Question From ( 151 To 200 )
151. 3 hours ago a 65-year-old female patient felt sharp abdominal pain irradiating to the right scapula, there was a single vomiting. She has a history of rheumatoid arthritis. Objectively: pale skin, AP100/60 mm Hg, Ps- 60/min. Abdomen is significantly painful and tense in the epigastrium and right subcostal areat, there are positive symptoms of parietal peritoneum irritation over the right costal arch, that is tympanitis. What is the tactics of an emergency doctor?
A. To take the patient to the surgical hospital
B. To inject pain-killers and watch the dynamics
C. To perform gastric lavage
D. To inject spasmolytics
E. To take the patient to the rheumatological department
Answer: To take the patient to the surgical hospital
Explanation
| The clinical presentation is consistent with a possible acute abdomen, which is a medical emergency requiring urgent surgical evaluation and management. The presence of positive signs of peritoneal irritation, including abdominal pain and tenderness, abdominal distension, and tympanitis, suggests that there may be a possible perforation or rupture of an organ within the abdomen, such as the appendix, gallbladder, or intestine. Injecting pain-killers (B) or spasmolytics (D) may provide temporary relief of symptoms but they will not address the underlying cause of the acute abdomen and may mask the severity of the condition, leading to delayed diagnosis and treatment. Gastric lavage (C) is not indicated in this case as it is unlikely to be helpful in the management of an acute abdomen. Taking the patient to the rheumatological department (E) is not indicated in this case as the patient’s symptoms suggest an acute surgical emergency rather than a rheumatological issue. |
152. A 72-year-old patient complains of pain and bleeding during defecation. Digital rectal investigation revealed a tumour of the anal canal. After verification of the diagnosis the patient was diagnosed with squamous cell carcinoma. The secondary (metastatic) tumour will be most probably found in:
A. Lungs
B. Liver
C. Pelvic bones
D. Mediastinum
E. Brain
Answer: Lungs
Explanation
| Squamous cell carcinoma of the anal canal is a type of cancer that arises from the squamous cells lining the anal canal. Depending on the stage of the cancer, it can spread to other parts of the body through the lymphatic system or bloodstream, leading to the development of secondary (metastatic) tumors. The lungs are a common site for the metastasis of squamous cell carcinoma of the anal canal, as they are a frequent site for the spread of many types of cancer. Other common sites of metastasis include the liver (B) and pelvic bones (C). However, the lungs are the most likely location in this case. Mediastinum (D) and brain (E) are also possible sites of metastasis, but they are less common than the lungs, liver, and pelvic bones in cases of squamous cell carcinoma of the anal canal. |
153. A patient has a stab wound on his right foot. On the fourth day after injury the patient’s body temperature rose up to 38oC, inguinal lymph nodes became enlarged and painful, skin over them reddened. What complication might be suspected?
A. Lymphadenitis
B. Lymphangitis
C. Phlegmon
D. Tetanus
E. Erysipelas
Answer: Lymphadenitis
Explanation
| Lymphadenitis is an inflammation of the lymph nodes, which can occur as a result of an infection or injury. In this case, the symptoms suggest that the patient may have developed an infection in the foot as a result of the stab wound, which has spread to the nearby lymph nodes in the groin, leading to their enlargement, pain, and inflammation. Lymphangitis (B) is an inflammation of the lymphatic vessels, which can occur as a result of an infection or injury. However, the symptoms described in this case are more consistent with lymphadenitis than with lymphangitis. Phlegmon (C) is a type of deep tissue infection that can occur as a result of an injury or wound, and is characterized by the formation of a pus-filled cavity within the affected tissue. While it is a possible complication of a stab wound, the symptoms described in this case are more consistent with lymphadenitis. Tetanus (D) is a bacterial infection that can occur as a result of a contaminated wound, but it typically presents with muscle stiffness, spasms, and pain, rather than fever, lymph node enlargement, and skin redness. Erysipelas (E) is a bacterial infection that can occur as a result of a skin injury or wound, and is characterized by redness, swelling, and pain in the affected area. While it is a possible complication of a stab wound, the symptoms described in this case are more consistent with lymphadenitis. |
154. A 25-year-old female patient complains about having amenorrhea for 3 years. She associates it with difficult labour complicated by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective examination reveals no pathological changes of uterus and its appendages. What is the desease pathogenesis?
A. Hypoproduction of gonadotropin
B. Hyperproduction of estrogens
C. Hyperproduction of androgens
D. Hypoproduction of progesterone
E. Hyperproduction of prolactin
Answer: Hypoproduction of gonadotropin
Explanation
| Gonadotropins are hormones produced by the pituitary gland that play a crucial role in regulating the menstrual cycle and reproductive function. A decrease in the production of gonadotropins, particularly luteinizing hormone (LH) and follicle-stimulating hormone (FSH), can lead to a disruption in the menstrual cycle, including amenorrhea, as well as other symptoms such as loss of weight, hair fragility and loss, lack of appetite, and depression. The difficult labour and massive hemorrhage may have contributed to the hypoproduction of gonadotropin by causing damage to the pituitary gland or disrupting the hormonal balance necessary for normal reproductive function. Hyperproduction of estrogens (B) or androgens (C) may lead to menstrual irregularities, but they are less likely to be the cause of amenorrhea in this case. Hypoproduction of progesterone (D) may also contribute to menstrual irregularities, but it is not likely to be the primary cause of amenorrhea in this case. Hyperproduction of prolactin (E) can lead to amenorrhea, but it is typically associated with galactorrhea (milk production from the breasts), which is not described in this case. |
155. During a surgery on a 30-year-old patient a dark ileo-ileal conglomerate was discovered, the intussusceptum intestine was considered to be unviable. The intussuscipiens intestine was dilated to 7-8 cm, swollen, full of intestinal contents and gases. What pathology led to the surgery?
A. Invagination (combined) obstruction
B. Strangulation obstruction
C. Obturation obstruction
D. Paralytic obstruction
E. Spastic obstruction
Answer: Invagination (combined) obstruction
Explanation
| Invagination, also known as intussusception, is a medical condition in which a segment of intestine invaginates or telescopes into another adjacent segment of intestine, leading to obstruction of the intestinal lumen. This can result in a reduction of blood flow to the affected area, leading to ischemia and necrosis of the involved bowel segment. Combined invagination occurs when both the intussusceptum and intussuscipiens are involved in the telescoping, leading to a more severe form of obstruction. Strangulation obstruction (B) occurs when the blood supply to a segment of intestine is compromised, leading to ischemia and necrosis of the bowel. Obturation obstruction (C) occurs when the intestinal lumen is obstructed by a physical obstruction such as a tumor, fecal impaction, or foreign body. Paralytic obstruction (D) occurs when there is a failure of normal intestinal motility, leading to a functional obstruction. Spastic obstruction (E) occurs when there is abnormal intestinal smooth muscle contraction, leading to a functional obstruction. None of these conditions are consistent with the findings in this case. |
156. In the current year general practitioners of the municipal polyclinic have referred 11 patients with coronary artery disease to the in-patient hospital. In 3 cases the diagnosis wasn’t confirmed. What managerial decision shoud be made in such case?
A. Analysis of each case of diagnostic divergence
B. Analysis of medical check-up quality
C. Analysis of diagnostic examination quality
D. Analysis of doctors’ skill level
E. Analysis of material and technical basisof the polyclinic
Answer: Analysis of each case of diagnostic divergence
Explanation
| Diagnostic divergence is a situation in which there is a difference between the diagnosis made by the referring physician and the final diagnosis made by the specialist or hospital. In this case, since there were three cases where the diagnosis was not confirmed, it is important to analyze each case individually to identify any possible causes of the diagnostic divergence. This analysis should include a review of the medical history, physical examination, diagnostic tests, and any other relevant information to identify possible factors that may have contributed to the divergence. This analysis may help to identify any potential areas for improvement in the diagnostic process, such as the quality of medical check-ups (B), the quality of diagnostic examinations (C), the skill level of the doctors (D), or the material and technical basis of the polyclinic (E). |
157. It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate the level of daylight illumination?
A. Illuminometer
B. Anemometer
C. Katathermometer
D. Actinometer
E. Psychrometer
Answer: Illuminometer
Explanation
| An illuminometer is a device used for measuring the intensity of light in a given area. It is commonly used to measure the level of daylight illumination in indoor spaces, such as hospital wards, to ensure that they meet the recommended standards for lighting levels. Anemometer (B) is a device used for measuring wind speed and direction. It is not appropriate for measuring the level of daylight illumination. Katathermometer (C) is an obsolete device used for measuring temperature. It is not appropriate for measuring the level of daylight illumination. Actinometer (D) is a device used for measuring the intensity of radiation, particularly ultraviolet radiation. It is not appropriate for measuring the level of daylight illumination. Psychrometer (E) is a device used for measuring relative humidity and dew point. It is not appropriate for measuring the level of daylight illumination. |
158. A 43-year-old patient had been admitted to a hospital with clinical presentations of ischiorectal periproctitis. On the 12th day of treatment the patient’s condition deteriorated: there was an increase in the rate of intoxication and hepatic failure, the body temperature became hectic, AP was 100/60 mm Hg. USI of liver revealed a hydrophilic formation. In blood: WBCs – 19, 6 · 109/l, RBCs.- 3, 0 · 1012/l, Hb- 98 g/l. What complication was developed?
