest a disruption or injury to the membranous part of the urethra, which is a serious condition that requires prompt treatment. The presence of macrohematuria and urethrorrhagia indicate significant bleeding, which can lead to a rapid deterioration of the patient’s condition. Epicystostomy, or the creation of a temporary opening in the bladder through the abdominal wall, is the treatment of choice in cases of traumatic urethral injury. This procedure allows for urine diversion and decompression of the bladder, which can help to reduce the risk of infection and further injury to the urinary tract. It also allows for continued drainage of urine while the urethral injury is healing. Urethra bougienage or primary suturing of the urethra are not appropriate treatment options for this type of injury, as they can further damage the urethra and increase the risk of complications. Cold to the perineum and hemostatic therapy may be helpful in controlling bleeding, but they do not address the underlying injury to the urethra. |
152. A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38oC, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
A. Sepsis
B. Putrid phlegmon
C. Erysipelas
D. Allergic reaction
E. Erysipeloid
Answer: Sepsis
Explanation
| The patient’s symptoms and wound findings are suggestive of a postoperative wound infection, which can lead to sepsis, a potentially life-threatening condition characterized by a systemic inflammatory response to infection. The presence of a fever, leukocytosis, and wound discharge are all indicative of an ongoing infection. The change in color of the granulation tissue from red to pale suggests a decrease in blood supply, which can occur with the development of tissue necrosis and bacterial invasion. The discharge of pus from the wound is also consistent with an infectious process. Putrid phlegmon is a form of soft tissue infection that is characterized by the production of gas in the tissues, which is not described in the case scenario. Erysipelas is a skin infection caused by Streptococcus bacteria, but it typically presents with a well-defined, raised, and erythematous rash, which is not seen in this case. Allergic reactions and erysipeloid are unlikely to cause the combination of symptoms seen in this patient. |
153. A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
A. Iridocyclitis
B. Iritis
C. Keratitis
D. Choroiditis
E. Acute attack of glaucoma
Answer: Iridocyclitis
Explanation
| The patient’s symptoms and findings, including acute pain in the eye, vision impairment, photophobia, lacrimation, pericorneal injection, flattening of iris relief, and iris discoloration, are consistent with iridocyclitis, also known as anterior uveitis. Iridocyclitis is an inflammation of the iris and ciliary body, which can be caused by autoimmune disorders, infections, or trauma. The patient’s history of rheumatism is a risk factor for the development of iridocyclitis, as autoimmune disorders are a common cause of this condition. The presence of pericorneal injection and iris discoloration suggest inflammation of the iris, while the flattening of iris relief may be due to ciliary spasm. Keratitis is an inflammation of the cornea, which typically presents with a different set of symptoms and findings. Choroiditis is an inflammation of the choroid, which is not supported by the patient’s physical exam findings. An acute attack of glaucoma may present with similar symptoms, but would typically be associated with increased intraocular pressure and a different set of physical exam findings. Iritis is another term for iridocyclitis, and can be considered a synonym for this condition. |
154. Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he felt acute pulsating pain at the end of the nail bone which was getting worse at pressing. Nail fold became hyperemic, body temperature rose up to 37, 5oC, there was a change in nail plate colour. What is the most likely diagnosis?
A. Subungual panaritium
B. Erysipelas
C. Paronychia
D. Erysipeloid
E. Abscess
Answer: Subungual panaritium
Explanation
| The patient’s symptoms and findings, including acute pulsating pain, hyperemia of the nail fold, color changes in the nail plate, and fever, suggest the development of an infection in the finger. In this case, the infection appears to be focused around the nail bed, which indicates a subungual panaritium. Subungual panaritium is a type of infection that occurs around the nail bed, usually as a result of trauma or injury. The infection can spread to the surrounding tissues, leading to pain, swelling, and redness. The presence of fever suggests that the infection may be more severe and may require medical attention. Erysipelas is a skin infection caused by Streptococcus bacteria, which typically presents with a well-defined, raised, and erythematous rash, which is not seen in this case. Paronychia is a superficial infection of the skin around the nail, but it typically presents with different symptoms and does not involve the nail bed. Erysipeloid is a rare bacterial infection that can occur after contact with infected animals or animal products, which is unlikely to be the cause of this patient’s symptoms. Abscess can occur in any part of the body, including the finger, but the location of the pain and other findings suggest that the infection is focused around the nail bed. |
155. Statistic of patients of common medical practice displays constant increase in elderly and old people number. What kind of pathology is expected to prevail in the morbidity structure of population in question?
A. Chronic pathology
B. Occupational pathology
C. Non-epidemic pathology
D. Acute pathology
E. Infectious pathology
Answer: Chronic pathology
Explanation
| The most likely pathology to prevail in the morbidity structure of an aging population is A) Chronic pathology. As people age, they are more likely to develop chronic diseases such as heart disease, cancer, diabetes, and arthritis. These conditions tend to be long-lasting and can have a significant impact on a person’s quality of life. Chronic diseases can also be expensive to manage, which can be a burden on individuals, families, and healthcare systems. In contrast, acute diseases tend to be short-lived and may be more common in younger populations. Infectious diseases can occur at any age, but the incidence may be lower in older populations due to increased immunity to common pathogens. Occupational pathology refers to diseases that are caused by exposure to hazards in the workplace, and while they may be more common in certain professions, they are not necessarily more prevalent in older populations. Non-epidemic pathology is a broad category that is not specific to any particular age group or disease type. |
156. A 30-year-old patient consulted a doctor about menstruation absence for 2 years after labour, loss of hair, body weight loss. The labour was complicated by a haemorrhage caused by uterus hypotonia. Objectively: the patient is asthenic, external genitals are hypoplastic, the uterus body is small and painless. The appendages are not palpaple. What is the most likely diagnosis?
A. Sheehan’s syndrome
B. Ovarian amenorrhea
C. Turner’s syndrome
D. Exhausted overy syndrome
E. Galactorrhea-amenorrhea syndrome
Answer: Sheehan’s syndrome
Explanation
| The patient’s symptoms and findings, including menstruation absence after labor, loss of hair, body weight loss, hypoplastic external genitals, small and painless uterus, and non-palpable appendages, are consistent with Sheehan’s syndrome. This condition is caused by ischemic necrosis of the pituitary gland, which can occur as a result of severe postpartum hemorrhage, leading to a deficiency in anterior pituitary hormones. The patient’s history of hemorrhage caused by uterine hypotonia is a risk factor for the development of Sheehan’s syndrome. The presence of hypoplastic external genitals and non-palpable appendages suggest a lack of ovarian function, which can be a consequence of pituitary hormone deficiency. Ovarian amenorrhea, exhausted ovary syndrome, and galactorrhea-amenorrhea syndrome can also cause menstrual irregularities, but they are less likely to be associated with the patient’s other symptoms and findings. Turner’s syndrome is a genetic disorder that affects females, but it typically presents with a different set of symptoms and physical exam findings, including short stature, webbed neck, and a wide carrying angle of the arms. |
157. A 25-year-old patient complains of burning and pain during urination, purulent discharges from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic, hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis: recent acute gonorrheal urethritis. What supplemental data of clinical examinations will alow to specify the diagnosis?
A. Microscopy of the urethral discharges
B. Serological blood analysis
C. Common urine analysis
D. Coccal cells detection during discharge microscopy
E. Yeast cells detection during discharge microscopy
Answer: Microscopy of the urethral discharges
Explanation
| The supplemental data of clinical examinations that will allow to specify the diagnosis in this case is A) Microscopy of the urethral discharges. The patient’s symptoms and findings are suggestive of gonorrheal urethritis, which is a sexually transmitted infection caused by the Neisseria gonorrhoeae bacteria. Microscopy of the urethral discharge can help to confirm the diagnosis by allowing for the direct visualization of the bacteria. In gonorrheal urethritis, the urethral discharge typically contains numerous gram-negative diplococci, which are characteristic of Neisseria gonorrhoeae. Serological blood analysis and common urine analysis are not specific tests for gonorrheal urethritis and are unlikely to provide useful information for the diagnosis of this condition. Coccal cell detection during discharge microscopy is a more general term for the observation of any type of spherical-shaped bacterial cells, which may be present in a variety of infections. Yeast cell detection during discharge microscopy is also unlikely to be relevant in this case, as yeast infections typically present with different symptoms and findings. |
158. A 28-year-old patient has been admitted to the gynecological department three days after a casual coitus. She complains about pain in her lower abdomen and during urination, profuse purulent discharges from the vagina, body temperature rise up to 37, 8oC. The patient was diagnosed with acute bi-lateral adnexitis. Supplemental examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes within the whole visual field, diplococcal bacteria located both intra- and extracellularly. What is the etiology of acute adnexitis in this patient?
A. Gonorrheal
B. Colibacterial
C. Chlamydial
D. Trichomonadal
E. Staphylococcal
Answer: Gonorrheal
Explanation
| The most likely etiology of acute adnexitis in this patient is A) Gonorrheal. The patient’s symptoms and findings, including pain in the lower abdomen and during urination, purulent vaginal discharge, and fever, are consistent with acute pelvic inflammatory disease (PID), which is often caused by sexually transmitted infections (STIs). The presence of intracellular and extracellular diplococcal bacteria on vaginal examination is highly suggestive of Neisseria gonorrhoeae, the bacteria responsible for gonorrhea. Other STIs, such as chlamydia and trichomoniasis, can also cause PID, but are less likely to be associated with the patient’s specific findings. Colibacterial infections can occur in the urinary tract, but are less commonly associated with PID. Staphylococcal infections can cause a range of infections, but are not typically associated with PID. The 4th degree of purity of the vaginal secretion and the presence of leukocytes within the whole visual field are indicative of an active inflammatory process in the reproductive tract, which is consistent with PID. The diagnosis of gonorrheal PID can be confirmed with further laboratory testing, such as culture or nucleic acid amplification testing (NAAT) of vaginal or cervical secretions. |
159. A boy is 8 year old. His physical development is compliant with his age. The child has had cardiac murmur since birth. Objectively: skin and visible mucous membranes are of normal colour. AP- 100/70 mm Hg. Auscultation revealed systolo-diastolic murmur and diastolic shock above the pulmonary artery. ECG shows overload of the left heart. Roentgenoscopy shows coarsening of the lung pattern, heart shadow of normal form. What is the most likely diagnosis?
