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51. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination reveals convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?

A. Encephalopathy due to hyperbilirubinemia

B. Skull injury

C. Brain tumour

D. Hydrocephalus

E. Spastic cerebral palsy

Answer: Encephalopathy due to hyperbilirubinemia


The most probable explanation for the newborn’s condition based on the given information is A. Encephalopathy due to hyperbilirubinemia. Hyperbilirubinemia refers to an elevated level of bilirubin in the blood, leading to jaundice. In severe cases, when the bilirubin levels become extremely high, it can cause neurological complications known as bilirubin encephalopathy or kernicterus. 

The symptoms described in the scenario, such as severe jaundice, poor suckling, hypotonia (weak muscle tone), hypodynamia (reduced movement), periodical excitation, neonatal convulsions, and loss of neonatal primitive reflexes, are consistent with the signs of bilirubin encephalopathy. The additional findings of convergent squint (crossed eyes), rotatory nystagmus (involuntary eye movement), and setting sun eye sign (upward deviation of the eyes with a white sclera visible above the iris) suggest involvement of the central nervous system. 

Bilirubin encephalopathy occurs when the unconjugated bilirubin, which is a breakdown product of red blood cells, crosses the blood-brain barrier and accumulates in the brain, causing toxic effects on the central nervous system. Prompt medical intervention is required to reduce the bilirubin levels and prevent further neurological damage. Treatment may involve phototherapy, where the baby is exposed to specialized lights that help break down bilirubin, or in severe cases, exchange transfusion to replace the baby’s blood with fresh donor blood. 

It’s important to note that other conditions, such as skull injury, brain tumor, hydrocephalus, or spastic cerebral palsy, may present with similar neurological symptoms, but given the context of hyperbilirubinemia and the specific findings mentioned, encephalopathy due to hyperbilirubinemia is the most likely explanation.

52. A 52 y.o. hard smoker patient complains of persistent cough with purulent sputum discharge especially in mornings, dyspnea provoked even by slight physical exertion, wheezing chest, tahypnoe, general weakness. He considers himself to be ill during 12 years. The overwritten conditions appear 3-4 times per year usually after common cold and have tendency to progress. What disease do you think about first of all?

A. Chronic obstructive lung disease

B. Bronchial asthma

C. Mucoviscidosis (cystic fibrosis)

D. Bronchoectatic disease

E. Aspergillosis

Answer: Chronic obstructive lung disease


The most probable disease in this case, based on the provided information, is A. Chronic obstructive lung disease (COPD). COPD is a chronic respiratory condition commonly associated with long-term smoking. The symptoms described by the patient, such as persistent cough with purulent sputum discharge, dyspnea (shortness of breath) even with slight physical exertion, wheezing chest, tachypnea (rapid breathing), and general weakness, are all typical manifestations of COPD. 

The patient’s history of smoking for 12 years, the progression of symptoms following common cold episodes, and the presence of chronic respiratory symptoms indicate a likelihood of COPD. The chronic inflammation and narrowing of the airways, along with the excessive production of mucus, contribute to the symptoms experienced by the patient. While bronchial asthma may also present with similar symptoms such as cough, wheezing, and dyspnea, the patient’s history of persistent symptoms for 12 years and the association with smoking make COPD a more probable diagnosis. 

Mucoviscidosis (cystic fibrosis) is a genetic disorder characterized by the production of thick mucus that affects multiple organs, including the lungs. However, the onset of symptoms in adulthood and the strong association with smoking make COPD a more likely diagnosis in this case. 

Bronchoectatic disease refers to the permanent dilation of the bronchi due to chronic infection and inflammation. Although it can cause chronic cough and sputum production, the history of smoking and the characteristic symptoms of COPD make it a less likely diagnosis compared to COPD. Aspergillosis, which is a fungal infection caused by Aspergillus, can affect the respiratory system. However, it typically presents with different symptoms and is less likely in the absence of specific risk factors or clinical findings suggestive of fungal infection. 

It’s important to note that a definitive diagnosis can only be made by a healthcare professional after a thorough evaluation, including medical history, physical examination, and possibly additional diagnostic tests such as pulmonary function tests and imaging studies.

53. 3 weeks ago the patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

A. Glomerulonephritis

B. Cystitis

C. Pyelonephritis

D. Intestinal nephritis

E. Renal amyloidosis

Answer: Glomerulonephritis


Based on the given information, the most probable preliminary diagnosis is A. Glomerulonephritis. Glomerulonephritis is an inflammation of the glomeruli, which are the filtering units in the kidneys. It can occur as a complication following a streptococcal infection such as tonsillitis.

The presence of edema, arterial hypertension, hematuria (blood in the urine), proteinuria (excessive protein in the urine), and the presence of granular and erythrocyte casts are characteristic findings in glomerulonephritis. Edema and arterial hypertension are signs of fluid retention and increased blood pressure, which can occur due to impaired kidney function in glomerulonephritis. Hematuria, proteinuria, and the presence of casts indicate damage to the glomeruli, leading to blood and protein leakage into the urine. 

Cystitis refers to inflammation of the urinary bladder and typically presents with symptoms such as urinary frequency, urgency, and pain or discomfort during urination. It is less likely to cause hypertension and significant proteinuria. Pyelonephritis is an infection of the kidneys and can cause symptoms such as fever, flank pain, and urinary symptoms.

While it can lead to proteinuria and hematuria, the presence of arterial hypertension and granular and erythrocyte casts suggests glomerular involvement rather than a primary infection of the kidneys. Intestinal nephritis and renal amyloidosis are less likely based on the given information and are not commonly associated with tonsillitis or the described clinical findings. It’s important to note that a definitive diagnosis can only be made by a healthcare professional after further evaluation, including laboratory tests and possibly a kidney biopsy.