A. Liver abscess
B. Pylephlebitis
C. Hepatic cyst
D. Liver necrosis
E. Budd-Chiari syndrome
Answer: Liver abscess
Explanation
| Ischiorectal periproctitis is an infection of the tissues surrounding the rectum and anus, which can lead to the development of abscesses. In this case, it is likely that the infection spread to the liver, leading to the development of a liver abscess. The symptoms, including the fever, low blood pressure, and high white blood cell count, are consistent with sepsis, which can occur in severe cases of liver abscess. Pylephlebitis (B) is a complication of intra-abdominal infections, which involves the inflammation of the portal vein and its branches. While it can lead to liver abscesses, the symptoms described in this case are more consistent with a primary liver abscess. Hepatic cyst (C) is a fluid-filled sac within the liver, which is usually benign and asymptomatic. It is unlikely to be the cause of the patient’s symptoms. Liver necrosis (D) is a severe form of liver damage that can occur as a result of a viral infection, drug toxicity, or other causes. While it can cause fever and other symptoms, it is less likely to be the cause of the patient’s symptoms than a liver abscess. Budd-Chiari syndrome (E) is a rare condition that involves the obstruction of the hepatic veins, which can lead to liver failure. While it can cause fever and other symptoms, it is less likely to be the cause of the patient’s symptoms than a liver abscess. |
159. A 32-year-old gravida complains of episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied by quickly 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 (cardiac type)
E. Psychosomatic disorders
Answer: Postcava compresseion by the gravid uterus
Explanation
| During pregnancy, the growing uterus can compress the inferior vena cava (IVC), which is the large vein that returns blood from the lower body to the heart. This can result in a decrease in venous return to the heart, leading to a decrease in cardiac output and a drop in blood pressure. In some cases, this can result in syncope or fainting. The symptoms described in the case, including the quick resolution of symptoms with a change in body position, are consistent with postcava compression. Bradycardia may also occur as a compensatory mechanism in response to decreased venous return. Pressure rise in the veins of extremities (B) and pressure fall in the veins of extremities (C) are less likely to be the cause of the patient’s symptoms, as they do not explain the quick resolution of symptoms with a change in body position. Vegetative-vascular dystonia (cardiac type) (D) and psychosomatic disorders (E) are possible causes of syncope, but they are less likely to be the cause in this case, as the symptoms are specifically related to pregnancy and the compression of the IVC by the gravid uterus. |
160. A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?
A. Diagnostic fractional curettage of uterine cavity
B. Colposcopy
C. USI
D. Cytosmear
E. Symptomatic therapy
Answer: Diagnostic fractional curettage of uterine cavity
Explanation
| Bloody discharge from the vagina in postmenopausal women is a concerning symptom that requires further investigation to rule out underlying gynecological malignancy. While gynecological examination may not reveal any pathological changes, this does not rule out the possibility of endometrial cancer or other gynecological malignancies. Diagnostic fractional curettage of the uterine cavity is a procedure that involves taking a sample of the endometrial tissue for histological examination. This is the preferred diagnostic test for postmenopausal women with vaginal bleeding, as it allows for the detection of endometrial cancer and other gynecological malignancies. Colposcopy (B) is a procedure used to examine the cervix for abnormal changes. It is not appropriate for the evaluation of postmenopausal vaginal bleeding. USI (C) is a useful imaging technique for the evaluation of pelvic organs, but it is not as accurate as diagnostic fractional curettage in detecting endometrial malignancies. Cytosmear (D) is a screening test for cervical cancer and is not appropriate for the evaluation of postmenopausal vaginal bleeding. Symptomatic therapy (E) may be appropriate for some cases of postmenopausal vaginal bleeding, but it should only be considered after ruling out underlying malignancies. |
161. A factory worker has ARD complicated by acute bronchitis. He receives treatment in the outpatient setting. The attending doctor has issued him a medical certificate for 5 days and then extended its duration by 5 more days. Patient can’t get down to work because of his health status. Who should extend the duration of medical certificate for this patient?
A. A department chief
B. Medical superintendent
C. Deputy medical superintendent in charge of temporary disability examination
D. Deputy medical superintendent in charge of medical treatment
E. Medical advisory commission
Answer: A department chief
Explanation
| In many countries, the authority to extend medical certificates lies with the employer or the department head. In this case, the department chief would be responsible for extending the duration of the medical certificate beyond the initial 5 days, as well as any subsequent extensions. Medical superintendent (B), Deputy medical superintendent in charge of temporary disability examination (C), Deputy medical superintendent in charge of medical treatment (D), and Medical advisory commission (E) are not typically involved in the process of extending medical certificates for employees. Their roles may be related to the management of healthcare facilities or the evaluation of disability, but they do not have the authority to extend medical certificates for individual patients. |
162. An ambulance delivered a 21- year-old woman to the gynaecological department with complaints of colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was palpated in the cervical canal. Uterine appendages weren’t palpable. Fornices are free, deep and painless. Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?
A. Abortion in progress
B. Cervical pregnancy
C. Threat of abortion
D. Incipient abortion
E. Interrupted fallopian pregnancy
Answer: Abortion in progress
Explanation
| Abortion is the termination of pregnancy before the fetus is viable. In this case, the presence of a gestational sac in the cervical canal suggests that the patient is likely experiencing a miscarriage, which is also known as a spontaneous abortion. Cervical pregnancy (B) is a rare type of ectopic pregnancy in which the embryo implants in the cervix rather than in the uterus. While the patient’s symptoms may suggest an ectopic pregnancy, the finding of a gestational sac in the cervical canal is more consistent with an abortion in progress. Threat of abortion (C) and incipient abortion (D) are terms used to describe early stages of a threatened miscarriage. In this case, the presence of a gestational sac in the cervical canal suggests that the patient is likely experiencing a more advanced stage of pregnancy loss. Interrupted fallopian pregnancy (E) is a type of ectopic pregnancy in which the embryo implants in the fallopian tube and subsequently dies. While the patient’s symptoms may suggest an ectopic pregnancy, the finding of a gestational sac in the cervical canal is more consistent with an abortion in progress. |
163. According to the report of water quality control, drinking city water has the following characteristics: turbidity – 1,5 mg/m3, odour – 3 points, metallic taste – 2 points, pale yellow colour, colour index – 20o, temperature – 12o. Which of these factors doesn’t comply with hygienic requirements?
A. Odour
B. Turbidity
C. Colour index
D. Temperature
E. Taste
Answer: Odour
Explanation
| The presence of an unpleasant odour in drinking water is an indication of contamination or chemical impurities that can pose a health risk to consumers. In this case, the water has an odour rating of 3 points, which suggests that it has an unpleasant smell. Turbidity (B) is the measure of the cloudiness or haziness of water caused by suspended particles. The level of turbidity in the drinking water of 1.5 mg/m3 is within acceptable limits. Colour index (C) is a measure of the intensity of colour in water. The pale yellow colour and colour index of 20o are within acceptable limits. Temperature (D) is not a factor that is typically regulated by hygienic requirements for drinking water. However, drinking water that is too hot or too cold can be uncomfortable to consume. Taste (E) is another important factor in drinking water quality. However, in this case, the metallic taste with a rating of 2 points is within acceptable limits. |
164. On the fifth day after a casual sexual contact a 25-year-old female patient consulted a doctor about purulent discharges from the genital tracts and itch. Vaginal examination showed that vaginal part of uterine cervix was hyperemic and edematic. There was an erosive area around the external orifice of uterus. There were mucopurulent profuse discharges from the cervical canal, uterine body and appendages exhibited no changes. Bacterioscopic examination revealed bean-shaped diplococci that became red after Gram’s staining. What is the most likely diagnosis?