A. Atrioseptal defect
B. Pulmonary artery stenosis
C. Aorta coarctation
D. Fallot’s tetrad
E. Patent ductus arteriosus
Answer: Atrioseptal defect
Explanation
| The patient’s history of a cardiac murmur since birth, along with the findings of a systolo-diastolic murmur and diastolic shock above the pulmonary artery, suggest the presence of a congenital heart defect. The ECG findings of left heart overload and the coarsening of the lung pattern on roentgenoscopy further support this diagnosis. Atrioseptal defect, also known as atrial septal defect, is a congenital heart defect in which there is a hole in the wall that separates the two upper chambers of the heart. This can lead to increased blood flow to the lungs and cause symptoms such as shortness of breath, fatigue, and heart palpitations. The diastolic shock above the pulmonary artery may be due to increased blood flow through the pulmonary valve. Pulmonary artery stenosis, aorta coarctation, Fallot’s tetrad, and patent ductus arteriosus are also congenital heart defects that can present with similar symptoms and findings. However, the presence of a systolo-diastolic murmur and diastolic shock above the pulmonary artery is more indicative of an atrioseptal defect. |
160. A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?
A. Disturbed urine outflow from the kidney
B. Increase in relative density of urine
C. Ureteric twists
D. Destruction of glomerules
E. Renal artery spasm
Answer: Disturbed urine outflow from the kidney
Explanation
| The mechanism of the attack development in this patient with urolithiasis is A) Disturbed urine outflow from the kidney. Renal colic is a common symptom of urolithiasis, which is the presence of stones, or calculi, in the urinary system. The presence of a stone in the urinary tract can cause a blockage or obstruction, which can lead to a buildup of pressure in the kidney or ureter, causing pain and discomfort. The pain associated with renal colic is typically severe and can be accompanied by nausea and vomiting. The obstruction of the urinary tract can be caused by a stone that has become lodged in the ureter, or by the swelling of the ureter due to inflammation. The obstruction leads to a build-up of urine in the kidney, which can cause the pressure to increase and the pain to worsen. Increase in relative density of urine, ureteric twists, destruction of glomerules, and renal artery spasm are not typically associated with the development of renal colic in patients with urolithiasis. |
161. A 25-year-old woman came to a maternity welfare clinic and complained about being unable to conceive within 3 years of regular sexual life. Examination revealed weight gain, male pattern of hair distribution on the pubis, excessive pilosis of thighs. Ovaries were dense and enlarged, basal temperature was monophase. What is the most likely diagnosis?
A. Sclerocystosis of ovaries
B. Tubo-ovaritis
C. Adrenogenital syndrome
D. Premenstrual syndrome
E. Gonadal dysgenesis
Answer: Sclerocystosis of ovaries
Explanation
| The patient’s symptoms and findings, including weight gain, male pattern hair distribution on the pubis, excessive pilosis of thighs, dense and enlarged ovaries, and monophasic basal temperature, are consistent with PCOS. PCOS is a condition that affects the ovaries and is characterized by the presence of multiple small cysts (follicles) on the ovaries, which can cause hormonal imbalances and lead to a range of symptoms, including irregular menstrual periods, acne, and excessive hair growth. The patient’s difficulty conceiving is also a common symptom of PCOS, as hormonal imbalances can interfere with ovulation and make it more difficult to become pregnant. Other common symptoms of PCOS include insulin resistance, which can lead to weight gain and an increased risk of type 2 diabetes. Tubo-ovaritis, adrenogenital syndrome, premenstrual syndrome, and gonadal dysgenesis are less likely to be associated with the patient’s specific symptoms and findings. Tubo-ovaritis is an infection of the ovaries and/or fallopian tubes that can cause pain and fever, but is less likely to cause the hormonal imbalances and cysts associated with PCOS. Adrenogenital syndrome is a group of genetic disorders that affect the adrenal glands and can cause hormonal imbalances, but typically presents with different symptoms and findings. Premenstrual syndrome is a condition that affects some women before their menstrual period and is characterized by emotional and physical symptoms, but is not typically associated with the hormonal imbalances and cysts seen in PCOS. Gonadal dysgenesis is a genetic condition that affects the development of the reproductive system and typically presents with different symptoms and findings. |
162. A 32-year-old gravida complains about episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied byquickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?
A. Postcava compresseion by the gravid uterus
B. Pressure rise in the veins of extremities
C. Pressure fall in the veins of extremities
D. Vegetative-vascular dystonia (cardial type)
E. Psychosomatic disorders
Answer: Postcava compresseion by the gravid uterus
Explanation
| The most likely reason for the patient’s condition is A) Postcava compression by the gravid uterus. During pregnancy, the gravid uterus can compress the inferior vena cava (IVC), which is the large vein that carries deoxygenated blood from the lower body to the heart. This can lead to a decrease in blood flow and a drop in blood pressure, which can cause dizziness, lightheadedness, and syncope (fainting). The patient’s symptoms of unconsciousness and spontaneous syncopes that quickly resolve after a change of body position, along with episodes of quickly elapsing bradycardia, are consistent with a diagnosis of vasovagal syncope, which is a common type of syncope that can be triggered by a decrease in blood flow to the brain. Other possible causes of syncope during pregnancy include blood pressure changes, such as orthostatic hypotension (a drop in blood pressure upon standing up), and cardiac arrhythmias. However, the patient’s symptoms are more suggestive of IVC compression, which is a common cause of syncope during pregnancy. Pressure rise in the veins of extremities, pressure fall in the veins of extremities, vegetative-vascular dystonia (cardial type), and psychosomatic disorders are less likely to be associated with the patient’s specific symptoms and findings. |
163. A 49-year-old woman complains about headache, head and neck going hot, increased perspiration, palpitation, arterial pressure rise up to 170/100 mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, body weight increase by 5 kg over the last half a year. What is the most likely diagnosis?
A. Climacteric syndrome
B. Premenstrual syndrome
C. Vegetative-vascular dystonia
D. Arterial hypertension
E. Postcastration syndrome
Answer: Climacteric syndrome
Explanation
| The patient’s age and symptoms, including headache, hot flashes, increased perspiration, palpitation, high blood pressure, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, and weight gain, are consistent with the hormonal changes associated with menopause. During menopause, the ovaries gradually stop producing estrogen and other hormones, which can cause a range of symptoms related to hormonal imbalances. Hot flashes, or sudden feelings of warmth, are a common symptom of menopause, as are changes in mood, sleep disturbances, and changes in menstrual patterns. High blood pressure can also occur during menopause due to changes in hormone levels and changes in the body’s metabolism. Premenstrual syndrome (PMS) is a condition that affects some women during the menstrual cycle and is characterized by emotional and physical symptoms, but typically occurs before menstruation, rather than after. Vegetative-vascular dystonia and arterial hypertension can cause some of the symptoms seen in menopause, but are less likely to be associated with the patient’s specific findings. Postcastration syndrome refers to the symptoms that can occur after surgical removal of the ovaries and is less likely to be the cause of the patient’s symptoms, as she still reports having rare and scarce menses. |
164. The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be the most informative for the analysis of this data?
A. Correlation factor
B. Student’s criterion
C. Standardized index
D. Fitting criterion
E. Sign index
Answer: Correlation factor
Explanation
| The most informative index for the analysis of the correlation between service record and eosinophil concentration in blood in workers at dyeing shops of textile factories is A) Correlation factor. The correlation factor, also known as the correlation coefficient, is a statistical measure that assesses the strength and direction of the linear relationship between two variables. In this case, the correlation between service record and eosinophil concentration in blood is of interest, and the correlation coefficient can provide valuable information about the strength and direction of this relationship. A positive correlation coefficient indicates a positive linear relationship between the two variables, meaning that as one variable increases, the other variable also tends to increase. A negative correlation coefficient indicates the opposite, that as one variable increases, the other variable tends to decrease. Other statistical measures, such as Student’s criterion, standardized index, fitting criterion, and sign index, may also be useful for analyzing the data, but they are less specific to assessing the correlation between two variables. Student’s criterion is used to test the significance of the difference between two means, and standardized index is used to normalize data. Fitting criterion is used to assess the fit of a model to data, and sign index is used to determine the direction of a difference between two groups. |
165. A 38-year-old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, ostealgia. Objectively: the patient’s skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen – by 5 cm, painless. In blood: erythrocytes – 2, 7 · 1012/l, Hb- 84 g/l, leukocytes – 58 · 109/l, eosinophils – 1%, stab neutrophils – 2%, segmented neutrophils – 12%, lymphocytes – 83%, lymphoblasts – 2%, smudge cells; ESR- 57 mm/h. What is the most likely diagnosis?