54. 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L, AST (asparate aminotransferase)- 2,1 mmol/L per hour, ALT– 1,8 mmol/L, alkaline phosphotase- 4,6 mmol/L per hour, cholesterol– 9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

A. Primary biliary liver cirrhosis

B. Primary liver cancer

C. Chronic viral hepatitis B

D. Acute viral hepatitis B

E. Alcoholic liver cirrhosis

Answer: Primary biliary liver cirrhosis


Based on the given information, the most probable diagnosis is A. Primary biliary liver cirrhosis. Primary biliary liver cirrhosis is an autoimmune liver disease characterized by progressive destruction of the small bile ducts within the liver. The symptoms and findings described in the patient align with this diagnosis. The itching, jaundice, hyperpigmentation of the skin, and multiple xanthelasma palpebrae (yellowish cholesterol-filled deposits on the eyelids) are all commonly associated with primary biliary liver cirrhosis. 

The enlargement of the liver, with a hard edge, suggests liver involvement. The elevated levels of total bilirubin and direct bilirubin indicate impaired liver function and cholestasis (reduced bile flow). The elevated levels of AST, ALT, and alkaline phosphatase are indicative of liver damage. The high cholesterol level may be a consequence of impaired bile metabolism. The presence of antimitochondrial antibodies (AMAs) M2 in a high titer is a characteristic finding in primary biliary liver cirrhosis.

These antibodies target the mitochondria within the liver cells and contribute to the destruction of the bile ducts. Primary liver cancer (hepatocellular carcinoma) is less likely in this case, as the described symptoms and findings are more consistent with chronic liver disease rather than a localized tumor. 

Chronic viral hepatitis B could also cause liver cirrhosis, but the absence of specific markers for hepatitis B and the presence of antimitochondrial antibodies point more towards primary biliary liver cirrhosis as the probable diagnosis. Acute viral hepatitis B would typically present with symptoms such as acute jaundice, fatigue, nausea, and a recent history of exposure to hepatitis B virus.

The chronic nature of the patient’s symptoms makes acute viral hepatitis B less likely. Alcoholic liver cirrhosis could be considered, but the absence of a significant alcohol history and the presence of antimitochondrial antibodies make primary biliary liver cirrhosis a more likely diagnosis. It’s important to note that a definitive diagnosis would require further evaluation by a healthcare professional, including imaging studies, liver biopsy, and additional laboratory tests.

55. The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:

A. Jaundice

B. Empyema of the gall-bladder

C. Emphysematous gall-bladder

D. Gall-bladder perforation

E. Cholangitis conditioned by the presence of stones in the bile tract



The correct answer is A. Jaundice. Complications of acute cholecystitis that may require surgical intervention include: B. Empyema of the gall-bladder: This refers to the accumulation of pus within the gallbladder, which requires drainage and may necessitate surgical removal. 

C. Emphysematous gall-bladder: This condition involves the presence of gas within the gallbladder, often caused by a bacterial infection. Surgical intervention is usually required to remove the gallbladder and treat the infection. D. Gall-bladder perforation: In some cases, acute cholecystitis can lead to the perforation (rupture) of the gallbladder. This is a severe complication that requires immediate surgical intervention. E. Cholangitis conditioned by the presence of stones in the bile tract: Cholangitis refers to the inflammation of the bile ducts, and it can be caused by the presence of stones in the bile tract.

Surgical intervention, such as endoscopic retrograde cholangiopancreatography (ERCP) or surgical removal of the stones, may be necessary. Jaundice, on the other hand, is not typically a complication of acute cholecystitis. Jaundice is more commonly associated with other conditions such as obstructive jaundice due to gallstones in the common bile duct or liver disease. 

It’s important to note that the specific management of complications in acute cholecystitis may vary depending on the individual case and the severity of the condition. A healthcare professional should be consulted for proper evaluation and management.

56. The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. Oshaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

A. Paget’s disease

B. Hyperparathyoid dystrophy

C. Chronic osteomyelitis

D. Myeloma

E. Mottled disease (marble disease)

Answer:  Paget’s disease


The most probable diagnosis in this case is A. Paget’s disease (also known as Paget’s disease of bone). Paget’s disease is a chronic bone disorder characterized by abnormal bone remodeling. It typically affects older individuals and can involve one or multiple bones in the body. The key features of Paget’s disease include: Recurrent fractures: Patients with Paget’s disease may experience frequent fractures without significant trauma. The affected bones are weakened and prone to fractures. 

O-shaped deformity of the legs: As the disease progresses, it can lead to deformities in the long bones, such as bowing of the legs (O-shaped deformity) in the knee joints. Thickening of flat bones: X-rays may show thickening of flat bones, such as the skull, pelvis, and spine. This is due to excessive bone remodeling and increased bone turnover. Hyperostosis along the bone axis: X-rays may also reveal areas of increased bone density along the bone axis, known as the “cotton wool” appearance.

This is a characteristic finding in Paget’s disease. Normal serum calcium: Unlike hyperparathyroidism (option B), which is characterized by increased serum calcium levels, Paget’s disease typically does not cause significant abnormalities in serum calcium levels. 

It’s important to note that a comprehensive evaluation, including clinical assessment, imaging studies, and laboratory tests, should be conducted to confirm the diagnosis of Paget’s disease and rule out other possible conditions. Treatment options for Paget’s disease may include medications to manage symptoms and slow down bone turnover. A consultation with a healthcare professional is necessary for proper evaluation, diagnosis, and management of this condition.

57. The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached 1,5% of her bodyweight. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP– 75/50 mm Hg. What is the further treatment?