A. Acute gonorrheal endocervicitis
B. Trichomonal colpitis
C. Candidal vulvovaginitis
D. Clamydial endocervicitis
E. Bacterial vaginism
Answer: Acute gonorrheal endocervicitis
Explanation
| Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The characteristic symptoms of gonorrhea in women include purulent discharges from the genital tracts, itching, and inflammation of the cervix. The presence of bean-shaped diplococci that become red after Gram’s staining is highly suggestive of gonorrhea. Trichomonal colpitis (B) is a type of vaginal infection caused by the protozoan parasite Trichomonas vaginalis. The symptoms include frothy, greenish-yellow discharge with a foul odor, itching, and inflammation of the vaginal walls. The finding of bean-shaped diplococci is not consistent with trichomoniasis. Candidal vulvovaginitis (C) is a type of vaginal infection caused by the fungus Candida. The symptoms include white, cottage cheese-like discharge, itching, and inflammation of the vaginal walls. The finding of bean-shaped diplococci is not consistent with candidiasis. Chlamydial endocervicitis (D) is a type of sexually transmitted infection caused by the bacterium Chlamydia trachomatis. The symptoms include mucopurulent discharge, cervical inflammation, and pelvic pain. However, the presence of bean-shaped diplococci is not consistent with chlamydial infection. Bacterial vaginosis (E) is a type of vaginal infection caused by an imbalance of bacteria in the vaginal flora. The symptoms include thin, grayish-white discharge with a fishy odor, itching, and inflammation of the vaginal walls. The finding of bean-shaped diplococci is not consistent with bacterial vaginosis. |
165. The correlation between the service record and eosinophil concentration in blood has been studied in female workers of 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 correlation factor, also known as the Pearson correlation coefficient, is a statistical measure that assesses the strength and direction of the linear relationship between two variables. In this case, the two variables are the service record and eosinophil concentration in blood in female workers of dyeing shops of textile factories. The correlation factor is the most informative index for analyzing this data because it measures the strength and direction of the relationship between the two variables, and can help determine whether there is a significant association between the service record and eosinophil concentration in blood. If the correlation coefficient is positive, it indicates a positive relationship between the two variables, meaning that as one variable increases, the other variable also tends to increase. If the correlation coefficient is negative, it indicates a negative relationship between the two variables, meaning that as one variable increases, the other variable tends to decrease. If the correlation coefficient is close to zero, it indicates that there is little or no relationship between the two variables. |
166. A 30-year-old female patient has been delivered to the gynaecological department with complaints of acute pain in the lower abdomen and body temperature 38, 8oC. In history: sexual life out of wedlock and two artificial abortions. Gynaecological examination reveals no changes of uterine. The appendages are enlarged and painful on both sides. Vaginal discharges are purulent and profuse. What study is required to confirm a diagnosis?
A. Bacteriological and bacterioscopic analysis
B. Hysteroscopy
C. Curettage of uterine cavity
D. Colposcopy
E. Laparoscopy
Answer: Bacteriological and bacterioscopic analysis
Explanation
| The symptoms described in the patient – acute lower abdominal pain, high fever, vaginal discharge, and painful and enlarged appendages on both sides – are suggestive of a pelvic inflammatory disease (PID). PID is an infection of the female reproductive organs, including the uterus, ovaries, and fallopian tubes, and is often caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhea. Bacteriological and bacterioscopic analysis of the vaginal discharge can help to identify the causative microorganisms and guide the selection of appropriate antibiotics for treatment. The analysis involves collecting a sample of the vaginal discharge and examining it under a microscope for the presence of bacteria or other microorganisms. Culturing the sample can also help to identify the specific type of bacteria and determine their susceptibility to antibiotics. Other diagnostic tests, such as ultrasound or laparoscopy, may also be useful in confirming a diagnosis of PID, but the initial step in evaluation of a suspected PID is to perform a thorough gynecological examination and obtain samples for bacteriological and bacterioscopic analysis. |
167. A 38-year-old patient complains of inertness, subfebrile temperature, enlargement of lymph nodes, nasal haemorrhages, bone pain. 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
| CLL is a type of cancer of the blood and bone marrow that affects lymphocytes, a type of white blood cell. The symptoms of CLL can be non-specific and may include fatigue, fever, night sweats, weight loss, enlarged lymph nodes, and bone pain. The blood tests in this case show a low red blood cell count (anemia) and a very high white blood cell count, with a high percentage of lymphocytes and smudge cells, which are characteristic of CLL. While other types of leukemia and lymphoma can also cause similar symptoms and blood abnormalities, the presence of smudge cells is highly suggestive of CLL. Additionally, the painless enlargement of the liver and spleen, sternalgia, and nasal hemorrhages, are common findings in CLL. Further tests such as flow cytometry, immunophenotyping, and bone marrow biopsy may be needed to confirm the diagnosis of CLL and to determine the stage and prognosis of the disease. Therefore, based on the symptoms, laboratory findings, and clinical examination, the most likely diagnosis in this case is Chronic Lymphatic Leukemia (CLL). |
168. A 25-year-old victim of a road accient complains of chest pain, dyspnea. Objectively: the patient is in a grave condition, Ps- 120/min, AP- 90/70 mm Hg.There is pathological mobility of fragments of IIIV ribs on the right. Percussion reveals a box sound over the right lung, breathing sounds cannot be auscultated on the right. What examination should be administered in the first place?
A. X-ray of chest organs
B. Bronchoscopy
C. Pleural puncture
D. USI of chest organs
E. Thoracoscopy
Answer: X-ray of chest organs
Explanation
| The patient’s symptoms and clinical findings are suggestive of a possible chest injury, such as a rib fracture or pneumothorax, which is a condition in which air leaks into the pleural cavity, causing lung collapse and difficulty breathing. A chest X-ray is a simple and non-invasive diagnostic test that can quickly identify abnormalities in the chest, such as the presence of a pneumothorax or rib fractures. In this case, an X-ray of the chest can help to confirm the diagnosis and guide further management, such as the need for chest tube insertion or surgery. While other diagnostic tests such as bronchoscopy, pleural puncture, USI of chest organs, or thoracoscopy may also be useful in the evaluation of chest injuries, they are more invasive and are generally reserved for cases where the diagnosis is unclear or the initial treatment is not effective. |
169. A 24-year-old patient complains about putting on weight, limosis. Objectively: the patient’s constitution is of hypersthenic type, body weight index is 33,2 kg/m2, waist circumference is 100 cm. Correlation of waist circumference to the thigh circumference is 0,95. What is the most likely diagnosis?