A. Chronic lymphatic leukemia
B. Chronic myeloleukemia
C. Acute lymphatic leukemia
D. Acute myeloleukemia
E. Lymphogranulomatosis
Answer: Chronic lymphatic leukemia
Explanation
| The patient’s symptoms, including fatigue, subfebrile temperature, lymphadenopathy, ostealgia, and bleeding, along with the findings of pale skin and mucous membranes, enlarged painless lymph nodes, hepatomegaly, and splenomegaly, are consistent with the diagnosis of CLL. CLL is a type of cancer that affects the white blood cells, specifically the lymphocytes, and is characterized by the presence of abnormal lymphocytes in the blood and bone marrow. The patient’s blood test results, including low red blood cell count (anemia), low hemoglobin levels, high white blood cell count (leukocytosis), and abnormal lymphocytes, along with the presence of smudge cells, are also consistent with CLL. Chronic myeloleukemia (CML), acute lymphatic leukemia (ALL), acute myeloleukemia (AML), and lymphogranulomatosis (Hodgkin’s lymphoma) are less likely to be associated with the patient’s specific symptoms and findings. CML is a type of leukemia that affects the myeloid cells, while ALL and AML are acute leukemias that can have different symptoms and laboratory findings than CLL. Hodgkin’s lymphoma typically presents with different symptoms and findings than CLL, although lymphadenopathy can be a common feature. |
166. A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR – 20 mm/h, crude protein – 85/l, γglobulines – 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
Answer: Systemic scleroderma
Explanation
| The patient’s symptoms and findings, including numbness, paleness, muscle rigidity, and intermittent pulse in the fingers, polyarthralgia, dysphagia, constipation, masklike face, solid edema of hands, enlarged heart, dry rales in lungs, and laboratory findings of elevated gamma globulins and crude protein, are consistent with the diagnosis of systemic scleroderma. Systemic scleroderma is a connective tissue disorder that affects multiple organs and tissues, including the skin, blood vessels, muscles, and internal organs. The disease can cause a range of symptoms, including Raynaud’s phenomenon (numbness and color changes in the fingers or toes in response to cold or stress), skin thickening and tightening, joint pain and stiffness, dysphagia, and gastrointestinal symptoms. Dermatomyositis can also cause muscle weakness and skin changes, but is less likely to cause the other symptoms and findings seen in this patient. Rheumatoid arthritis and systemic lupus erythematosus can cause joint pain and other symptoms, but are less likely to cause the skin changes and organ involvement seen in systemic scleroderma. Raynaud’s disease, which is characterized by vasospasm of the fingers or toes in response to cold or stress, is a common feature of systemic scleroderma, but is not a specific diagnosis on its own. |
167. A 36-year-old female patient complains of general weakness, edemata of her face and hands, rapid fatiguability during walking, difficult diglutition, cardiac irregularities. These symptoms turned up 11 days after a holiday at the seaside. Objectively: face erythema, edema of shin muscles. Heart sounds are muffled, AP is 100/70 mm Hg. In blood: ASAT activity is 0,95 millimole/h·l, ALAT – 1,3 millimole/h·l, aldolase – 9,2 IU/l, creatine phosphokinase – 2,5 millimole Р/g·l. What method of study would be the most specific?
A. Muscle biopsy
B. ECG
C. Echocardiogram
D. Electromyography
E. Determination of cortisol concentration in blood and urine
Answer: Muscle biopsy
Explanation
| The patient’s symptoms and findings, including weakness, edema, rapid fatiguability, difficulty swallowing, cardiac irregularities, and elevated muscle enzyme levels, are consistent with a diagnosis of myositis, which is an inflammatory condition that affects the muscles. Muscle biopsy is the most specific method of diagnosing myositis, as it can provide direct visualization of muscle tissue and allow for the assessment of inflammation and other pathological changes. Other diagnostic tests, such as ECG, echocardiogram, electromyography, and cortisol measurement, can provide additional information about the patient’s condition, but are less specific to myositis. ECG and echocardiogram can be used to evaluate cardiac function, which may be affected by myositis in some cases. Electromyography can help assess muscle function and detect abnormalities in muscle activity, which can be indicative of myositis. Cortisol measurement can be used to assess adrenal function, which can be affected by some forms of myositis, but is not specific to the condition itself. Therefore, muscle biopsy is the most specific method for determining whether myositis is the underlying cause of the patient’s symptoms and findings. |
168. A 33-year-old patient has acute blood loss: erythrocytes – 2, 2 · 1012/l, Hb- 55 g/l, blood group is A(II)Rh+. Accidentally the patient got a transfusion of donor erythrocyte mass of AB(IV )Rh+ group. An hour later the patient became anxious, got abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature – 38, 6oC. After catheterization of urinary bladder 12 ml/h of darkbrown urine were obtained. What complication is it?
A. Acute renal insufficiency
B. Cardial shock
C. Allergic reaction to the donor erythrocyte mass
D. Citrate intoxication
E. Toxic infectious shock
Answer: Acute renal insufficiency
Explanation
| The patient received a transfusion of donor erythrocytes that were not compatible with their blood type. This can cause an acute hemolytic transfusion reaction, which is a potentially life-threatening complication that can result in the destruction of the transfused red blood cells and the release of hemoglobin and other substances into the bloodstream. Symptoms of an acute hemolytic transfusion reaction include anxiety, abdominal and lumbar pain, tachycardia, hypotension, fever, and dark-colored urine, which is due to the presence of hemoglobin breakdown products in the urine. These symptoms typically occur within the first hour of the transfusion. The patient’s symptoms and findings, including dark brown urine, fever, and abdominal and lumbar pain, suggest that the patient is experiencing an acute renal insufficiency, which is a potential complication of an acute hemolytic transfusion reaction. The destruction of red blood cells can lead to the formation of blood clots in the kidneys, which can cause renal failure. Cardiac shock, allergic reaction to the donor erythrocyte mass, citrate intoxication, and toxic infectious shock are less likely to be associated with the patient’s specific symptoms and findings. Cardiac shock can occur in severe cases of acute hemolytic transfusion reaction, but would likely present with additional symptoms, such as chest pain and shortness of breath. Allergic reactions can occur, but would typically present with symptoms such as hives, itching, and respiratory distress. Citrate intoxication can occur due to the anticoagulant used in stored blood, but would typically present with symptoms such as hypocalcemia and metabolic alkalosis. Toxic infectious shock is a rare complication of transfusion and would present with symptoms such as fever, hypotension, and organ failure. |
169. A 45-year-old man has been exhibiting high activity for the last 2 weeks, he became talkative, euphoric, had little sleep, claimed being able “to save the humanity”and solve the problem of cancer and AIDS, gave money the starangers. What is the most likely diagnosis?
A. Maniacal onset
B. Panic disorder
C. Agitated depression
D. Schizo-affective disorder
E. Catatonic excitation
Answer: Maniacal onset
Explanation
| The patient’s symptoms, including high activity, talkativeness, euphoria, decreased need for sleep, grandiosity, impulsivity, and giving away money, are consistent with a manic episode. Mania is a state of elevated or irritable mood, energy, and activity that can last for at least one week and can significantly impair a person’s functioning and judgment. Bipolar disorder is a mental illness characterized by the presence of manic and depressive episodes, which can occur in a cyclic pattern. The patient’s symptoms suggest the presence of a manic episode, which is a key feature of bipolar disorder. Panic disorder, agitated depression, schizo-affective disorder, and catatonic excitation are less likely to be associated with the patient’s specific symptoms and findings. Panic disorder is characterized by recurrent panic attacks, which are sudden and intense episodes of fear and anxiety. Agitated depression is a subtype of major depressive disorder that is characterized by agitation, restlessness, and irritability. Schizo-affective disorder is a mental illness that combines symptoms of both schizophrenia and mood disorders, such as bipolar disorder or depression. Catatonic excitation is a rare form of catatonia that is characterized by excessive motor activity and excitement. |
170. A 67-year-old female patient suffering from the essential hypertension suddenly at night developed headache, dyspnea that quickly progressed to asphyxia. Objectively: the patient is pale, with sweaty forehead, AP- 210/140 mm Hg, heart rate – 120/min, auscultation revealed solitary dry rales and moist rales in the lower parts. The shins are pastose. What kind of emergency aid would be the most efficient in this case?
A. Nitroglycerin and furosemide intravenously
B. Enalapril and furosemide intravenously
C. Digoxin and nitroglycerin intravenously
D. Labetalol and furosemide intravenously
E. Nitroglycerin intravenously and capoten internally
Answer: Nitroglycerin and furosemide intravenously
Explanation
| The patient’s symptoms and findings, including sudden onset of headache and dyspnea with rapid progression to asphyxia, pale skin with sweaty forehead, high blood pressure (210/140 mm Hg), tachycardia (120/min), pulmonary edema (solitary dry and moist rales in the lower parts), and peripheral edema (pitting edema in the shins), suggest the presence of hypertensive emergency, which is a severe and potentially life-threatening complication of hypertension. Nitroglycerin is a vasodilator that can help reduce blood pressure and relieve symptoms of pulmonary edema. Furosemide is a loop diuretic that can help reduce fluid overload and relieve symptoms of pulmonary and peripheral edema. Enalapril and captopril are angiotensin-converting enzyme (ACE) inhibitors that can also help reduce blood pressure and relieve symptoms of hypertension and heart failure, but they may not be as effective in a hypertensive emergency as they take longer to take effect. Digoxin is a medication used to treat heart failure and is not typically used in the treatment of hypertensive emergencies. Labetalol is a beta-blocker that can help reduce blood pressure and relieve symptoms of hypertension and heart failure, but it may not be as effective in a hypertensive emergency as it can worsen pulmonary edema and can cause bronchospasm in patients with asthma or chronic obstructive pulmonary disease. Therefore, the most efficient emergency aid in this case would be nitroglycerin and furosemide intravenously to rapidly reduce blood pressure and relieve symptoms of pulmonary and peripheral edema. |
171. A patient suffering from gastroesophageal reflux has taken from time to time a certain drug that “reduces acidity”over 5 years. This drug was recommended by a pharmaceutist. The following side effects are observed: osteoporosis, muscle asthenia, indisposition. What drug has such following effects?