A. Uterine extirpation

B. Supravaginal uterine amputation

C. Uterine vessels ligation

D. Inner glomal artery ligation

E. Putting clamps on the uterine cervix

Answer: Uterine extirpation


In this situation, the most appropriate treatment option would be A. Uterine extirpation, also known as a hysterectomy. The woman is experiencing severe postpartum hemorrhage with ongoing bleeding, which is not responding to conservative measures.

The signs and symptoms, such as pale skin, acrocyanosis, oliguria, confusion, tachycardia (pulse of 130 bpm), and hypotension (blood pressure of 75/50 mm Hg), indicate a significant loss of blood volume and hypovolemic shock. Uterine extirpation involves the complete removal of the uterus, which is a definitive surgical intervention to control the bleeding.

It eliminates the source of bleeding and helps stabilize the patient’s condition. In this case, with conservative methods proving ineffective and the patient’s critical condition, prompt surgical intervention is necessary to prevent further complications and potential life-threatening consequences. 

It’s important to note that the decision for hysterectomy should be made based on the individual patient’s condition, the severity of bleeding, and the potential risks and benefits. The specific details of the procedure and postoperative care would be determined by the healthcare professionals involved in the patient’s care.

58. A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower abdomen. She has had the last menstruation 3,5 months ago. The pulse is 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36, 60C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?

A. Inevitable abortion

B. Incipient abortion

C. Incomplete abortion

D. Complete abortion

E. Disfunctional bleeding

Answer: Inevitable abortion


I apologize for the confusion in my previous response. Given the symptoms and findings described, the correct diagnosis in this case is A. Inevitable abortion. An inevitable abortion refers to a pregnancy loss that cannot be prevented or stopped. It is characterized by vaginal bleeding, lower abdominal pain, and an enlarged uterus consistent with the gestational age. 

In this scenario, the woman presents with a mild bloody discharge from the vagina, pain in the lower abdomen, an enlarged uterus corresponding to 12 weeks of gestation, and tenderness in the lower parts of the abdomen.

These symptoms suggest that the pregnancy is not viable and that a spontaneous abortion is inevitable. Further evaluation, such as ultrasound examination and serial monitoring of hormone levels, may be performed to confirm the diagnosis and assess the completeness of the abortion. The management and treatment options will depend on the specific circumstances and the patient’s preferences.

59. 18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has suddenly appeared unconscious at home. The patient had no menses within last 3 months. On examination: pale skin, the pulse- 110 bpm, BP- 80/60 mm Hg. The Schyotkin’s sign is positive. Hb- 76 g/L. The vaginal examination: the uterus is a little bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct size. The posterior fornix of the vagina is tendern and overhangs inside. What is the most probable diagnosis?

A. Impaired extrauterine pregnancy

B. Ovarian apoplexy

C. Twist of cystoma of right uterine adnexa

D. Acute salpingoophoritis

E. Acute appendicitis

Answer: Impaired extrauterine pregnancy


Based on the given information, the most probable diagnosis in this case is A. Impaired extrauterine pregnancy, commonly known as ectopic pregnancy. Ectopic pregnancy refers to the implantation of a fertilized egg outside of the uterus, typically in the fallopian tube. It is a potentially life-threatening condition and requires immediate medical attention. 

The symptoms and findings described in the scenario are suggestive of an ectopic pregnancy. The woman has a history of no menses for the past 3 months, which raises suspicion of a possible pregnancy. The sudden loss of consciousness could be attributed to internal bleeding resulting from a ruptured ectopic pregnancy. 

On examination, the patient presents with pale skin, tachycardia (pulse rate of 110 bpm), hypotension (blood pressure of 80/60 mm Hg), and positive Schyotkin’s sign (pain in the cervical area upon bimanual examination). The presence of a tender, enlarged uterus with painful displacement and lateral swelling suggests an ectopic pregnancy. 

Immediate medical intervention, such as surgical removal of the ectopic pregnancy, is required to prevent further complications, including severe bleeding and hemodynamic instability.

60. A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical hospital with complains of pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?

A. Placental presentation

B. Premature placental separation

C. Uterine rupture

D. Threatened premature labor

E. Incipient abortion

Answer: Placental presentation


Based on the information provided, the most probable diagnosis in this case is A. Placental presentation, also known as placenta previa. Placenta previa occurs when the placenta partially or completely covers the opening of the cervix, which can lead to painless vaginal bleeding.

The symptoms described in the scenario, including pain in the lower abdomen and bloody vaginal discharge, are consistent with this condition. The finding of a formed and closed cervix suggests that the bleeding is not due to cervical factors but rather related to the position of the placenta.

The location of the fetal head high above the minor pelvis entry indicates that the presenting part of the fetus is not engaged in the pelvis, which can be associated with placenta previa. Placental presentation is a condition that requires close monitoring and medical intervention.

The amount of bleeding described (up to 200 ml per day) is significant and requires immediate attention. Maternal and fetal well-being should be closely monitored, and the patient may require hospitalization for observation and management. 

Delivery of the baby through cesarean section is usually necessary in cases of placenta previa to avoid potential complications, such as excessive bleeding and fetal distress during vaginal delivery. Again, I apologize for the incorrect initial response, and I hope this clarification helps.

61. In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingo-oophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. From what diagnostic method will you start the workup in this case of sterility?