A. Alimentary constitutional obesity of the I stage, abdominal type
B. Hypothalamic Itsenko-Cushing obesity of the II stage, gynoid type
C. Alimentary constitutional obesity of the III stage, gynoid type
D. Alimentary constitutional obesity of the II stage, abdominal type
E. Hypothalamic Itsenko-Cushing obesity of the I stage, abdominal type
Answer: Alimentary constitutional obesity of the I stage, abdominal type
Explanation
| Alimentary constitutional obesity is a type of obesity that is caused by excessive calorie intake and a sedentary lifestyle, and is often associated with a predisposition to obesity based on genetic factors. This type of obesity is classified into three stages, with stage I being the mildest form and stage III being the most severe. In this case, the patient’s body mass index (BMI) is 33.2 kg/m2, which is considered obese, and the waist circumference is 100 cm, which is above the normal range for women. The correlation of waist circumference to thigh circumference is 0.95, which indicates that the patient has an abdominal type of obesity, in which excess fat is primarily deposited in the abdomen. There are no other specific features or symptoms described in the case that suggest a secondary cause of obesity, such as Cushing’s syndrome or hypothalamic dysfunction, which are associated with different patterns of fat distribution and may require additional diagnostic tests to diagnose. |
170. 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
| Systemic scleroderma is a rare autoimmune disease that affects the connective tissues of the body, leading to hardening and thickening of the skin, blood vessels, and internal organs. The symptoms in this patient, such as numbness, paleness, muscle rigidness, intermittent pulse, and solid edema of the hands, are suggestive of Raynaud’s phenomenon, which is a common feature of systemic scleroderma. Other symptoms and findings in this patient, such as polyarthralgia, dysphagia, constipation, dry rales in lungs, and enlarged heart, are also consistent with systemic scleroderma, which can affect multiple organs and cause a range of symptoms. Laboratory findings in systemic scleroderma may include an elevated ESR, as seen in this patient, as well as abnormalities in blood proteins and autoantibodies. While other autoimmune diseases such as dermatomyositis, rheumatoid arthritis, and systemic lupus erythematosus may also cause similar symptoms and laboratory abnormalities, the presence of Raynaud’s phenomenon and skin thickening suggest a diagnosis of systemic scleroderma. |
171. A 45-year-old man has been exhibiting high activity for the last 2 weeks, he is talkative, euphoric, has little sleep, claims being able “to save the humanity and solve the problem of cancer and AIDS”, gives money to 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
| A manic episode is a period of abnormally elevated or irritable mood, increased energy, decreased need for sleep, grandiosity, increased talkativeness, racing thoughts, distractibility, and impulsivity. The symptoms in this patient, such as high activity level, talkativeness, euphoria, little sleep, grandiose ideas, and giving money to strangers, are all characteristic of a manic episode. Manic episodes are a feature of bipolar disorder, a mood disorder characterized by both manic and depressive episodes. However, a manic episode can also occur as part of other psychiatric disorders, such as schizoaffective disorder or substance-induced mood disorder. The other options listed (panic disorder, agitated depression, catatonic excitation) do not fit with the symptoms described in the case and are not consistent with a manic episode. |
172. A parturient woman is 25 years old, it is her second day of postpartum period. It was her first full-term uncomplicated labour. The lochia should be:
A. Bloody
B. Sanguino-serous
C. Mucous
D. Purulent
E. Serous
Answer: Bloody
Explanation
| Lochia is the vaginal discharge that occurs after childbirth, and it is composed of blood, mucus, and uterine tissue. Immediately after delivery, lochia is typically bright red and bloody, and over time, it becomes less bloody and changes in color and consistency. On the second day of postpartum period, the lochia is expected to be predominantly bloody, with some clots and tissue present. This is because the uterus is still shedding the lining that built up during pregnancy, and there may be some minor bleeding from the site where the placenta was attached. Sanguino-serous lochia is typically present on the third to fourth day, mucous lochia on the fifth to seventh day, and serous lochia on the eighth to tenth day after delivery. Purulent lochia is not normal and may indicate an infection, which requires prompt medical attention. |
173. 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
| Endometrioid cysts, also known as endometriomas, are benign ovarian cysts that develop when endometrial tissue grows in the ovaries. These cysts can cause pain, discomfort, and infertility, and may require treatment. Surgical laparoscopy is the preferred treatment for endometrioid cysts that are causing infertility. During laparoscopy, the cysts can be removed while preserving the ovarian tissue and function. This procedure is minimally invasive and has a high success rate in restoring fertility. Anti-inflammatory therapy and conservative therapy with estrogen-progestagenic drugs may be used to manage the symptoms of endometriosis, but they are not effective in treating endometrioid cysts or restoring fertility. Hormonal therapy with androgenic hormones is not recommended for the treatment of endometrioid cysts, as it can lead to masculinization and other adverse effects. Sanatorium-and-spa treatment may be useful in managing stress and improving overall health, but it is not a treatment for endometrioid cysts. |
174. A 6-year-old girl drank some coloured fizzy drink which gave her a feeling of pressure in the throat. 30 minutes later the child’s lips got swollen, then edema gradually spread over the whole face, laryngeal breathing became difficult. The child is excited. Ps- 120/min, breathing rate – 28/min, breathing is noisy, indrawing of intercostal spaces is observed. What basic aid is most appropriate for the restoration of laryngeal breathing?
A. Corticosteroids
B. Sedative drugs
C. Tracheostomy
D. Antibacterial drugs
E. Conicotomy
Answer: Corticosteroids
Explanation
| The symptoms described are consistent with an allergic reaction, possibly anaphylaxis, to an ingredient in the fizzy drink the child consumed. The swelling of the lips, progressive facial edema, difficulty breathing, and noisy breathing are all signs of airway obstruction, which can be life-threatening. Corticosteroids are recommended as the initial treatment for anaphylaxis to reduce airway inflammation and swelling. They can be administered intravenously or intramuscularly, depending on the severity of the reaction. Sedative drugs, antibacterial drugs, and conicotomy are not appropriate for the treatment of anaphylaxis and may even worsen the condition. Tracheostomy is a last resort measure if the airway obstruction cannot be relieved by other methods. |
175. A 60-year-old patient had eaten too much fatty food, which resulted in sudden pain in the right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth. Two days later the patient presented with jaundice, dark urine. Objectively: sclera and skin are icteric, abdomen is swollen, liver is increased by 3 cm, soft, painful on palpation, Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, MayoRobson’s symptoms are positive. Which method should be applied for diagnosis in the first place?
A. USI of gallbladder and biliary duct
B. Fibrogastroduodenoscopy
C. X-ray of abdominal organs
D. Radionuclide scanning of liver and gallbladder
E. Diagnostic laparotomy
Answer: USI of gallbladder and biliary duct
Explanation
| The patient’s symptoms of sudden pain in the right subcostal area, nausea, bilious vomiting, strong sensation of bitterness in the mouth, and subsequent jaundice, dark urine, icteric sclera and skin, and swollen, painful liver are all consistent with acute cholecystitis, a condition characterized by inflammation and infection of the gallbladder. The positive Ortner’s, Kehr’s, Murphy’s, Zakharyin’s, and Mayo-Robson’s signs all suggest a diagnosis of acute cholecystitis. Ultrasonography (USI) of the gallbladder and biliary duct is a reliable and non-invasive method for diagnosing acute cholecystitis. USI can detect signs of inflammation, such as gallbladder wall thickening, pericholecystic fluid, and the presence of gallstones or biliary sludge, which can help confirm the diagnosis. Fibrogastroduodenoscopy, X-ray of abdominal organs, radionuclide scanning of liver and gallbladder, and diagnostic laparotomy are not typically used as first-line diagnostic methods for acute cholecystitis. |
176. A 20 year-old patient complains of nosebleeds, numbness of the lower extremities. Objectively: hyperaemia of face, on the upper extremities AP is160/90 mm Hg, and 80/50 mm Hg on the lower ones. Pulse on the popliteal and pedal arteries is of poor volume, there is systolic murmur over the carotid arteries. What is the most likely diagnosis?
A. Aorta coarctation
B. Dissecting aortic aneurysm
C. Aortopulmonary window
D. Ventricular septal defect
E. Atrial septal defect
Answer: Aorta coarctation
Explanation
| Aortic coarctation is a congenital heart defect that occurs when the aorta is narrowed, leading to increased blood pressure and reduced blood flow to the lower body. Symptoms can include nosebleeds, numbness or weakness in the lower extremities, and a difference in blood pressure between the upper and lower extremities. The hyperemia of the face, high blood pressure in the upper extremities (160/90 mm Hg), low blood pressure in the lower extremities (80/50 mm Hg), poor volume pulse in the popliteal and pedal arteries, and systolic murmur over the carotid arteries are all consistent with aortic coarctation. Dissecting aortic aneurysm, aortopulmonary window, ventricular septal defect, and atrial septal defect are other congenital heart defects that can cause similar symptoms, but they are less likely to present with the specific combination of findings described in the case. |
177. An 8-month-old baby has had problems with nasal breathing and mucopurulent discharge from the nose for a week. Examination reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease are these symptoms most typical for?