A. Aluminium-bearing antacid
B. Inhibitor of proton pump
C. H2-blocker
D. Metoclopramide
E. Gastrozepin
Answer: Aluminium-bearing antacid
Explanation
| Aluminium-containing antacids are commonly used to treat gastroesophageal reflux disease (GERD) by neutralizing stomach acid. However, prolonged use of these antacids can lead to several side effects, including osteoporosis, muscle weakness, and malaise. Aluminium can bind to phosphate in the body, which can lead to decreased absorption of calcium, resulting in osteoporosis. Additionally, aluminium can accumulate in muscle tissue, leading to muscle weakness and fatigue. Malaise or a general feeling of discomfort can also result from the accumulation of aluminium in the body. Inhibitors of proton pump, H2-blockers, metoclopramide, and gastrozepin are other medications used to treat GERD, but they do not have the same side effects as aluminium-containing antacids. Proton pump inhibitors and H2-blockers work by reducing the production of stomach acid, while metoclopramide and gastrozepin work by improving the movement of food through the digestive system. Therefore, in this case, the most likely drug that the patient has been taking and that is causing the observed side effects is an aluminium-containing antacid. |
172. A 26-year-old patient complains about considerable muscle weakness, dizziness, extended abdominal pain, nausea and vomiting giving no relief. The disease has been gradually developing within 6 months. There was progress of general weakness, skin darkening. The patient fell into grave condition after an ARD: there appeared abdominal pain and frequent vomiting. Objectively: the skin is dry with diffuse pigmentation. Heart sounds are significantly weakened, heart rate – 60/min, AP- 80/40 mm Hg. The abdomen is slightly painful in the epigastrial region. In blood: WBCs – 8, 1 · 109/l, glucose – 3,0 millimole/l. What is the most likely diagnosis?
A. Chronic adrenal insufficiency. Addisonian crisis
B. Acute pancreatitis
C. Toxic infectious shock
D. Acute food poisoning
E. Acute cholecystitis
Answer: Chronic adrenal insufficiency. Addisonian crisis
Explanation
| The patient’s symptoms and findings, including muscle weakness, dizziness, abdominal pain, nausea, vomiting, skin darkening, and a gradual onset over the past 6 months, suggest the presence of chronic adrenal insufficiency. Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol and aldosterone, which are hormones that regulate the body’s response to stress and maintain fluid and electrolyte balance. The patient’s recent history of acute respiratory disease (ARD) may have triggered an Addisonian crisis, which is a life-threatening complication of adrenal insufficiency that can occur in response to stress, such as infection or surgery. Symptoms of an Addisonian crisis can include severe abdominal pain, vomiting, hypotension, and electrolyte imbalances. The patient’s diffuse skin pigmentation is a characteristic feature of chronic adrenal insufficiency, which results from the overproduction of melanocyte-stimulating hormone (MSH) due to the lack of cortisol inhibition. Acute pancreatitis, toxic infectious shock, acute food poisoning, and acute cholecystitis are less likely to be associated with the patient’s specific symptoms and findings. Acute pancreatitis typically presents with severe abdominal pain, nausea, and vomiting, but is not associated with skin pigmentation or adrenal insufficiency. Toxic infectious shock is characterized by fever, hypotension, and organ failure, but is not typically associated with adrenal insufficiency. Acute food poisoning can cause abdominal pain, nausea, and vomiting, but does not typically have a gradual onset over several months. Acute cholecystitis typically presents with right upper quadrant abdominal pain and fever. |
173. A puerpera is 25 years old, it is her second day of postpartum period. It was her first labour, it took place at full term. The lochia should be:
A. Bloody
B. Sanguino-serous
C. Mucous
D. Purulent
E. Serous
Answer: Bloody
Explanation
| The most likely type of lochia for this patient on the second day of the postpartum period is B) Bloody. Lochia is the discharge of blood, mucus, and uterine tissue that occurs after childbirth. The amount and type of lochia can vary depending on the time since delivery and other factors, such as breastfeeding. On the first few days after delivery, the lochia is typically bright red and mostly composed of blood, which is why the most likely type of lochia for this patient on the second day of the postpartum period is bloody. As the days go by, the lochia will gradually change in color and composition, becoming more serous and eventually turning to a yellowish-white color. Sanguino-serous, mucous, purulent, and serous lochia are not typically seen on the second day of the postpartum period. Sanguino-serous lochia is seen after a few days, when the lochia becomes less bloody and more serous. Mucous lochia is typically seen after the first week, when the discharge becomes thicker and more mucous. Purulent lochia is a sign of infection and is not normal after childbirth. Serous lochia is seen later in the postpartum period, when the discharge becomes more watery and yellowish-white in color. |
174. A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6 years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What is the optimal treatment method?
A. Surgical laparoscopy
B. Anti-inflammatory therapy
C. Conservative therapy with estrogengestagenic drugs
D. Hormonal therapy with androgenic hormones
E. Sanatorium-and-spa treatment
Answer: Surgical laparoscopy
Explanation
| Endometriosis is a condition where the tissue that lines the uterus grows outside of the uterus, leading to the formation of cysts and scarring. Endometrioid cysts, also known as chocolate cysts, are a type of ovarian cyst that is associated with endometriosis. In cases where the endometrioid cyst is causing infertility, surgical removal is often recommended. Laparoscopic surgery is the preferred method for removing endometrioid cysts as it is minimally invasive and allows for a faster recovery time compared to open surgery. The surgeon will remove the cyst while preserving as much of the ovarian tissue as possible to maximize the patient’s chances of conceiving. Anti-inflammatory therapy, conservative therapy with estrogen-gestagenic drugs, hormonal therapy with androgenic hormones, and sanatorium-and-spa treatment are not effective treatments for endometrioid cysts and infertility. Anti-inflammatory therapy may provide temporary relief of symptoms but will not address the underlying cause of the cyst. Estrogen-gestagenic drugs and androgenic hormones may be used to manage symptoms of endometriosis but are not effective in treating endometrioid cysts. Sanatorium-and-spa treatment may provide some relief of symptoms but will not address the underlying cause of the cyst. |
175. A 20-year-old man complains about pain arising in the lower third of femoral bone under stress and at rest. He denies having a trauma. Objectively: the skin is of normal colour, deep palpation reveals pastosity and pain, knee joint motions are limited. X-ray picture of the meta-epyphisis of distal femur shows a destruction zone and spicules. In blood: immature cell forms, no signs of inflammation. What is the most likely diagnosis?
A. Osteogenic sarcoma
B. Hyperparathyroid dystrophy
C. Chronic osteomyelitis
D. Myelomatosis
E. Marble-bone disease
Answer: Osteogenic sarcoma
Explanation
| Osteogenic sarcoma is a type of bone cancer that typically occurs in young adults and presents with bone pain, swelling, and limited range of motion. The pain may occur at rest or with physical activity and is often worse at night. On physical examination, there may be swelling, tenderness, and limited range of motion of the affected joint. The X-ray may show a destruction zone and spicules. Hyperparathyroid dystrophy, chronic osteomyelitis, myelomatosis, and marble-bone disease are less likely to be associated with the patient’s specific symptoms and findings. Hyperparathyroid dystrophy is a condition where the parathyroid glands produce too much parathyroid hormone, leading to weakened bones and increased risk of fractures, but it typically does not present with a destruction zone on X-ray. Chronic osteomyelitis is a bone infection that can present with bone pain, but there should be signs of inflammation in the blood work. Myelomatosis is a type of cancer that affects the bone marrow and typically presents with bone pain, but immature cell forms in the blood work are not typically seen. Marble-bone disease, also known as osteopetrosis, is a rare genetic disorder that causes the bones to become overly dense and brittle, but it typically does not present with destruction zones on X-ray. Therefore, in this case, the most likely diagnosis is osteogenic sarcoma. |
176. A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
A. Streptococcus
B. Staphylococcus
C. Pneumococcus
D. Klebsiella
E. Proteus
Answer: Streptococcus
Explanation
| Acute rheumatic fever is a systemic inflammatory disease that can occur after an untreated or inadequately treated streptococcal pharyngitis infection. The disease can affect multiple organs, including the heart, joints, skin, and nervous system. Carditis, or inflammation of the heart, is a common presentation of acute rheumatic fever. Streptococcus is the most common causative agent of acute rheumatic fever, and a history of recent streptococcal pharyngitis or tonsillitis is a major criterion for the diagnosis of the disease. Other criteria include fever, joint pain, skin rash, and evidence of inflammation on blood tests. Staphylococcus, pneumococcus, Klebsiella, and Proteus are less likely to be associated with acute rheumatic fever and carditis. While these bacteria can cause infections, they are not typically associated with the development of rheumatic fever. |
177. A department chief of an in-patient hospital is going to inspect resident doctors as to observation of medicaltechnological standards of patient service. What documentation should be checked for this purpose?