A. Hysterosalpingography

B. Hormone investigation

C. Ultra sound investigation

D. Diagnostic scraping out of the uterine cavity

E. Hysteroscopia

Answer: Hysterosalpingography


In the case of a 28-year-old woman complaining of infertility for three years, with a history of one artificial abortion and chronic salpingo-oophoritis, the initial diagnostic method to consider is A. Hysterosalpingography. Hysterosalpingography is a radiological procedure used to evaluate the patency of the fallopian tubes and the shape and contour of the uterine cavity. It involves the injection of a contrast agent into the cervix, followed by X-ray imaging to visualize the passage of the dye through the uterus and fallopian tubes. This procedure can help identify abnormalities such as blockages or structural abnormalities in the fallopian tubes, uterine fibroids, or uterine adhesions, which can contribute to infertility. By performing hysterosalpingography, the gynecologist can assess the status of the fallopian tubes and uterine cavity, which are crucial for natural conception. If the fallopian tubes are blocked or damaged, it can prevent the sperm from reaching the egg or the fertilized egg from reaching the uterus. While hormone investigation, ultrasound investigation, diagnostic scraping of the uterine cavity, and hysteroscopy can provide additional information, hysterosalpingography is a commonly used initial step to evaluate tubal patency and uterine abnormalities in cases of infertility. It’s important to note that the specific diagnostic approach may vary depending on the individual patient’s history, clinical findings, and local protocols, so it’s best to consult with a healthcare professional for a comprehensive evaluation and personalized management plan.

62. A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38, 40C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through out. What disease should a doctor consider first of all?

A. Carbuncle

B. Furuncle

C. Acute skin cellulitis

D. Carbuncle associated with anthrax

E. Skin abscess

Answer: Carbuncle.


Based on the description provided, the most likely diagnosis in this case would be A. Carbuncle. A carbuncle is a deep-seated skin infection that involves multiple hair follicles. It typically presents as a painful, swollen, and inflamed area of skin, often with a central area of necrosis or ulceration.

Carbuncles are commonly caused by a bacterial infection, most often Staphylococcus aureus. The key features mentioned in the case that support the diagnosis of carbuncle are: Severely painful swelling localized on the posterior neckFever and general weaknessInfiltrate elevated above surrounding skin with tense and blue reddish discoloration Presence of purulent necrotic pustules

connected with each other, forming a large skin necrosisThinned necrotic skin with sieve-like holes discharging pusCarbuncles are more commonly seen in individuals with predisposing factors such as diabetes mellitus, as mentioned in the patient’s history. 

It’s important to note that a healthcare professional would need to evaluate the patient and consider other possible diagnoses based on a thorough examination and potentially additional tests.

63. A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement What kind of penetrative chest wound complications has developed in patient?

A. Pericardium tamponade

B. Massive hemothorax

C. Open pneumothorax

D. Closed pneumothorax

E. Valve-likes pneumothorax

Answer: Pericardial tamponade.


Based on the information provided, the most likely complication that has developed in this patient with a penetrating chest wound is A. Pericardial tamponade. Pericardial tamponade occurs when fluid, such as blood, accumulates in the pericardial sac surrounding the heart, leading to compression of the heart chambers.

This can result in impaired cardiac function and hemodynamic instability. The key findings mentioned in the case that support the diagnosis of pericardial tamponade are: Confusion, which may be due to decreased cerebral perfusionDilated neck veins, which indicate increased central venous pressure Diminished apical beat, suggesting impaired cardiac function Evident heart enlargement, possibly due to fluid accumulation within the pericardial sac Other possible complications of penetrating chest wounds include hemothorax (blood accumulation in the pleural cavity),

open pneumothorax (communication between the pleural cavity and the external environment), closed pneumothorax (trapped air in the pleural cavity), and tension pneumothorax (one-way valve mechanism leading to increasing pressure in the pleural cavity).

However, the specific findings described in the case, such as heart enlargement and dilated neck veins, are more indicative of pericardial tamponade. Immediate medical intervention, such as pericardiocentesis or a surgical procedure, would be required to relieve the pressure on the heart and restore cardiac function in this patient.

64. A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

A. Corrosive esophagitis and stricture

B. Esophagitis

C. Esophageal diverticula

D. Cardiac achalasia

E. Cardiac insufficiency

Answer: Corrosive esophagitis and stricture


Based on the information provided, the most likely complication that the patient has developed is A. Corrosive esophagitis and stricture. A chemical burn of the esophagus can lead to inflammation and damage to the esophageal tissues, resulting in corrosive esophagitis. Over time, as the inflammation heals, scar tissue may form and lead to the narrowing of the esophagus, causing a stricture. This can result in difficulty swallowing, pain behind the breastbone, and the need to consume only liquid food. 

The progression of symptoms, including the development of cough and dyspnea while swallowing, further supports the diagnosis of corrosive esophagitis and stricture. The scar tissue and narrowing of the esophagus can cause food to become trapped, leading to respiratory symptoms during swallowing. Other options such as esophagitis (inflammation of the esophagus), esophageal diverticula (outpouchings of the esophageal wall), cardiac achalasia (impaired relaxation of the lower esophageal sphincter), and cardiac insufficiency (heart failure) are less likely given the history of a recent chemical burn and the specific symptoms described. 

Management of corrosive esophagitis and stricture may involve medical interventions such as acid-suppressing medications, pain management, and nutritional support. In some cases, endoscopic dilation or surgical procedures may be necessary to alleviate the narrowing and improve swallowing function.

65. An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sicklist, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?

A. Issued regardless of company’s ownership

B. Issued only to empties of state-owned companies

C. Issued only on condition of payment guarantee by the company’s proprietor

D. Issued a medical certificate of a set form

E. Issued a medical certificate of a free form

Answer: Issued regardless of company’s ownership.


The correct answer is A. Issued regardless of company’s ownership. In most countries, including those with both private and state-owned companies, employees are entitled to sick leave when they are unable to work due to illness.

The issuance of a sick leave or sick-list is not typically dependent on the ownership of the company. The primary factor determining whether a sick leave should be issued is the medical condition of the employee and their inability to perform their job duties due to illness. It is the responsibility of the attending physician or healthcare professional to assess the patient’s condition and determine the need for a sick leave. 