A. Ethmoiditis
B. Sphenoiditis
C. Maxillary sinusitis
D. Frontitis
E. Hemisinusitis
Answer: Ethmoiditis
Explanation
| Ethmoiditis is an inflammation of the ethmoid sinuses, which are located between the eyes and the nose. It is a common cause of sinusitis in infants and young children. The symptoms of ethmoiditis include nasal congestion, rhinorrhea (mucopurulent discharge from the nose), and difficulty breathing through the nose. The presence of rhinedema, muco-purulent discharges from the middle nasal meatus, and on the back of the pharynx are all typical findings in ethmoiditis. Other symptoms of ethmoiditis may include fever, headache, facial pain or pressure, and irritability in infants. Sphenoiditis, maxillary sinusitis, frontitis, and hemisinusitis are other types of sinusitis that can occur in children, but they typically present with different symptoms and findings. |
178. 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
| Health cards of in-patients contain important information about the patient’s medical history, including their current diagnosis, treatment plan, medications, and vital signs. Checking the health cards of in-patients can help ensure that the resident doctors are following appropriate medical-technological standards of patient service, such as providing the correct medications and treatments, monitoring vital signs, and documenting the patient’s progress. While B. Statistic cards of discharged patients, C. Treatment sheets, D. Registry of operative interventions, and E. Annual report of a patient care institution may also contain useful information about patient care, they may not provide a comprehensive picture of the care provided by the resident doctors or their adherence to medical-technological standards. |
179. While asessing the health status of graduates of a secondary school, the doctor found one of them to have grade 3 tonsillar hypertrophy, chronic rhinitis and vegetative-vascular dystonia. The organism functionality is reduced. This student belongs to the following health group:
A. III
B. II
C. I
D. IV
E. V
Answer: III
Explanation
| Grade 3 tonsillar hypertrophy, chronic rhinitis, and vegetative-vascular dystonia are conditions that indicate a significant impairment of health. When assessing the health status of individuals, various criteria are used to determine the severity or degree of impairment. In this case, the presence of grade 3 tonsillar hypertrophy suggests that the student’s tonsils are significantly enlarged, which can lead to breathing difficulties and recurrent throat infections. Chronic rhinitis refers to long-term inflammation of the nasal passages, which can cause symptoms such as nasal congestion, runny nose, and sneezing. Vegetative-vascular dystonia, also known as autonomic dysfunction, is a disorder of the autonomic nervous system that can manifest with symptoms such as dizziness, palpitations, and impaired regulation of blood pressure. Considering the combination of these conditions and the reduced functionality of the student’s organism, the individual belongs to health group III. Health group classification systems may vary, but in general, health group III represents individuals with moderate impairment of health and functionality. This classification suggests that the student’s health status is significantly compromised and may require medical intervention and management. |
180. A 17-year-old patient complains of pain in the area of the left knee joint. Soft tissues of thigh in the affected region are infiltrated, joint function is limited. X-ray picture of the distal metaepiphysis of the left femur shows a destruction focus with periosteum detachment and Codman’s triangle found at the defect border in the bone cortex. X-ray of chest reveals multiple small focal metastases. What treatment is indicated?
A. Palliative chemotherapy
B. Radioiodine therapy
C. Distance gamma-ray therapy
D. Disarticulation of the lower extremity
E. Amputation of the lower extremity
Answer: Palliative chemotherapy
Explanation
| The given clinical presentation suggests a malignant bone tumor with evidence of metastasis. The presence of pain in the area of the left knee joint, infiltration of soft tissues, and limited joint function, along with the X-ray findings of a destruction focus with periosteum detachment and Codman’s triangle in the bone cortex, are characteristic of an aggressive bone lesion. Additionally, the X-ray of the chest revealing multiple small focal metastases indicates the spread of the tumor to distant sites, further supporting the diagnosis of metastatic bone cancer. In this scenario, the most appropriate treatment option is palliative chemotherapy. Palliative chemotherapy aims to control the progression of the disease, relieve symptoms, and improve the patient’s quality of life. It is used when the cancer has spread and is no longer curable with localized therapies such as surgery or radiation therapy. Palliative chemotherapy involves the administration of anticancer drugs that target and destroy cancer cells or slow down their growth. By treating the systemic disease, it can help alleviate symptoms, shrink tumors, and potentially prolong survival. It is an important component of the overall management of metastatic bone cancer. Options B, C, D, and E (Radioiodine therapy, Distance gamma-ray therapy, Disarticulation of the lower extremity, and Amputation of the lower extremity) are not indicated in this case because they are not appropriate treatments for metastatic bone cancer. Radioiodine therapy is specific to certain types of thyroid cancer. Distance gamma-ray therapy refers to the treatment of distant metastases using high-energy radiation, but it is not the primary treatment modality for this condition. Disarticulation and amputation are extreme measures and are not warranted based on the information provided. |
181. 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 respect of its volume and composition. Muscle tonus is within norm. What is the most likely diagnosis?
A. Pylorospasm
B. Meningitis
C. Pylorostenosis
D. Microcephaly
E. Craniostenosis
Answer: Pylorospasm
Explanation
| Pylorospasm is a condition characterized by the involuntary spasms or narrowing of the pylorus, which is the muscular valve between the stomach and the small intestine. It typically occurs in infants and can lead to symptoms such as regurgitation or vomiting of small portions of milk after feeding. In the given scenario, the 1-month-old boy presents with signs of excitement, a head circumference of 37 cm, and a prefontanel (the soft spot on the baby’s head) measuring 2×2 cm. These measurements are within the normal range for a 1-month-old infant. Additionally, the normal muscle tonus suggests no significant abnormality in muscle stiffness. The presence of regurgitation of small portions of milk after feeding is a common symptom of pylorospasm. It occurs due to the narrowing of the pylorus, which restricts the passage of milk from the stomach to the intestines, leading to the backward flow of milk. The other options, B. Meningitis, C. Pylorostenosis, D. Microcephaly, and E. Craniostenosis, are less likely in this case based on the provided information. Meningitis typically presents with more severe symptoms such as fever, irritability, neck stiffness, and abnormal behavior. Pylorostenosis refers to the hypertrophy or narrowing of the pylorus, which causes projectile vomiting and poor weight gain, whereas in this case, the child’s weight and stool are described as normal. Microcephaly is characterized by an abnormally small head circumference, which is not the case here. Craniostenosis refers to the premature fusion of the skull sutures, leading to an abnormal head shape, which is not mentioned in the scenario. |
182. As a result of lifting a load a 62-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 provided information suggests a clinical presentation consistent with discogenic compression of the L5 nerve root. The 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, along with the specific muscle weakness and sensory changes, indicate nerve involvement at the L5 level. To further specify the diagnosis of discogenic compression of the L5 root, the most effective examination method is a Magnetic Resonance Imaging (MRI) scan. MRI provides detailed images of the spinal structures, including the intervertebral discs, nerve roots, and surrounding soft tissues. It allows visualization of any disc herniation or other abnormalities that may be compressing the L5 nerve root. MRI is considered the gold standard imaging modality for diagnosing disc-related pathologies and assessing nerve root compression. Options B, C, D, and E (Spinal column X-ray, Electromyography, Angiography, and Lumbar puncture) are not the most appropriate choices in this case: Spinal column X-ray: While X-rays can help visualize the bony structures of the spine, they are not as effective as MRI in assessing soft tissue abnormalities like disc herniation. Electromyography (EMG): EMG is a test that evaluates the electrical activity of muscles and nerves. It can be useful in assessing nerve damage or dysfunction, but it does not provide direct visualization of the spinal structures or specify the cause of the compression. Angiography: Angiography is a diagnostic procedure used to visualize blood vessels. It is not the most suitable method for diagnosing discogenic compression of a nerve root. Lumbar puncture: Lumbar puncture (also known as a spinal tap) is a procedure to collect cerebrospinal fluid (CSF) for analysis. It is not directly related to diagnosing discogenic compression of a nerve root and would not provide the necessary information in this case. |
183. At first appointment with an obstetrician-gynaecologist a pregnant woman is referred to other medical specialists. She must be obligatory examined by the following specialists:
A. Therapeutist and dentist
B. Therapeutist and endocrinologist
C. Dentist and phthisiatrician
D. ENT and ophthalmologist
E. Dentist and cardiologist
Answer: Therapeutist and dentist
Explanation
| A therapeutist is important to assess the overall health of the pregnant woman and to manage any pre-existing medical conditions, such as hypertension or diabetes, that may affect the pregnancy. The therapeutist can also make recommendations for appropriate prenatal care and screening tests. Dental health is also important during pregnancy, as hormonal changes can increase the risk of gum disease and other dental problems. It is recommended that pregnant women receive a dental checkup and cleaning during pregnancy to maintain good oral health. While other specialists, such as endocrinologist, phthisiatrician, ENT, ophthalmologist, and cardiologist, may be needed in certain cases depending on the woman’s medical history or specific risk factors, the therapeutist and dentist are the two specialists that are generally recommended for all pregnant women. |
184. 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. Perform the Heimlich manoever
B. Perform conicotomy immediately
C. Send for an anesthesiologist and wait for him
D. Use an inhalation of β2-adrenoceptor agonist
E. Make a subcutaneous injection of dexamethasone
Answer: Perform the Heimlich manoever
Explanation
| The patient’s symptoms of coarse breathing, skin cyanosis, tachycardia, and arterial hypertension are consistent with airway obstruction, which can be life-threatening in patients with a history of bronchial asthma. The aspiration of the salbutamol inhaler cap can cause a complete or partial blockage of the airway, leading to the symptoms described. The Heimlich manoeuvre is a first aid technique used to dislodge an obstruction from the airway. It involves standing behind the patient, placing a fist above the navel and below the ribcage, and applying upward pressure to the abdomen to create a strong exhalation and dislodge the obstruction. If the patient is unable to breathe or speak, the Heimlich manoeuvre should be performed immediately. Performing conicotomy or waiting for an anesthesiologist may take too long and can worsen the patient’s condition. Using an inhalation of β2-adrenoceptor agonist or subcutaneous injection of dexamethasone may not be effective in relieving the airway obstruction caused by the inhaler cap. |
185. A 19-year-old student has been hospitalized on an emergency basis because of severe dyspnea, pain in the left side of chest. The patient got sick 3 days ago. Objectively: body temperature – 38, 8oC. BH – 42/min., hypopnoe. There is dullness of percussion sound on the right of the scapula middle, breathing sounds cannot be auscultated. The left border of heart is displaced outwards by 3 cm. Embryocardia is preent, HR – 110/min. The right hypochondrium is painful on palpation. What are the immediate treatment measures in this situation?