A. Health cards of in-patients
B. Statistic cards of discharged patients
C. Treatment sheets
D. Registry of operative interventions
E. Annual report of a patient care institution
Answer: Health cards of in-patients
Explanation
| The documentation that should be checked for the purpose of inspecting resident doctors as to the observation of medical-technological standards of patient service is A) Health cards of in-patients. Health cards, also known as medical records, contain detailed information about a patient’s medical history, diagnosis, treatment, and progress. Checking the health cards of in-patients will allow the department chief to review the quality of care provided by the resident doctors, including the accuracy of the diagnosis, appropriateness of treatment, and effectiveness of interventions. Statistic cards of discharged patients, treatment sheets, registry of operative interventions, and an annual report of a patient care institution may also provide valuable information about the quality of care provided by the resident doctors, but health cards of in-patients are the most comprehensive source of information. Statistic cards of discharged patients may provide information about the number and types of procedures performed, but may not provide detailed information about individual patients. Treatment sheets and registry of operative interventions may provide information about specific procedures, but may not provide a comprehensive overview of the patient’s medical history and progress. The annual report of a patient care institution may provide information about the overall quality of care provided by the institution, but may not provide specific information about individual patients. |
178. Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a mettalic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:
A. Mercury
B. Lead
C. Manganese
D. Toluol
E. Tetraethyl lead
Answer: Mercury
Explanation
| Mercury is a toxic heavy metal that can cause a range of health effects, including damage to the nervous system, gastrointestinal problems, and cardiovascular effects. Exposure to mercury can occur through inhalation of vapors or ingestion of contaminated food or water. The symptoms described in the workers, including metallic taste in the mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, and abrupt decrease in cardiac activity, are consistent with mercury poisoning. Neurological symptoms such as unsteady walk and sleep disturbance are common in cases of mercury poisoning, as the metal can damage the nervous system. Gastrointestinal symptoms such as stomatitis and dyspepsia can also occur, as well as cardiovascular effects such as a decrease in cardiac activity. Lead, manganese, toluol, and tetraethyl lead are also toxic substances that can cause a range of health effects, but they are less likely to be associated with the specific symptoms described in this case. Lead exposure can cause neurological symptoms, gastrointestinal problems, and anemia. Manganese exposure can cause neurological symptoms similar to those seen in Parkinson’s disease. Toluol exposure can cause neurological symptoms such as headaches and dizziness, as well as gastrointestinal problems. Tetraethyl lead is a toxic substance that was commonly used in gasoline, but is no longer in use due to its health effects, which include neurological symptoms and gastrointestinal problems. However, none of these substances are typically associated with the abrupt decrease in cardiac activity described in this case. |
179. A full-term infant has respiratory rate of 26/min, heart rate of 90/min, blue skin, muscle hypotonia. During catheter suction of mucus and amniotic fluid from the nose and mouth the child reacted with a grimace. Low reflexes. Auscultation revealed weakened vesicular respiration above lungs. Heart sounds are loud. After 5 minutes the respiration became rhythmic, at the rate of 38/min, heart rate of 120/min. What is the most likely diagnosis?
A. Asphyxia
B. Inborn pneumonia
C. Birth trauma
D. Bronchopulmonary dysplasia
E. Respiratory distress syndrome
Answer: Asphyxia
Explanation
| Asphyxia is a condition where the body is deprived of oxygen, which can occur during childbirth and can lead to a range of symptoms, including blue skin, muscle hypotonia, and low reflexes. In severe cases, asphyxia can lead to brain damage or death. The infant’s respiratory rate of 26/min, heart rate of 90/min, and weakened vesicular respiration above the lungs are consistent with asphyxia. The grimace reaction during catheter suction may also be a sign of asphyxia. The improvement in the infant’s respiratory rate and heart rate after 5 minutes may be a sign of recovery from the asphyxia. Inborn pneumonia, birth trauma, bronchopulmonary dysplasia, and respiratory distress syndrome are less likely to be associated with the symptoms described in this case. Inborn pneumonia is a type of pneumonia that occurs in newborns, but typically presents with respiratory symptoms such as cough, rapid breathing, and grunting. Birth trauma may cause injury to the infant during delivery, but typically does not present with blue skin or weakened vesicular respiration. Bronchopulmonary dysplasia is a chronic lung disease that can occur in premature infants, but is unlikely in a full-term infant. Respiratory distress syndrome is also more common in premature infants and typically presents with rapid breathing, grunting, and a bluish tint to the skin. |
180. Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:
A. Antibacterial therapy
B. Instrumental revision of uterine cavity
C. Haemostatic therapy
D. Contracting agents
E. Intrauterine instillation of dioxine
Answer: Antibacterial therapy
Explanation
| The prophylaxis of endometritis in the postpartum period following a manual investigation of the uterine cavity and massage should involve A) Antibacterial therapy. Endometritis is a common complication of childbirth and can occur when bacteria from the genital tract enter the uterus during delivery. A manual investigation of the uterine cavity and massage can increase the risk of endometritis by introducing bacteria into the uterus. Antibacterial therapy is the most effective prophylactic measure for preventing endometritis in the postpartum period. Antibiotics should be administered prophylactically immediately after delivery to reduce the risk of infection. The choice of antibiotic may depend on local antibiotic resistance patterns and the individual patient’s risk factors. Instrumental revision of the uterine cavity, haemostatic therapy, contracting agents, and intrauterine instillation of dioxin are not typically used for the prophylaxis of endometritis in the postpartum period. Instrumental revision of the uterine cavity may be necessary if retained placental tissue or other debris is present, but it is not a prophylactic measure. Haemostatic therapy and contracting agents may be used to manage bleeding, but do not prevent endometritis. Intrauterine instillation of dioxin is not a standard prophylactic measure and may have adverse effects on the uterus. |
181. A 35-year-old man complains about intense lumbar pain irradiating to the inguinal area, external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive Pasternatsky’s symptom. Urine analysis revealed that RBCs and WBCs covered the total fi- eld of microscope; the urine exhibited high protein concentration. These clinical presentations were most likely caused by the following pathology:
A. Urolithiasis, renal colic
B. Cholelithiasis, biliary colic
C. Renal infarct
D. Intestinal obstruction
E. Osteochondrosis, acute radicular syndrome
Answer: Urolithiasis, renal colic
Explanation
| The clinical presentations of intense lumbar pain irradiating to the inguinal area, external genitalia, thigh, frequent urination, chill, nausea, vomiting, positive Pasternatsky’s symptom, and abnormal urine analysis with RBCs and WBCs covering the total field of microscope and high protein concentration are most likely caused by A) Urolithiasis, renal colic. Renal colic is a type of pain that occurs when a kidney stone blocks urine flow and causes pressure to build up in the urinary tract. The pain typically radiates from the flank to the inguinal area, external genitalia, and thigh, and may be associated with frequent urination, nausea, and vomiting. The positive Pasternatsky’s sign indicates irritation of the kidney or ureter, which is common in cases of renal colic. The abnormal urine analysis with RBCs and WBCs covering the total field of microscope and high protein concentration are also consistent with urolithiasis, as the presence of kidney stones can cause irritation and inflammation in the urinary tract, leading to hematuria, pyuria, and proteinuria. Cholelithiasis, renal infarct, intestinal obstruction, and osteochondrosis with acute radicular syndrome are less likely to be associated with the symptoms described in this case. Cholelithiasis typically presents with pain in the right upper quadrant of the abdomen, while renal infarct may cause sudden onset of severe flank pain and may be associated with fever and hypotension. Intestinal obstruction may cause abdominal pain, distension, and constipation or vomiting. Osteochondrosis with acute radicular syndrome typically presents with back pain that radiates to the leg, but is not typically associated with urinary symptoms or abnormal urine analysis. |
182. Head circumference of a 1-monthold boy with signs of excitement is 37 cm, prefontanel is 2×2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in its volume and composition. Muscle tone is within norm. What is the most likely diagnosis?
A. Pylorospasm
B. Meningitis
C. Pylorostenosis
D. Microcephaly
E. Craniostenosis
Answer: Pylorospasm
Explanation
| The most likely diagnosis for the 1-month-old boy with signs of excitement, head circumference of 37 cm, prefontanel of 2×2 cm, regurgitation of small portions of milk after feeding, and normal muscle tone is A) Pylorospasm. Pylorospasm is a condition in which the muscle at the lower end of the stomach (the pylorus) spasms and prevents food from leaving the stomach. This can lead to symptoms such as vomiting, regurgitation, and signs of excitement or irritability in infants. The head circumference and prefontanel size are within the normal range for a 1-month-old infant and are not indicative of any abnormalities. Meningitis is a serious infection of the membranes surrounding the brain and spinal cord and typically presents with symptoms such as fever, headache, and neck stiffness. Pylorostenosis is a condition in which the pylorus becomes narrowed or blocked, leading to symptoms such as vomiting and poor weight gain. Microcephaly is a condition in which the head circumference is smaller than expected for the age and sex of the infant, and typically indicates abnormal brain development. Craniostenosis is a condition in which the skull bones fuse prematurely, leading to an abnormal head shape. None of these conditions explain the symptoms described in this case, which are most consistent with pylorospasm. |
183. A patient consulted a venereologist about painful urination, reddening of the external opening of urethra, profuse purulent discharges from the urethra. He considers himself to be ill for 3 days. He also associates the disease with a casual sexual contact that took place for about a week ago. If provisional diagnosis “acute gonorrheal urethritis”is confirmed, then bacteriological study of urethral discharges will reveal:
A. Gram-negative diplococci
B. Gram-positive diplococci
C. Spirochaete
D. Proteus vulgaris
E. Mycoplasma
Answer: Gram-negative diplococci
Explanation
| If the provisional diagnosis of “acute gonorrheal urethritis” is confirmed in a patient with painful urination, reddening of the external opening of urethra, and profuse purulent discharges from the urethra, the bacteriological study of urethral discharges is most likely to reveal A) Gram-negative diplococci. Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae, which is a gram-negative diplococcus. The symptoms described in this case, including painful urination, reddening of the external opening of the urethra, and profuse purulent discharges from the urethra, are consistent with acute gonorrheal urethritis. Bacteriological examination of urethral discharges is the most reliable method for diagnosing gonorrhea. In males, a Gram stain of urethral discharge will reveal gram-negative diplococci within polymorphonuclear leukocytes. Culture of the organism in selective media is another method to confirm the diagnosis of gonorrhea. Spirochaete is a group of bacteria with a spiral shape, which are responsible for causing diseases such as syphilis and Lyme disease. Proteus vulgaris is a gram-negative bacterium that is part of the normal intestinal flora and is not typically associated with sexually transmitted infections. Mycoplasma is a group of bacteria that lack a cell wall and are associated with infections such as pneumonia and urinary tract infections, but are not commonly associated with gonorrhea. |
184. As a result of load lifting a 68-yearold female felt acute pain in the lumbar region, in a buttock, posterolateral surface of her right thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior tibial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue’s sign. What examination method would be the most effective for specification of the diagnosis of discogenic compression of L5 root?