The sick leave is a legal protection for employees, regardless of the company’s ownership, to ensure that they have the necessary time off to recover from their illness without facing adverse consequences such as loss of income or job security.

66. A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?

A. The doctor in charge of the case together with the head of department

B. Deputy head physician on the working ability expertise

C. The doctor in charge of the case with the permission of the head of department

D. Working ability expertise committee

E. The head of department

Answer:The doctor in charge of the case together with the head of department


Based on the presented

67. A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?

A. Use of neutral creams to protect skin

B. Frequent skin washing with detergents

C. Systematic use of local corticosteroids

D. Systematic skin disinfection

E. Avoidance of skin insolation

Answer: Use of neutral creams to protect skin


To prevent exacerbations of atopic dermatitis in a 13-year-old patient, the doctor should give the following recommendations: A. Use of neutral creams to protect the skin: Emollients and moisturizers play a crucial role in managing atopic dermatitis. They help to hydrate the skin, maintain its barrier function, and prevent dryness and itching. Using neutral creams or emollients without added fragrances or irritants can help protect the skin and reduce the risk of flare-ups. 

B. Frequent skin washing with detergents: It is generally recommended to minimize frequent washing and use gentle cleansers or soap substitutes when washing. Frequent washing and harsh detergents can strip the skin of its natural oils and disrupt the skin barrier, leading to dryness and irritation. Instead, short and lukewarm baths or showers should be taken, followed by gentle patting dry and immediate application of moisturizer. 

C. Systematic use of local corticosteroids: Local corticosteroids may be prescribed during active flare-ups of atopic dermatitis to help reduce inflammation and itching. However, they should be used judiciously and under the guidance of a healthcare professional. Systematic use of corticosteroids is not recommended for long-term management or prevention of exacerbations. D. Systematic skin disinfection: Systematic skin disinfection is not typically necessary for the prevention of atopic dermatitis exacerbations. Excessive use of disinfectants and antimicrobial products can disrupt the natural skin microbiome and potentially exacerbate skin symptoms.

It is generally advised to maintain good hygiene practices without excessive use of disinfectants. E. Avoidance of skin insolation: Sun exposure or skin insolation can have variable effects on atopic dermatitis. Some individuals may find that sunlight exposure helps improve their symptoms, while others may experience worsening or increased sensitivity to sunlight.

It is important for patients to be mindful of their individual response to sun exposure and take necessary precautions such as using sun protection measures (sunscreen, protective clothing, etc.) when needed. It’s important to note that these recommendations are general in nature, and the doctor may provide specific advice tailored to the patient’s condition and individual needs.

68. A full-term new-born suffered anteand intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial haemorrhage in this case?

A. Subarachnoid hemorrhages

B. Small hemorrhages in brain tissue

C. Subdural hemorrhages

D. Periventricular hemorrhages

E. Haemorrhages in ventricles of brain

Answer: Subarachnoid hemorrhages


Based on the presented

69. A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joint’s pain. On examination: excited, t 0- 390, Ps- 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

A. Influenza with cerebral edema manifestations

B. Influenza, typical disease duration

C. Respiratory syncytial virus

D. Parainfluenza

E. Adenovirus infection

Answer: Influenza with cerebral edema manifestations


Based on the symptoms described, the most likely diagnosis in this case is: A. Influenza with cerebral edema manifestations The patient presents with headache, vomiting at the peak of the headache, pain during eye movement, joint pain, and tonic and clonus cramps.

These symptoms, along with uncertain meningeal signs, suggest the possibility of cerebral edema associated with influenza. Cerebral edema is a rare but serious complication of influenza, particularly in children and adolescents. It can cause increased intracranial pressure, leading to symptoms such as headache, vomiting, and neurological manifestations like seizures or altered mental status. 

It’s important to note that a proper medical evaluation is necessary to confirm the diagnosis and rule out other possible causes.

70. A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?

A. Cardiogenic shock

B. Cardiac asthma

C. Pulmonary artery thromboembolia

D. Disquamative aortic aneurizm

E. Cardiac tamponade

Answer: Cardiogenic shock


Based on the symptoms and findings described, the most likely disorder in this case is: A. Cardiogenic shock The patient is experiencing severe substernal pain radiating to the left shoulder, weakness, pale skin, and cold sweat. These symptoms, along with a low blood pressure (70/50 mm Hg) and weak heart sounds, suggest cardiogenic shock.

Cardiogenic shock occurs when the heart is unable to pump enough blood to meet the body’s demands, leading to decreased blood pressure and inadequate tissue perfusion. 

The elevated ST-segment on the ECG in leads II, III, and aVF also supports the diagnosis of myocardial ischemia or infarction, which can lead to cardiogenic shock. It’s important to note that a proper medical evaluation is necessary to confirm the diagnosis and initiate appropriate treatment.

71. In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of the patients should be observed. Which of these rights is the most significant?

A. The right to the protection of the patient’s interests

B. The right to the free choice

C. The right to the information

D. The right to be heard

E. The right to the protection from incompetence

Answer: The right to the protection of the patient’s interests


All of the rights listed are important in ensuring proper care and treatment for patients. However, the most significant right among them may vary depending on individual perspectives. That being said, one could argue that the right to the protection of the patient’s interests is the most significant. This right encompasses the overall well-being and best interests of the patient.

It includes the right to receive appropriate and effective medical care, the right to privacy and confidentiality, the right to be treated with dignity and respect, and the right to make informed decisions about one’s own healthcare. 

While the other rights listed (the right to free choice, the right to information, the right to be heard, and the right to protection from incompetence) are also important, they are all interconnected with and contribute to the overarching goal of protecting the patient’s interests. Ultimately, it is crucial for healthcare providers and institutions to uphold all these rights and ensure that patients are treated ethically, respectfully, and with their best interests in mind.