A. Urgent puncture of pleural cavity
B. Administartion of antibiotics of penicillin group
C. Injection of lasix
D. Injection of cardiac glycosides
E. Transfer of the patient to the thoracic surgery department
Answer: Urgent puncture of pleural cavity
Explanation
| The symptoms and findings described in the case are consistent with a diagnosis of pleural effusion, which is the accumulation of fluid in the pleural space surrounding the lungs. The symptoms of dyspnea, chest pain, fever, and tachypnea are all typical of pleural effusion. The dullness of percussion sound on the right side of the scapula middle and the absence of breathing sounds also suggest the presence of pleural effusion. The displacement of the left border of the heart and the presence of embryocardia indicate that the pleural effusion is causing significant pressure on the heart. Urgent puncture of the pleural cavity, also known as thoracentesis, is the immediate treatment of choice in this situation. Thoracentesis involves inserting a needle or catheter into the pleural space to drain the accumulated fluid and relieve pressure on the lungs and heart. This procedure can be performed at the bedside and is usually safe and effective. Antibiotics of penicillin group, injection of lasix, and injection of cardiac glycosides may be needed later in the treatment course depending on the underlying cause of the pleural effusion and the patient’s response to treatment. Transfer of the patient to the thoracic surgery department may also be necessary if the pleural effusion is not effectively managed with thoracentesis or if there is a need for more invasive procedures, such as video-assisted thoracoscopic surgery (VATS) or open thoracotomy. |
186. 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
| Vesiculopustulosis is a common skin condition in newborns that is characterized by the appearance of multiple vesicles or pustules filled with serous or seropurulent fluid on the scalp, neck, and diaper area. The lesions are usually small and can be surrounded by erythema. The cause of vesiculopustulosis is not entirely clear, but it is believed to be related to the immaturity of the newborn’s skin and the exposure to irritants. Impetigo neonatorum and impetigo are also bacterial skin infections that can cause vesicles or pustules on the skin. However, these conditions usually present with more inflammatory and crusted lesions, and the general condition of the child may be affected. Miliaria, also known as heat rash, is another skin condition that can cause small vesicles or papules on the skin. However, miliaria is typically associated with sweating and occlusion of sweat glands, and it is usually not accompanied by seropurulent fluid. Epidermolysis bullosa is a rare genetic disorder that causes blistering and skin fragility. However, the onset of symptoms in epidermolysis bullosa is usually in infancy or early childhood, and the lesions are usually more widespread and severe than those seen in vesiculopustulosis. |
187. A pregnant woman was delivered to the gynecological unit with complaints of pain in the lower abdomen and insignificant bloody discharges from the genital tracts for 3 hours. Last menstruation was 3 months ago. Vaginal examination showed that body of womb was in the 10th week of gestation, a fingertip could be inserted into the external orifice of uterus, bloody discharges were insignificant. USI showed small vesicles in the uterine cavity. What is the most likely diagnosis?
A. Grape mole
B. Abortion in progress
C. Incipient abortion
D. Threat of spontaneous abortion
E. Incomplete abortion
Answer: Grape mole
Explanation
| Grape mole, also known as complete hydatidiform mole, is a type of gestational trophoblastic disease that occurs when there is an abnormal fertilization of the egg, resulting in the formation of an abnormal pregnancy. The condition is characterized by the presence of small vesicles or cysts in the uterine cavity, which are visible on ultrasound. The symptoms of grape mole may include vaginal bleeding, abdominal pain, and a uterus that is larger than expected for the gestational age. In this case, the patient’s symptoms of abdominal pain and bloody discharge, along with the finding of small vesicles in the uterine cavity on ultrasound, are consistent with a diagnosis of grape mole. The fact that the uterus is enlarged and the cervical os is open also suggests that there may be a complete mole. Abortion, incipient abortion, threat of spontaneous abortion, and incomplete abortion are all possible diagnoses in cases of vaginal bleeding during pregnancy. However, the presence of small vesicles in the uterine cavity on ultrasound is not typically seen in these conditions. |
188. A 30-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
| In this case, the presence of a fistula with purulent discharge, redness, and fluctuation in the region of the operative wound indicates an ongoing infection. The X-ray findings of brachial bone destruction with sequestra further support the diagnosis of posttraumatic osteomyelitis. Sequestra are fragments of dead bone that can result from inadequate blood supply and subsequent necrosis in the area affected by the infection. The other options, B. Hematogenic osteomyelitis, C. Wound abscess, D. Posttraumatic phlegmon, and E. Suture sinus, are less likely in this scenario based on the provided information: Hematogenic osteomyelitis typically occurs when bacteria reach the bone through the bloodstream, often affecting multiple sites. It is less likely in this case since the infection is localized to the region of the operative wound. Wound abscess refers to a localized collection of pus within the wound, which may occur due to infection. However, in this case, the involvement of the bone and the presence of sequestra suggest a deeper infection than just a superficial wound abscess. Posttraumatic phlegmon refers to diffuse inflammation and infection of the soft tissues following trauma. While it can occur after an open fracture, the presence of bone destruction and sequestra suggests involvement beyond the soft tissues alone. Suture sinus refers to a persistent tract or channel that forms between the surface of the skin and deeper tissues due to poor healing around sutures. While this can occur as a wound healing complication, the presence of purulent discharge, redness, and bone destruction in this case indicates a more severe and infectious process. |
189. A 50-year-old male suburbanite underwent treatment in rural outpatient clinic for pneumonia. The treatment didn’t have effect and the disease got complicated by exudative pleuritis. What prevention and treatment facility should the patient be referred to for further aid?