A. Magnetic resonance scan
B. Spinal column X-ray
C. Electromyography
D. Angiography
E. Lumbar puncture
Answer: Magnetic resonance scan
Explanation
| The most effective examination method for specification of the diagnosis of discogenic compression of L5 root in a 68-year-old female with acute pain in the lumbar region, buttock, posterolateral surface of the right thigh, external surface of the right shin, and dorsal surface of the foot, weakness of the anterior tibial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes, low Achilles reflex on the right, and positive Lasegue’s sign, is A) Magnetic resonance scan. Discogenic compression of L5 root is a common cause of low back pain with radiation to the buttock, thigh, and foot, as well as weakness and sensory changes in the affected limb. Magnetic resonance imaging (MRI) is the most effective examination method for diagnosing discogenic compression of the nerve root, as it can provide detailed images of the spinal column and surrounding tissues, including any herniated discs or other abnormalities that may be compressing the nerve root. Spinal column X-ray may be useful for detecting fractures or other bony abnormalities, but is less effective than MRI for detecting soft tissue abnormalities such as herniated discs. Electromyography may be used to measure nerve and muscle function, but is not typically used as a primary diagnostic tool for discogenic compression of the nerve root. Angiography is a diagnostic tool used to evaluate blood vessels and is not useful for diagnosing discogenic compression of the nerve root. Lumbar puncture is a procedure used to collect cerebrospinal fluid and is not typically used for diagnosing discogenic compression of the nerve root. |
185. A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a histrory of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?
A. To perform the Heimlich manoever
B. To perform conicotomy immediately
C. To send for an anesthesiologist and wait for him
D. To use an inhalation of β2-adrenoceptor agonist
E. To make a subcutaneous injection of dexamethasone
Answer: To perform the Heimlich manoever
Explanation
| In a patient with coarse breathing, skin cyanosis, tachycardia, and arterial hypertension after inhalation of salbutamol with a cap that was aspirated, the doctor should take immediate measures to relieve the obstruction. The most appropriate action in this scenario would be A) To perform the Heimlich maneuver. The Heimlich maneuver is a technique used to dislodge an obstruction from the airway by applying pressure to the abdomen. It is the first-line treatment for choking and can be effective in cases where an object is aspirated into the airway. In this case, the patient has a history of bronchial asthma and is likely experiencing an acute exacerbation of their condition due to the obstruction caused by the aspirated cap. Performing a conicotomy or sending for an anesthesiologist would not be appropriate as they are more invasive procedures that may delay treatment. Using an inhalation of β2-adrenoceptor agonist or making a subcutaneous injection of dexamethasone may be useful in treating the bronchospasm associated with asthma, but would not be effective in relieving the obstruction caused by the aspirated cap. Therefore, the most appropriate measure in this case would be to perform the Heimlich maneuver to relieve the obstruction and restore airway patency. Once the obstruction is relieved, the patient can be evaluated for any further treatment needs, such as bronchodilators or corticosteroids. |
186. A 28-year-old patient was delivered to the admission ward in the unconscious state with generalized epileptic attacks taking place every 15-20 minutes. During transportation the patient was given two injections of diazepam, magnesia sulphate, but they failed to bring the patient to consciousness. What department should render emergency aid?
A. Resuscitation department
B. Neurological department
C. Surgcal department
D. Therapeutic department
E. Psychiatric department
Answer: Resuscitation department
Explanation
| In the case of a 28-year-old patient with generalized epileptic seizures and unconsciousness despite two injections of diazepam and magnesia sulfate, the most appropriate department to render emergency aid would be A) Resuscitation department. The patient’s condition is critical and requires immediate intervention to stabilize their vital signs and manage the seizures. The resuscitation department is equipped to handle emergency situations such as this and has the necessary resources, including trained personnel and equipment, to manage the patient’s airway, breathing, and circulation. The neurological department may be involved in the patient’s care once their condition is stabilized, but the priority at this stage is to manage the acute medical emergency. The surgical and therapeutic departments may not be equipped to manage the patient’s condition and would require transfer to a higher level of care. The psychiatric department is not appropriate for the management of acute medical emergencies. In summary, the resuscitation department would be the most appropriate department to render emergency aid to a patient with generalized epileptic seizures and unconsciousness, as they have the necessary resources and expertise to manage the patient’s condition and stabilize their vital signs. |
187. On the second day after preventi-ve vaccination a 2-year-old boy presented with abdominal pain without clear localization, body temperature rose up to 38oC. On the third day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and around the joints. Knee joints were edematic and slightly painful. Examination of other organs and systems revealed no pathological changes. What is the most likely diagnosis?
A. Haemorrhagic vasculitis
B. Thrombocytopenic purpura
C. Meningococcemia
D. Urticaria
E. DIC syndrome
Answer: Haemorrhagic vasculitis
Explanation
| The most likely diagnosis for a 2-year-old boy who presented with abdominal pain, fever, and subsequently developed red papular hemorrhagic eruption on the extensor surfaces of limbs and around the joints, with edematous and slightly painful knee joints, on the second and third day after preventive vaccination is A) Haemorrhagic vasculitis. Haemorrhagic vasculitis, also known as Henoch-Schonlein purpura, is a type of vasculitis that affects small blood vessels and causes inflammation and bleeding in the skin, joints, and gastrointestinal tract. It often occurs in children and is characterized by a triad of symptoms including palpable purpura (red or purple spots), arthritis, and abdominal pain. It can be triggered by various factors, including infections and immunizations. Thrombocytopenic purpura is a condition characterized by low platelet counts and bleeding under the skin, which can cause purpura. Meningococcemia is a bacterial infection that can cause fever, rash, and purpura, but is typically more severe and would be expected to cause more widespread symptoms. Urticaria is a skin condition that causes itching and hives, but does not typically cause hemorrhagic eruptions or joint symptoms. DIC syndrome, or disseminated intravascular coagulation, is a condition in which abnormal clotting and bleeding occur throughout the body, but is not typically associated with a papular hemorrhagic rash or joint symptoms. In summary, the clinical presentation of a 2-year-old boy with abdominal pain, fever, and red papular hemorrhagic eruption with joint symptoms after preventive vaccination is most consistent with haemorrhagic vasculitis. |
188. On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?
A. Vesiculopustulosis
B. Impetigo neonatorum
C. Miliaria
D. Impetigo
E. Epidermolysis bullosa
Answer: Vesiculopustulosis
Explanation
| The appearance of multiple vesicles filled with seropurulent fluid in the region of occiput, neck, and buttocks on the 6th day of life in a newborn with normal general condition is suggestive of vesiculopustulosis, also known as transient neonatal pustular melanosis. Vesiculopustulosis is a common benign skin condition that affects newborns, typically appearing within the first week of life. It is characterized by the appearance of multiple vesicles or pustules filled with seropurulent fluid on the skin, primarily on the face, neck, chest, and diaper area. The condition is self-limiting and resolves spontaneously within a few days to weeks without any treatment. Impetigo neonatorum is a bacterial skin infection that can occur in newborns, typically appearing as crusted, honey-colored lesions on the skin. Miliaria, also known as heat rash, is a condition characterized by the appearance of small, red, itchy bumps on the skin caused by blocked sweat ducts. Impetigo is a bacterial skin infection that can occur in people of all ages, typically appearing as crusted, honey-colored lesions on the skin. Epidermolysis bullosa is a rare genetic disorder characterized by skin fragility and blistering. In summary, the appearance of multiple vesicles filled with seropurulent fluid in a newborn with normal general condition on the 6th day of life is most consistent with vesiculopustulosis, a common benign skin condition that typically resolves spontaneously within a few days to weeks without any treatment. |
189. A 60-year-old patient complains about asphyxia, palpitation, rapid fatiguability. He has 8 year history of essential hypertension. Objectively: the left cardiac border is 2 cm deviated to the left from the medioclavicular line, heart sounds are rhythmic and weak; there is diastolic shock above aorta. AP- 170/100 mm Hg. Liver – +2 cm; shin pastosity is present. ECG shows deviation of cardiac axis to the left, left ventricle hypertrophy. Ejection fraction – 63%. What type of cardiac insufficiency is observed?