72. A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field

A. Artesian well water

B. Spring water

C. River water

D. Rain water

E. Water from melted snow

Answer: Artesian well water


The best choice for the military unit in this scenario is A. Artesian well water. 

Artesian wells:

  • Source deep underground aquifers, often isolated from surface contaminants.
  • Naturally filtered through layers of rock and sediment.
  • Less susceptible to pollution compared to surface water sources.

Other options:

  1. Spring water: Can be a good choice, but springs are susceptible to nearby contamination.
  2. River water: High risk of pollution from runoff and human activity. Requires extensive treatment before drinking.
  3. Rainwater: May contain impurities and needs treatment or collection from clean surfaces.
  4. Melted snow: Can be relatively clean, but depends on the environment and potential airborne pollutants.

In a field situation, prioritizing a source with minimal risk of contamination is crucial. Artesian wells offer the most reliable option due to their depth and natural filtration.

Here are some additional points to consider:

  • Accessibility: Artesian wells might require specific equipment to access the water, depending on the well design.
  • Water quality testing: Ideally, even artesian well water should be tested for safety, especially if the geological conditions of the area are unknown.

However, given the limited time frame (3-day rest) and the need for a reliable source, artesian well water presents the best initial option for the military unit.

73. The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?

A. A baby dead at the age up to 12 months

B. A baby dead at the age up to 1 months

C. A baby dead at the age over 28 days

D. A baby dead at the age up to 6 days

E. A baby dead at birth

Answer: A baby dead at the age up to 12 months


In infant mortality investigation, the unit of observation is typically defined as “A baby dead at the age up to 12 months” (option A). This is because infant mortality refers to the death of infants within their first year of life. The time frame of up to 12 months allows for a comprehensive analysis of infant deaths during this crucial period. 

Options B, C, D, and E define narrower time frames within the first year or immediately after birth, which do not encompass the full scope of infant mortality.

Infant mortality rates are typically calculated based on the number of deaths per 1,000 live births within the first year of life, and thus a broader time frame is considered for accurate analysis and comparison.

74. Chief district pediatrician has to carry out analysis of infant mortality rate. What should he take as a unit of the observation?

A. Child death case at the age up to 1 year

B. Child death case at the age up to the first month

C. Child death case after 28 days of life

D. Child death case during first 7 days of life

E. Child death case on labor

Answer: Child death case at the age up to 1 year


In order to carry out an analysis of infant mortality rate, the chief district pediatrician should take “Child death case at the age up to 1 year” (option A) as the unit of observation. Infant mortality rate refers to the number of deaths of infants under the age of 1 year per 1,000 live births.

By considering deaths within the first year of life, a comprehensive assessment of infant mortality can be made. 

Options B, C, D, and E refer to narrower time frames within the first year of life or immediately after birth, which do not capture the complete picture of infant mortality. To calculate the infant mortality rate accurately and compare it across different populations or time periods, the unit of observation should be deaths within the first year of life.

75. A 43 y.o. patient complains of mass and, pain in the right breast, elevation of temperature to 37, 20C during 3 last months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A. Cancer of right mammary gland

B. Right side acute mastitis

C. Right side chronic mastitis

D. Premenstrual syndrome

E. Tuberculosis of right mammary gland

Answer: Cancer of right mammary gland


Based on the provided information, the most probable diagnosis for this patient is A. Cancer of the right mammary gland. The presence of a mass in the right breast, along with pain, elevation of temperature, and worsening symptoms before menstruation, raises suspicion for breast cancer.

Other clinical findings such as edema, hyperemia, and a retracted nipple further support this diagnosis. While acute mastitis (option B) can cause similar symptoms such as breast pain, swelling, and redness, the chronicity of symptoms for three months and the palpable infiltration in the lower quadrants make cancer a more likely diagnosis. 

Chronic mastitis (option C) typically presents with recurrent or persistent inflammation of the breast, but the prolonged duration of symptoms and the presence of suspicious findings suggest a more concerning diagnosis. Premenstrual syndrome (option D) primarily refers to a collection of physical and emotional symptoms that occur in the days leading up to menstruation and is not typically associated with the specific breast findings described in the case. 

Tuberculosis of the mammary gland (option E) is a rare condition that can cause breast pain and swelling, but it is less likely in this case considering the presence of a palpable infiltration and the chronicity of symptoms. 

It is important to note that a definitive diagnosis can only be made through further evaluation and diagnostic tests such as imaging and biopsy. Therefore, it is crucial for the patient to consult a healthcare professional for proper evaluation and management.

76. A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fi- xed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A. Ancylosing spondyloarthritis

B. Tuberculous spondylitis

C. Psoriatic spondyloarthropatia

D. Spondyloarthropatia on the background of Reiter’s disease

E. Spread osteochondrosis of the vertebral column

Answer: Ancylosing spondyloarthritis


Based on the provided information, the most likely diagnosis for this patient is A. Ankylosing spondylitis. Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints. It typically presents with pain and stiffness in the lower back and hips, which can worsen with physical exertion. The pain may also be present in other areas of the spine, such as the cervical and thoracic regions.

The forward inclination of the body with a fixed posture, as described in the case, is a characteristic feature of ankylosing spondylitis. Additional findings such as gluteal muscle atrophy and ossification of the longitudinal ligament seen on spine radiography further support the diagnosis. These findings are commonly observed in ankylosing spondylitis due to chronic inflammation and structural changes in the spine. Tuberculous spondylitis (option B) refers to a form of spinal tuberculosis and typically presents with back pain, but the clinical picture in the case is more consistent with ankylosing spondylitis. 