A. Central district hospital
B. Regional hospital
C. Phthisio-pulmonological dispensary
D. Municipal hospital
E. Tuberculosis dispensary
Answer: Central district hospital
Explanation
| In this case, the patient’s pneumonia has progressed to exudative pleuritis, indicating a need for more comprehensive care. The central district hospital is an appropriate referral option to provide a higher level of medical care, including further evaluation, diagnostic tests, and treatment options. They can initiate appropriate interventions and determine if more specialized care is required. Options B, C, D, and E (Regional hospital, Phthisio-pulmonological dispensary, Municipal hospital, and Tuberculosis dispensary) are not the most suitable choices in this context: Regional hospital: Regional hospitals generally have a higher level of specialization and resources compared to central district hospitals. While they can provide more advanced care, they may not be necessary for initial management in this case unless the patient’s condition worsens or specialized interventions are required. Phthisio-pulmonological dispensary: Phthisio-pulmonological dispensaries are specialized healthcare facilities that focus on the diagnosis, treatment, and prevention of tuberculosis. While the patient has developed exudative pleuritis, which may be associated with tuberculosis, there is no specific indication mentioned in the scenario to warrant referral to a tuberculosis-specific facility. Municipal hospital: Municipal hospitals are typically local healthcare facilities that provide general medical services to residents of a specific municipality. While they may offer a range of services, including some specialized care, the complexity of the patient’s condition in this scenario would likely be better managed at a central district hospital. Tuberculosis dispensary: Tuberculosis dispensaries specialize in the diagnosis and treatment of tuberculosis. As mentioned earlier, although the patient has developed exudative pleuritis, there is no specific indication provided to suggest tuberculosis as the underlying cause, and therefore referral to a tuberculosis dispensary is not necessary at this stage. |
190. 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
| Rubromycosis, also known as tinea pedis or athlete’s foot, is a fungal infection that affects the skin of the feet, particularly the toes and the soles. It is caused by dermatophytes, which are a group of fungi that can infect the skin, hair, and nails. In the given scenario, the patient being prepared for the operation due to varix dilatation of lower extremity veins has specific dermatological findings that are characteristic of rubromycosis: Flour-like desquamation along the skin folds: Rubromycosis commonly presents with scaling or peeling of the skin, particularly in areas where skin folds occur, such as between the toes. Greyish-yellow, thickened, and partially decayed toenails: Fungal nail involvement, known as onychomycosis, is frequently associated with rubromycosis. The toenails become discolored, thickened, and may show signs of decay. The other options, B. Pityriasis versicolor, C. Candidosis, D. Microsporia, and E. Microbial eczema, are less likely in this case based on the provided information: Pityriasis versicolor is a superficial fungal infection caused by Malassezia species. It typically presents with patches of hypo- or hyperpigmented skin, rather than flour-like desquamation or nail involvement. Candidosis, or candidiasis, is an infection caused by Candida species. It can occur in various areas of the body, including the skin and mucous membranes, but the described symptoms are not consistent with candidiasis. Microsporia, or tinea corporis, is a fungal infection of the skin caused by Microsporum species. It commonly manifests as circular or ring-shaped rashes, rather than the described symptoms. Microbial eczema refers to eczema or dermatitis caused by bacterial infection. The described symptoms are more characteristic of a fungal infection (rubromycosis) rather than a bacterial infection. |
191. A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is accentuated. AP- 240/120 mm Hg, HR92/min. Auscultation reveals some fine moisr rales in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?
A. Complicated hypertensic crisis
B. Acute myocardial infarction, pulmonary edema
C. Bronchial asthma exacerbation
D. Uncomplicated hypertensic crisis
E. Community-acquired pneumonia
Answer: Complicated hypertensic crisis
Explanation
| Hypertensive crisis is a medical emergency that occurs when blood pressure rises to a dangerously high level. The symptoms of hypertensive crisis may include headache, nausea, vomiting, chest pain, shortness of breath, and confusion. In this case, the patient’s symptoms of headache, nausea, and choking, along with the markedly elevated blood pressure and fine moist rales in the lungs, are consistent with a diagnosis of hypertensive crisis. The presence of left ventricular hypertrophy and overload on ECG, and the accentuated second aortic sound on cardiac auscultation, suggest that the patient has underlying hypertension that has led to cardiac complications. The fine moist rales heard on lung auscultation may indicate the presence of pulmonary edema, which can be a complication of hypertensive crisis. Acute myocardial infarction, bronchial asthma exacerbation, community-acquired pneumonia, and uncomplicated hypertensive crisis are all possible diagnoses in cases of headache, shortness of breath, and elevated blood pressure. However, the combination of symptoms and findings in this case point more strongly towards a complicated hypertensive crisis. |
192. A 43-year-old female patient was delivered to the hospital in grave condition. She has a history of 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
| Addison’s disease is a condition in which the adrenal glands do not produce enough hormones, including cortisol and aldosterone. Cortisol is an important hormone that plays a role in regulating blood pressure, blood sugar levels, and the immune system. In this case, the patient has a history of Addison’s disease and had stopped taking prednisolone, which is a steroid medication that is commonly used to replace cortisol in patients with adrenal insufficiency. The symptoms and findings described in the case, such as pigmented skin and mucous membranes, decreased skin and muscle turgor, muffled and rapid heart sounds, low blood pressure, and low sodium levels in the blood, are consistent with a diagnosis of adrenal crisis, which is a life-threatening complication of adrenal insufficiency. Adrenal crisis can occur when there is a sudden drop in cortisol levels, such as when a patient with adrenal insufficiency stops taking their medication. |
193. 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
| Based on the information provided, the forensic medical expertise of the newborn’s corpse indicates features consistent with live birth. Let’s examine the given findings that support this conclusion: Body weight of 3500 g and body length of 50 cm: These measurements fall within the normal range for a newborn, suggesting appropriate growth and development in utero. Smooth, moist, glossy umbilical cord without signs of drying: This indicates that the umbilical cord was recently attached to the placenta, which suggests a recent separation from the mother following birth. Positive hydrostatic tests: Hydrostatic tests are conducted to assess the airway patency of a newborn. Positive test results indicate that air was present in the lungs, which is consistent with breathing and lung expansion that occur after birth. Based on these findings, it can be concluded that the newborn experienced live birth. The normal body weight and length, along with the characteristics of the umbilical cord and positive hydrostatic tests, provide strong evidence that the newborn was born alive and had initiated the physiological processes associated with postnatal life. The other options, B. Stillbirth; C. Primary atelectasis; D. Secondary atelectasis; and E. Hyaline membrane disease, are less applicable in this scenario: Stillbirth refers to the delivery of a fetus that shows no signs of life. The provided findings suggest the opposite, indicating live birth rather than stillbirth. Primary atelectasis refers to incomplete lung expansion due to various factors, such as mucus obstruction. This condition is unlikely in this case, as the hydrostatic tests were positive, indicating lung expansion and the presence of air in the lungs. Secondary atelectasis refers to the collapse or incomplete expansion of the lung after birth. This condition is also unlikely, as the hydrostatic tests were positive, indicating proper lung expansion. Hyaline membrane disease (also known as respiratory distress syndrome) is a condition primarily seen in premature infants and is characterized by respiratory distress due to insufficient surfactant production. The information provided does not suggest any signs or symptoms associated with hyaline membrane disease. |
194. A primigravida is 22 years old. She has Rh(-), her husband has Rh(+). Antibodies to Rh weren’t found at 32 weeks of pregnancy. Redetermination of antibodies to Rh didn’t reveal them at 35 weeks of pregnancy as well. How often should the antibodies be determined hereafter?
A. Once a week
B. Once in two weeks
C. Once in three weeks
D. Montly
E. There is no need in further checks
Answer: Once a week
Explanation
| In this scenario, the primigravida (a woman who is pregnant for the first time) is Rh-negative, and her husband is Rh-positive. It is important to monitor the presence of Rh antibodies in the mother’s blood during pregnancy to assess the risk of Rh isoimmunization, which can occur if the fetus is Rh-positive. The absence of Rh antibodies at 32 weeks and 35 weeks of pregnancy does not guarantee that antibodies will not develop later. Rh isoimmunization can occur at any point during pregnancy, particularly after exposure to fetal Rh-positive blood during delivery or other events that cause mixing of fetal and maternal blood. To monitor for the development of Rh antibodies, it is recommended to determine the antibodies once a week in this case. This frequency allows for close monitoring of any potential immune response by checking for the presence of Rh antibodies on a regular basis. By conducting weekly checks, healthcare providers can promptly detect the development of Rh antibodies, assess the risk of Rh isoimmunization, and take appropriate measures to ensure the health and well-being of both the mother and the fetus. This includes the administration of Rh immune globulin (RhIg) to prevent the formation of antibodies in the mother’s blood if necessary. |
195. A patient is 50 years old, works as a builder with 20 years of service record. He was admitted to the hospital for chest pain, dry cough, minor dyspnea. Objectively: sallow skin, acrocyanosis, asbestos warts on the hands. In lungs – rough respiration, diffuse dry rales. The x-ray picture shows intensification of pulmonary pattern, signs of pulmonary emphysema. What is the most likely diagnosis?