A. Diastolic
B. Systolic
C. Combined
D. It’s a norm
E. Unspecified
Answer: Diastolic
Explanation
| Based on the given information, the type of cardiac insufficiency observed in the 60-year-old patient is most likely A) Diastolic. The patient’s symptoms of asphyxia, palpitation, and rapid fatiguability, along with the objective findings of left cardiac border deviation, weak heart sounds, diastolic shock above the aorta, and left ventricular hypertrophy, suggest the possibility of heart failure. The elevated blood pressure and liver enlargement are also consistent with the presence of heart failure. The ECG findings of left axis deviation and left ventricular hypertrophy further support the diagnosis of heart failure, with the ejection fraction of 63% indicating a preserved systolic function. These findings suggest that the patient is likely experiencing diastolic heart failure, which is characterized by impaired relaxation of the left ventricle and reduced filling of the heart during diastole, leading to increased pressures in the heart and lungs. Systolic heart failure, on the other hand, is characterized by reduced ejection fraction and impaired contraction of the left ventricle, with a corresponding decrease in cardiac output. Combined heart failure involves both systolic and diastolic dysfunction. In summary, the clinical and diagnostic findings suggest the presence of diastolic heart failure in the 60-year-old patient, characterized by impaired relaxation of the left ventricle and reduced filling of the heart during diastole, leading to increased pressures in the heart and lungs. |
190. A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?
A. Posttraumatic osteomyelitis
B. Hematogenic osteomyelitis
C. Wound abscess
D. Posttraumatic phlegmon
E. Suture sinus
Answer: Posttraumatic osteomyelitis
Explanation
| The most likely complication that has arisen in the postoperative period for the 3-year-old male patient with an open fracture of the brachial bone who now has a fistula with purulent discharge, redness, fluctuation, and bone destruction with sequestra on X-ray is A) Posttraumatic osteomyelitis. Posttraumatic osteomyelitis is a complication that can arise after open fractures and is caused by bacterial infection of the bone and surrounding tissues. The infection can spread through the bloodstream or directly from the wound, leading to inflammation, bone destruction, and the formation of a fistula or sinus tract with purulent discharge. The presence of sequestra on X-ray is a characteristic feature of chronic osteomyelitis. Hematogenous osteomyelitis is a type of bone infection that occurs when bacteria spread to bone tissue through the bloodstream, typically affecting the long bones in children. Wound abscess is a localized collection of pus within the tissues surrounding a wound. Posttraumatic phlegmon is a diffuse inflammation of soft tissues that can occur after trauma or surgery. Suture sinus is an opening that develops along a suture line, typically due to infection or poor wound healing. In summary, the presence of a fistula with purulent discharge, redness, fluctuation, and bone destruction with sequestra on X-ray in a 3-year-old male patient who had an open fracture of the brachial bone two months ago is most consistent with posttraumatic osteomyelitis, a complication that can arise after open fractures and is caused by bacterial infection of the bone and surrounding tissues. |
191. Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated on the grounds of this report?
A. Common morbidity rate
B. Index of pathological affection
C. Index of morbidity with temporary disability
D. Index of hospitalized morbidity
E. Index of basic non-epidemic morbidity
Answer: Common morbidity rate
Explanation
| The common morbidity rate is a measure of the overall burden of disease in a population, calculated as the number of cases of illness per unit of population over a specified period of time. In this case, the reporting form 12 would provide information on the number of cases of different diseases registered among the population of the district under charge, which can be used to calculate the common morbidity rate for the district. The index of pathological affection is a measure of the prevalence of a specific disease or condition in a population, calculated as the proportion of individuals affected by the disease or condition among the total population. The index of morbidity with temporary disability is a measure of the number of cases of illness or injury that result in temporary disability, calculated as the number of cases per unit of population over a specified period of time. The index of hospitalized morbidity is a measure of the number of cases of illness or injury that require hospitalization, calculated as the number of cases per unit of population over a specified period of time. The index of basic non-epidemic morbidity is a measure of the incidence of non-communicable diseases in a population, calculated as the number of cases per unit of population over a specified period of time. In summary, the index that is calculated on the grounds of a report on diseases registered among the population of a district under charge (reporting form 12) is the common morbidity rate, which is a measure of the overall burden of disease in the population, calculated as the number of cases of illness per unit of population over a specified period of time. |
192. A 49-year-old patient undergoes regular medical check-up for uterine fibromyoma. Within the last year the uterus has enlarged up to 20 weeks of gestation. What is the rational way of treatment?
A. Surgical treatment
B. Hormonal therapy
C. Further surveillance
D. Embolization of uterine arteries
E. Treatment with prostaglandin inhibitors
Answer: Surgical treatment
Explanation
| The rational way of treatment for a 49-year-old patient with uterine fibroids that have enlarged up to 20 weeks of gestation within the last year is most likely A) Surgical treatment. Uterine fibroids are benign tumors that can grow in or around the uterus. They can cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel. In some cases, fibroids can grow rapidly, leading to significant enlargement of the uterus. Surgical treatment is often recommended for uterine fibroids that cause significant symptoms or have rapidly enlarged. The specific type of surgery depends on the size, location, and number of fibroids, as well as the patient’s reproductive plans. Options include myomectomy (removal of the fibroids while preserving the uterus), hysterectomy (removal of the uterus), or uterine artery embolization (blocking the blood supply to the fibroids to shrink them). Hormonal therapy can be used to manage symptoms of uterine fibroids, but it does not typically reduce the size of the fibroids. Further surveillance may be appropriate in some cases where the fibroids are small and not causing significant symptoms. Treatment with prostaglandin inhibitors may be used to manage heavy menstrual bleeding associated with fibroids, but it does not typically impact the size of the fibroids. In summary, for a 49-year-old patient with uterine fibroids that have enlarged up to 20 weeks of gestation within the last year, surgical treatment is the most rational way of treatment, depending on the size, location, and number of fibroids, as well as the patient’s reproductive plans. |
193. A patient is being prepared for the operation on account of varix dilatation of lower extremities veins. Examination of the patient’s soles revealed flour-like desquamation along the skin folds. All the toenails are greyish-yellow, thickened and partially decayed. What dermatosis should be suspected?
A. Rubromycosis
B. Pityriasis versicolor
C. Candidosis
D. Microsporia
E. Microbial eczema
Answer: Rubromycosis
Explanation
| The dermatosis that should be suspected in a patient with varicose dilatation of the lower extremity veins who has flour-like desquamation along the skin folds and greyish-yellow, thickened, and partially decayed toenails is A) Rubromycosis, also known as tinea pedis. Rubromycosis, or tinea pedis, is a fungal infection of the feet that typically occurs in warm, moist environments. It is characterized by symptoms such as redness, scaling, itching, and a burning sensation, particularly in the interdigital spaces and along the plantar and lateral aspects of the foot. The infection can also affect the toenails, causing thickening, discoloration, and partial decay. Pityriasis versicolor is a fungal infection of the skin that typically affects the trunk and upper extremities, causing hypopigmented or hyperpigmented macules or patches. Candidosis is a fungal infection caused by Candida species, typically occurring in moist areas of the skin and mucous membranes. Microsporia is a fungal infection of the skin and hair caused by Microsporum species. Microbial eczema is a skin condition characterized by redness, scaling, and itching, typically caused by bacterial or fungal infection. In summary, the dermatosis that should be suspected in a patient with varicose dilatation of the lower extremity veins who has flour-like desquamation along the skin folds and greyish-yellow, thickened, and partially decayed toenails is rubromycosis, or tinea pedis, a fungal infection of the feet that typically occurs in warm, moist environments. |
194. A 46-year-old patient was issued a 10-day sick list because of exacerbation of chronic cholecystitis. The patient’s general condition got better, but the clinical manifestations of the disease are still present. What authority is entitled to extend the sick list?
A. Medical Expert Commission
B. Family doctor
C. Deputy head doctor for terapeutic management
D. Deputy head doctor for medical-labour expertise
E. Head doctor
Answer: Medical Expert Commission
Explanation
| The authority that is entitled to extend a sick list for a 46-year-old patient with an exacerbation of chronic cholecystitis is A) Medical Expert Commission. A sick list is a document that certifies an individual’s inability to work due to illness or injury and is issued by a medical professional. The duration of a sick list is typically determined by the severity of the illness or injury, and it may be extended if the individual’s condition has not improved sufficiently to return to work. In this case, the patient’s general condition has improved, but the clinical manifestations of the disease are still present. To determine whether the sick leave should be extended, the patient should be evaluated by a medical expert commission, which is a group of medical professionals responsible for assessing the medical condition of patients and making recommendations for sick leave, disability, or other medical benefits. The family doctor may issue the initial sick leave, but extending the sick leave requires a more comprehensive evaluation by a medical expert commission. The deputy head doctor for therapeutic management and the head doctor may be involved in the decision-making process, but the medical expert commission has the final authority to extend the sick leave. The deputy head doctor for medical-labour expertise may be involved in evaluating the patient’s ability to return to work after the sick leave period ends. In summary, the authority that is entitled to extend a sick list for a 46-year-old patient with an exacerbation of chronic cholecystitis is the medical expert commission, which is responsible for assessing the patient’s medical condition and making recommendations for sick leave based on their evaluation. |
195. A 43-year-old female patient was delivered to the hospital in grave condition. She suffers from Addison’s disease. The patient had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented, skin and muscle turgor is decreased. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate – 96/min. In blood: Na – 120 millimole/l, K – 5,8 millimole/l. Development of this complication is primarily caused by the deficit of the following hormone:
A. Cortisol
B. Corticotropin (ACTH)
C. Adrenaline
D. Noradrenaline
E. Adrostendion
Answer: Cortisol
Explanation
| The complication seen in the 43-year-old female patient suffering from Addison’s disease who had stopped taking prednisolone a week before and is now in a grave condition is primarily caused by the deficit of cortisol, answer choice A. Addison’s disease is a condition characterized by the partial or complete failure of the adrenal glands to produce sufficient amounts of the hormones cortisol and aldosterone. Cortisol is an important hormone that helps regulate the body’s response to stress, maintain blood glucose levels, and modulate the immune system, among other functions. In this case, the patient had been regularly taking prednisolone, which is a synthetic form of cortisol, to manage her Addison’s disease. However, when she stopped taking the medication, her body was no longer receiving the necessary amount of cortisol, leading to a life-threatening condition known as acute adrenal crisis. The symptoms of acute adrenal crisis can include confusion, lethargy, dehydration, low blood pressure, and electrolyte imbalances, such as hyponatremia (low sodium) and hyperkalemia (high potassium), which are seen in this patient. Treatment typically involves immediate administration of intravenous hydrocortisone and management of any electrolyte imbalances. Corticotropin (ACTH) is a hormone produced by the pituitary gland that stimulates the production of cortisol by the adrenal glands. Adrenaline and noradrenaline are hormones produced by the adrenal medulla that help regulate the body’s response to stress. Adrostendion is a precursor hormone produced by the adrenal glands that can be converted to testosterone or estrogen in other parts of the body. In summary, the complication seen in the 43-year-old female patient suffering from Addison’s disease who had stopped taking prednisolone a week before and is now in a grave condition is primarily caused by the deficit of cortisol, which is an important hormone produced by the adrenal glands that helps regulate the body’s response to stress, maintain blood glucose levels, and modulate the immune system. |
196. Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:
A. Live birth
B. Stillbirth
C. Primary atelectasis
D. Secondary atelectasis
E. Hyaline membrane disease
Answer: Live birth
Explanation
| The forensic medical expertise of the corpse of a newborn with a body weight of 3500 g, body length of 50 cm, a smooth, moist, and glossy umbilical cord without any signs of drying, and positive hydrostatic tests is evidence of A) Live birth. The determination of live birth versus stillbirth is an important forensic issue in cases involving infant mortality. In general, live birth is defined as the complete expulsion or extraction of a fetus from its mother, regardless of whether the baby breathes, cries, or shows other signs of life after birth. Stillbirth, on the other hand, is defined as the birth of a fetus that shows no signs of life. In this case, the newborn had a body weight and length consistent with a viable, full-term infant, and the umbilical cord was smooth, moist, and glossy, without any signs of drying. These findings suggest that the baby was born alive and that the umbilical cord was still receiving blood flow at the time of delivery, as would be expected in a live birth. The positive hydrostatic tests are also consistent with a live birth, as they indicate the presence of air in the lungs, which is typically only present in babies who have taken their first breaths. Hydrostatic tests involve immersing the lungs in water and observing whether they float or sink, with floating lungs indicating the presence of air and suggesting live birth. Primary atelectasis, secondary atelectasis, and hyaline membrane disease are conditions that can occur in newborns but are not relevant to the determination of live birth versus stillbirth. In summary, the forensic medical expertise of the corpse of a newborn with a body weight and length consistent with a viable, full-term infant, a smooth, moist, and glossy umbilical cord without signs of drying, and positive hydrostatic tests is evidence of live birth. |
197. A maternity house has admitted a primagravida complaining of irregular, intense labour pains that have been lasting for 36 hours. The woman is tired, failed to fall asleep at night. The fetus is in longitudinal lie, with cephalic presentation. The fetus heartbeat is clear and rhythmic, 145/min. Vaginal examination revealed that the uterine cervix was up to 3 cm long, dense, with retroflexion; the external orifice was closed; the discharges were of mucous nature. What is the most likely diagnosis?