Psoriatic spondyloarthropathy (option C) is associated with psoriasis and can cause inflammation in the joints and spine. However, the symptoms described in the case are more suggestive of ankylosing spondylitis rather than psoriatic arthritis. Spondyloarthropathy on the background of Reiter’s disease (option D) is characterized by arthritis, urethritis, and conjunctivitis, which are not mentioned in the case description.

 Spread osteochondrosis of the vertebral column (option E) refers to degenerative changes in the spinal discs and is not typically associated with the specific symptoms and findings described in the case. It is important to consult a healthcare professional for a comprehensive evaluation, including further diagnostic tests and imaging, to confirm the diagnosis and develop an appropriate treatment plan.

77. A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers’ skin – greyish warts. Factory’s sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?

A. Thorax roentgenography

B. Bronchoscopy

C. Spirography

D. Bronchoalveolar lavage

E. Blood gases examination

Answer: Thorax roentgenography


The most informative method for verifying the diagnosis of asbestosis in this case would be A. Thorax roentgenography (chest X-ray). Asbestosis is a lung disease caused by prolonged exposure to asbestos fibers. It is characterized by fibrosis (scarring) of the lung tissue, which can lead to symptoms such as dyspnea (shortness of breath) and dry cough. 

Chest X-ray (thorax roentgenography) is commonly used as an initial screening tool for detecting and evaluating the extent of lung abnormalities associated with asbestosis. It can show characteristic findings such as bilateral interstitial opacities, especially in the lower lung fields.

The findings may appear as linear streaks or honeycomb patterns. While other methods such as bronchoscopy, spirography (spirometry), bronchoalveolar lavage, and blood gases examination can provide additional information in the evaluation of respiratory conditions, they are not as specific for diagnosing asbestosis as chest X-ray. Bronchoscopy involves inserting a thin, flexible tube with a camera into the airways to examine the lungs and collect samples for further analysis. It may be helpful in ruling out other lung conditions or identifying other potential causes of respiratory symptoms but is not specific to asbestosis. 

Spirography (spirometry) is a lung function test that measures how well a person can inhale and exhale air. While it can provide information about lung function, it is not specific to asbestosis. Bronchoalveolar lavage involves washing the lungs with a saline solution and collecting the fluid for analysis.

It can be useful in evaluating lung inflammation and infection, but it is not specific to asbestosis. Blood gases examination measures the levels of oxygen and carbon dioxide in the blood. It can provide information about respiratory function but does not directly confirm the diagnosis of asbestosis. It is important for the patient to consult with a healthcare professional who can evaluate their symptoms, conduct appropriate diagnostic tests, and provide an accurate diagnosis.

78. Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics for the last 5 years. What statistical values can help in calculations of diseases level dissamination?

A. Relative values

B. Standart values

C. Average values

D. Absolute values

E. Dynamic row

Answer: Relative values


In the study of morbidity rates for the population served at the polyclinics over the last 5 years, several statistical values can help in calculating the level of disease dissemination. These values include: A. Relative values: Relative values compare the frequency of a particular disease or condition within a specific population to a reference population. They are useful for understanding the proportion of individuals affected by a disease in relation to the total population. 

B. Standard values: Standard values provide a benchmark or reference point against which the observed morbidity rates can be compared. They help in assessing whether the observed rates are higher or lower than what would be expected based on established norms or standards. 

C. Average values: Average values, such as mean or median, can provide an overall measure of central tendency for the morbidity rates. They summarize the general level of disease occurrence in the population and can help in comparing different time periods or population groups. 

D. Absolute values: Absolute values represent the actual number of cases or events of a disease within a specific population. They provide a direct measure of disease burden and can be useful for understanding the absolute level of disease dissemination. 

. Dynamic row: It is unclear what is meant by “dynamic row” in this context. It may refer to a dynamic table or dataset that includes information on morbidity rates over time, allowing for analysis and tracking of disease dissemination patterns. To calculate the level of disease dissemination, a combination of these statistical values may be used, depending on the specific objectives and methodology of the study.

79. A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?

A. Echocardiography

B. Phonocardiography

C. Coronarography

D. Sphygmography

E. X-ray

Answer: Echocardiography


In this case, the most informative method of examination would be A. Echocardiography. Echocardiography is a non-invasive imaging technique that uses ultrasound waves to create real-time images of the heart. It provides detailed information about the structure and function of the heart, allowing for the evaluation of cardiac chambers, valves, and the thickness of the heart muscle. 

Given the patient’s symptoms of substernal pain, elevated blood pressure, signs of left ventricular hypertrophy on ECG, and aortic systolic murmur, echocardiography can help in diagnosing and assessing various conditions, such as aortic stenosis, left ventricular hypertrophy, or other structural abnormalities of the heart. Phonocardiography, sphygmography, and X-ray may provide some additional information, but they are not as comprehensive or specific as echocardiography in evaluating the underlying cardiac abnormalities.

Coronary angiography (coronarography) is primarily used to assess the patency of coronary arteries in cases of suspected coronary artery disease, and may not be the most appropriate method in this case without further indication of ischemic heart disease.

80. A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t 0- 38, 20, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?

A. Measles

B. Adenovirus infection

C. Scarlet fever

D. Rubella

E. Enterovirus exanthema

Answer: Measles


Based on the presented symptoms, the most probable preliminary diagnosis for the child is A. Measles. Measles is a highly contagious viral infection characterized by symptoms such as cough, skin rash, fever, facial swelling (hydropy), photosensitivity, conjunctivitis, and respiratory symptoms like seropurulent nasal discharge and dry crackles in the lungs. The rash typically starts on the face and then spreads to other parts of the body, including the neck and upper chest. 