A. Asbestosis
B. Lung cancer
C. Pneumonia
D. Chronic obstructive bronchitis
E. Tuberculosis
Answer: Asbestosis
Explanation
| Asbestosis is a lung disease caused by long-term exposure to asbestos fibers. The symptoms of asbestosis may include chest pain, dry cough, dyspnea, and clubbing of the fingers. In this case, the patient’s symptoms of chest pain, dry cough, and minor dyspnea, along with the presence of asbestos warts on the hands, are consistent with a diagnosis of asbestosis. The rough respiration and diffuse dry rales heard on lung auscultation, as well as the intensification of pulmonary pattern and signs of pulmonary emphysema seen on x-ray, are also consistent with the diagnosis of asbestosis. Asbestosis can lead to the development of pulmonary fibrosis and emphysema, which can cause chronic respiratory symptoms and abnormalities on imaging studies. Lung cancer, pneumonia, chronic obstructive bronchitis, and tuberculosis are all possible diagnoses in cases of chest pain, cough, and dyspnea. However, the presence of asbestos warts and the history of long-term exposure to asbestos fibers make asbestosis a more likely diagnosis in this case. |
196. A 14-year-old girl complains of pain in vaginal area and lower abdomen that last for 3-4 days and have been observed for 3 months about the same time. Each time pain is getting worse. Objectively: mammary glands are developed, hairiness corresponds to the age. The virginal membrane is intact, cyanotic and protruded. She has never had menstruation. She has been diagnosed with primary amenorrhea. What is the reason of amenorrhea?
A. Hymen atresia
B. Turner’s syndrome
C. Babinski-Frohlich syndrome
D. Pregnancy
E. Sexual development delay
Answer: Hymen atresia
Explanation
| Based on these findings, the most likely reason for the primary amenorrhea in this case is hymen atresia. Hymen atresia refers to a condition where the hymen, a thin membrane that partially covers the opening of the vagina, has a complete blockage, preventing the normal outflow of menstrual blood. This obstruction can lead to cyclic pain and the absence of menstruation. It is important to note that the other options provided are not applicable in this case: Turner’s syndrome (B) is a genetic disorder caused by a missing or incomplete X chromosome. It can be associated with delayed or absent puberty, but it typically presents with additional features such as short stature, webbed neck, and other physical abnormalities. Babinski-Frohlich syndrome (C), also known as hypothalamic hamartoma, is a rare condition characterized by early-onset obesity and precocious puberty. It does not present with the absence of menstruation. Pregnancy (D) is not likely in this case as the girl is a virgin, and her intact hymen suggests no sexual intercourse has taken place. Sexual development delay (E) is less likely as the girl has appropriate secondary sexual characteristics, indicating normal sexual development. |
197. A 22-year-old vegetarian patient with signs of malnutrition consulted a doctor about smell and taste distortion, angular stomatitis. Objectively: marked blue sclerae. The patient was diagnosed with iron deficiency anemia. What is the dominating clinical syndrome?
A. Sideropenic
B. Anaemic
C. Haemologic
D. Haemolytic
E. Myelodysplastic
Answer: Sideropenic
Explanation
| In this case, the 22-year-old vegetarian patient presents with signs of malnutrition, smell and taste distortion, angular stomatitis, and marked blue sclerae. The diagnosis of iron deficiency anemia has been made. Let’s analyze the information provided to determine the dominating clinical syndrome: Iron deficiency anemia is a type of anemia characterized by insufficient iron levels in the body, leading to decreased production of hemoglobin and red blood cells. The clinical syndrome associated with iron deficiency anemia is referred to as sideropenic syndrome. Sideropenic syndrome encompasses a range of clinical manifestations related to iron deficiency, including the symptoms mentioned in the case, such as smell and taste distortion, angular stomatitis (inflammation of the corners of the mouth), and the presence of marked blue sclerae. The blue sclerae are a characteristic feature of iron deficiency anemia and occur due to thinning of the collagen layer in the sclera, allowing the underlying choroidal vessels to show through. This gives a bluish appearance to the sclerae. The other options provided are not applicable in this case: Anaemic (B) and Haemologic (C) are not specific clinical syndromes associated with iron deficiency anemia. Haemolytic (D) refers to a condition characterized by increased breakdown of red blood cells, which is not the primary mechanism underlying iron deficiency anemia. Myelodysplastic (E) refers to a group of disorders characterized by abnormal development of blood cells in the bone marrow, which is not the primary diagnosis in this case. |
198. Condition of a patient with purulent otitis has abruptly deteriorated: he presents with headache, vomiting, febrile temperature, general hyperesthesia. There are meningeal signs, papilledemas. Focal symptoms are absent. Cerebrospinal fluid is turbid, pressure is high, there is albuminocytologic dissociation with neutrophil predominance. What disease can be suspected?
A. Secondary purulent meningitis
B. Meningoencephalitis
C. Serous meningitis
D. Primary purulent meningitis
E. Subarachnoid haemorrhage
Answer: Secondary purulent meningitis
Explanation
| In this case, the patient with purulent otitis has experienced an abrupt deterioration in their condition. They present with symptoms such as headache, vomiting, febrile temperature, general hyperesthesia, meningeal signs, papilledema, and turbid cerebrospinal fluid (CSF) with high pressure and albuminocytologic dissociation (neutrophil predominance). Based on these findings, the most likely disease that can be suspected is secondary purulent meningitis. Secondary purulent meningitis refers to an infection that spreads to the meninges from a nearby site, in this case, from the purulent otitis. The infection reaches the meninges, causing inflammation and a purulent response in the CSF. The symptoms, signs, and CSF findings are consistent with this diagnosis. The other options provided are less likely: Meningoencephalitis (B) refers to inflammation of both the meninges and the brain tissue. While the patient in this case may have signs of meningeal involvement, there is no mention of focal neurological symptoms or brain tissue involvement. Serous meningitis (C) is characterized by inflammation of the meninges with a non-purulent (serous) response in the CSF. The CSF findings described in the case (turbid with neutrophil predominance) suggest a purulent response. Primary purulent meningitis (D) refers to an infection that directly affects the meninges without a preceding focus of infection. However, in this case, the patient’s symptoms and history of purulent otitis suggest a secondary infection. Subarachnoid hemorrhage (E) is unlikely in this case as there is no mention of sudden-onset severe headache, loss of consciousness, or focal neurological deficits, which are characteristic of a subarachnoid hemorrhage. |
199. A municipal hospital reported on the number of operated patients including fatal outcomes following the operations. Which index of hospital work can be calculated on the ground of this data?
A. Postoperative lethality
B. Total lethality
C. Index of late hospitalization since a disease incursion
D. Standardized lethality
E. –
Answer: Postoperative lethality
Explanation
| The data reported by the municipal hospital on the number of operated patients, including fatal outcomes, allows for the calculation of the postoperative lethality index. Postoperative lethality refers to the rate or percentage of deaths that occur within a specific period following surgical procedures. By analyzing the number of patients who underwent surgery and the number of deaths that occurred after the operations, the postoperative lethality index can be calculated. This index provides valuable information about the mortality rate associated with surgical interventions in the hospital. The other options provided are not applicable in this context: Total lethality (B) generally refers to the overall mortality rate in a specific population or setting, including deaths from various causes, not specifically related to surgical procedures. Index of late hospitalization since a disease incursion (C) refers to the time elapsed between the onset of a disease and the admission of a patient to the hospital, which is unrelated to postoperative outcomes. Standardized lethality (D) typically involves adjusting mortality rates to account for various factors such as age, gender, and underlying health conditions, and is not specific to postoperative outcomes. |
200. A 10-year-old boy periodically has short states (up to 10-15 seconds) that can be characterized as a “sudden blackout”and are accompanied by gaze fixation in the upright position, absentminded and vacant face expression, lack of movements and following amnesia. Specify this state:
A. Absence
B. Obnubilation
C. Trance
D. Fugue
E. Thought block
Answer: Absence
Explanation
| Absence seizures, also known as petit mal seizures, are a type of generalized seizure that typically occurs in children. During an absence seizure, the individual experiences a brief loss of awareness and responsiveness. The seizure typically lasts for a few seconds, during which the person may exhibit staring, unresponsiveness, and a lack of movement. After the seizure, there is often no memory of the episode. The other options provided are less appropriate: Obnubilation (B) refers to a clouding of consciousness with reduced clarity of thought and impaired alertness. It does not typically involve the sudden blackout and vacant expression seen in absence seizures. Trance (C) is a state of altered consciousness characterized by a narrowed focus of attention, heightened suggestibility, and reduced awareness of the surroundings. It is different from the brief loss of awareness seen in absence seizures. Fugue (D) is a rare dissociative disorder characterized by a sudden and unexpected travel away from one’s usual environment, accompanied by amnesia for the period of the fugue state. It does not match the description provided for the boy’s short states. Thought block (E) refers to a symptom commonly seen in schizophrenia, where thoughts abruptly and involuntarily stop. It is not characteristic of absence seizures. |