A. Pathological preliminary period
B. Uterine cervix dystocia
C. Primary uterine inertia
D. Physiological preliminary period
E. Secondary uterine inertia
Answer: Pathological preliminary period
Explanation
| The most likely diagnosis for the primagravida who has been experiencing irregular and intense labor pains for 36 hours, with a cervix that is up to 3 cm long, dense, and retroflexed, and with closed external orifice and mucous discharge, is A) Pathological preliminary period. The preliminary period of labor, also known as the latent phase, is the early stage of labor when the cervix begins to soften, efface, and dilate. This stage can last for several hours to several days, and the contractions are typically mild and irregular. However, if the contractions are intense and irregular, as seen in this case, it may indicate a pathological preliminary period. Uterine cervix dystocia, also known as cervical dystocia, is a condition where the cervix fails to dilate or efface properly during labor, leading to prolonged labor and potential complications for the mother and baby. However, in this case, the cervix is up to 3 cm long, which is a normal finding for the early stages of labor. Primary uterine inertia, also known as hypotonic uterine dysfunction, is a condition where the uterus fails to contract effectively during labor, leading to prolonged labor and potential complications for the mother and baby. However, in this case, the fetal heartbeat is clear and rhythmic, and the uterus is contracting intensely, ruling out primary uterine inertia. Physiological preliminary period is a normal part of the labor process, characterized by mild and irregular contractions that gradually become more frequent and intense. However, in this case, the contractions are intense and irregular, indicating a pathological preliminary period. Secondary uterine inertia, also known as hypertonic uterine dysfunction, is a condition where the uterus contracts too frequently and too intensely, leading to prolonged labor and potential complications for the mother and baby. However, in this case, the contractions are irregular, ruling out secondary uterine inertia. In summary, the most likely diagnosis for the primagravida who has been experiencing irregular and intense labor pains for 36 hours, with a cervix that is up to 3 cm long, dense, and retroflexed, and with closed external orifice and mucous discharge, is a pathological preliminary period, which may require further evaluation and management by a healthcare provider. |
198. A 52-year-old patient works as a secretary and has 30 year record of service. She complains of spasms in her right hand during working and inability to type and write. Up to 80% of her work involves hand load. The patient has been presenting with these symptoms for 2 years. Objectively: the right hand is tense, there is an increase in muscle tone, attempts to write cause spasms. Examination revealed no pathological changes of CNS. What is the most likely diagnosis?
A. Spastic form of coordination neurosis
B. Neuralgic form of coordination neurosis
C. Paretic form of coordination neurosis
D. Hysteric neurosis
E. Chronic manganese intoxication
Answer: Spastic form of coordination neurosis
Explanation
| The most likely diagnosis for the 52-year-old patient who works as a secretary and complains of spasms in her right hand during work and inability to type and write, with an increase in muscle tone and no pathological changes of CNS, is A) Spastic form of coordination neurosis. Coordination neurosis, also known as functional movement disorder, is a condition characterized by abnormal movements or postures that are not caused by an underlying neurological or medical condition. There are several subtypes of coordination neurosis, including spastic, neuralgic, and paretic, among others. In this case, the patient’s symptoms suggest a spastic form of coordination neurosis, which is characterized by increased muscle tone, stiffness, and spasms. The fact that her symptoms are predominantly in her right hand, where up to 80% of her work involves hand load, further supports this diagnosis. Neuralgic and paretic forms of coordination neurosis are less likely in this case because there are no signs of nerve damage or weakness, respectively. Hysterical neurosis, also known as conversion disorder, is a psychological condition that can cause physical symptoms, but it typically presents with more dramatic and inconsistent symptoms that are not related to specific physical activities. Chronic manganese intoxication is a rare condition that can occur in individuals who are exposed to high levels of manganese, such as in certain industrial or occupational settings. However, this condition typically presents with a range of neurological symptoms, including tremors, muscle rigidity, and cognitive impairment, that are not consistent with the patient’s symptoms. In summary, the most likely diagnosis for the 52-year-old patient who works as a secretary and complains of spasms in her right hand during work and inability to type and write, with an increase in muscle tone and no pathological changes of CNS, is a spastic form of coordination neurosis, which is a type of functional movement disorder characterized by abnormal movements or postures that are not caused by an underlying neurological or medical condition. |
199. During examination at a military commissariat a 15-year-old teenager was found to have interval sysolic murmur on the cardiac apex, diastolic shock above the pulmonary artery, tachycardia. Which of the suuplemental examination methods will be the most informative for the diagnosis specification?
A. Echocardiography
B. Electrocardigraphy
C. Roengenography
D. Phonocardiography
E. Rheography
Answer: Echocardiography
Explanation
| The symptoms described in the scenario suggest the possibility of a cardiac abnormality, and further testing is necessary to determine the specific diagnosis. Of the options given, echocardiography would be the most informative supplemental examination method for diagnosing a cardiac abnormality. Echocardiography is a non-invasive imaging technique that uses high-frequency sound waves to produce images of the heart. It can provide detailed information about the structure and function of the heart, such as the size and thickness of the heart’s chambers, the motion of the heart’s walls and valves, and the blood flow through the heart. Electrocardiography (ECG) is a useful tool for diagnosing certain cardiac conditions, such as arrhythmias, but may not provide enough information to diagnose a structural abnormality of the heart. Roentgenography (X-ray) may be helpful in identifying certain cardiac abnormalities, but it is not as sensitive or specific as echocardiography. Phonocardiography and rheography are also useful diagnostic tools, but are less commonly used than echocardiography in the diagnosis of cardiac abnormalities. |
200. A 67-year-old female patient complains about edemata of face and legs, pain in the lumbar area that is getting worse at moving; great weakness, sometimes nasal haemorrhages, rise of body temperature up to 38, 4oC. Objectively: painfulness of vertebral column and ribs on palpation. Laboratorial study revealed daily proteinuria of 4,2 g, ESR- 52 mm/h. What changes of laboratory indices are to be expected?
A. Whole protein of blood serum – 101 g/l
B. Leukocytes – 15,3 g/l
C. Haemoglobin – 165 g/l
D. Albumins – 65%
E. γ-globulins – 14%
Answer: Whole protein of blood serum – 101 g/l
Explanation
| The symptoms and laboratory findings suggest a possible diagnosis of multiple myeloma, a type of blood cancer that affects plasma cells in the bone marrow. In multiple myeloma, there is an overproduction of abnormal plasma cells, which can lead to high levels of monoclonal immunoglobulins (M-proteins) in the blood and urine, as well as other laboratory abnormalities. Of the options given, the most likely change in laboratory indices in this patient with multiple myeloma would be an increase in the whole protein of blood serum. This is because multiple myeloma is characterized by the overproduction of M-proteins, which are a type of immunoglobulin (antibody) produced by the abnormal plasma cells. These M-proteins can lead to an increase in the total protein level in the blood. Leukocytes are white blood cells, which may or may not be affected in multiple myeloma. Haemoglobin is a measure of the oxygen-carrying capacity of the blood and is not typically affected by multiple myeloma. Albumins and γ-globulins are types of proteins in the blood that may be affected in multiple myeloma, but an increase in total protein is more specific to this disease. It is important to note that further diagnostic tests, such as bone marrow biopsy and imaging studies, would be necessary to confirm the diagnosis of multiple myeloma. |