The presentation of bright maculopapular rash with areas of merging, hyperemic throat, and the combination of respiratory and systemic symptoms are consistent with measles. Measles is caused by the measles virus and is spread through respiratory droplets. It’s important to note that a definitive diagnosis should be made by a healthcare professional through appropriate diagnostic testing, such as serological tests or viral identification from respiratory samples.

81. There were registered 500 cases of urolithiasis per 10000 inhabitants. What kind of statictical indices is presented?

A. Prevalence rate

B. Correlation coefficient

C. Index of visualization

D. Incidence rate

E. Index of compliance

Answer: Prevalence rate


The statistical index that is presented in this scenario is A. Prevalence rate. Prevalence rate refers to the proportion of individuals in a population who have a specific condition or disease at a given point in time. It is typically expressed as a percentage or a rate per a specific population size.

In this case, the prevalence rate of urolithiasis is given as 500 cases per 10,000 inhabitants. This means that out of the total population of 10,000, there are 500 individuals who have been diagnosed with urolithiasis. 

It’s important to note that prevalence rate provides information about the total number of existing cases of a disease or condition within a population, regardless of when they occurred. This is different from the incidence rate, which measures the number of new cases that develop within a specific time period.

82. At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of patient-used beds. What index of hospital work can be calculated based upon this data?

A. Bed turnover

B. Bed resources of the hospital

C. Average annual bed occupacy

D. Average duration of patients presence in the hospital

E. Average bed idle time

Answer: Bed turnover


The correct answer is A. Bed turnover.   Bed turnover is an index of hospital work that can be calculated based on the provided data. It is calculated by dividing the annual number of treated patients by the average annual number of patient-used beds.  

Bed turnover represents the rate at which beds are being occupied by patients over the course of a year. It indicates the frequency with which beds are being filled and vacated, reflecting the flow of patients in and out of the hospital. 

A higher bed turnover rate suggests a higher volume of patients being treated within a given bed capacity. It can be an indicator of the hospital’s efficiency in managing patient flow and maximizing bed utilization. However, it’s important to consider other factors such as the length of stay and the quality of care provided to patients to gain a comprehensive understanding of the hospital’s performance.

83. A 52 y.o. patient fell from 3 m hight on the ground with the right lumbar area. He complains of pain here. There is microhematuria in the urea. On urography kidney’s functioning is satisfactory. What is the most probable diagnosis?

A. Kidney’s contusion

. Subcapsular kidney’s rupture

C. Multile kidney’s ruptures

D. Paranephral hematoma

E. Kidney’s abruption

Answer: Kidney’s contusion


Based on the provided information, the most probable diagnosis in this case would be A. Kidney’s contusion. A kidney contusion refers to a bruise or injury to the kidney caused by blunt force trauma. In this scenario, the patient fell from a height and experienced pain in the right lumbar area.

The presence of microhematuria (blood in the urine) suggests injury to the kidney. Urography, which is a radiographic imaging technique used to visualize the urinary system, shows satisfactory kidney functioning. This indicates that the kidney itself is functioning properly, but there may be some injury or damage to the kidney tissue. 

It’s important to note that a comprehensive evaluation by a healthcare professional, including further diagnostic tests if necessary, would be required to confirm the diagnosis and determine the extent of the kidney injury.

84. A 3 y.o. child with weight defficiency suffers from permanent moist cough. There was a history of some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different moist rales. Level of sweat chloride is 80 mol/L. What is the most probable diagnosis?

A. Mucoviscidosis (cystic fibrosis)

B. Bronchial asthma

C. Recurrent bronchitis

D. Bronchiectasis

E. Pulmonary hypoplasia

Answer: Mucoviscidosis (cystic fibrosis)


Based on the provided information, the most probable diagnosis in this case would be A. Mucoviscidosis (cystic fibrosis). Mucoviscidosis, also known as cystic fibrosis (CF), is a genetic disorder that primarily affects the lungs and digestive system.

It is characterized by the production of abnormally thick and sticky mucus in the airways, leading to recurrent respiratory infections and other symptoms. In this case, the child has weight deficiency and a history of recurrent pneumonias with obstruction. The presence of a permanent moist cough, distended chest, dullness on percussion over the lower parts of the lungs, and a great number of different moist rales on auscultation are consistent with the respiratory manifestations of cystic fibrosis. 

The elevated sweat chloride level (80 mol/L) is a diagnostic finding in cystic fibrosis. Sweat chloride testing is a commonly used diagnostic test for CF, as individuals with CF have increased chloride levels in their sweat. It is important to note that a comprehensive evaluation by a healthcare professional, including genetic testing and other diagnostic tests, would be required to confirm the diagnosis of cystic fibrosis.

85. A 14 y.o. girl complains of profuse bloody genital discharges during 10 days after suppresion of menses for 1,5 months. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology on the internal genitalia. In blood: Нb– 70 g/L, RBC- 2, 3 ∗ 1012/L, Ht– 20. What is the most probable diagnosis?

A. Juvenale bleeding, posthemorrhagic anemia

B. Werlholf’s disease

C. Polycyst ovarian syndrome

D. Hormonoproductive ovary tumor

E. Noncomplete spontaneous abortion


Answer: Juvenale bleeding, posthemorrhagic anemia


The most probable diagnosis in this case is A. Juvenile bleeding, posthemorrhagic anemia. Juvenile bleeding, also known as dysfunctional uterine bleeding (DUB), refers to abnormal uterine bleeding that occurs in adolescent girls with disordered menstrual cycles.

It is characterized by irregular and unpredictable menstrual bleeding patterns. In this case, the 14-year-old girl complains of profuse bloody genital discharges that occur after the suppression of menses for 1.5 months. Similar bleedings have been recurring since she was 12 years old, indicating a history of irregular menstrual cycles. The absence of pathology on rectal examination suggests that the bleeding is originating from the uterus. 

The laboratory findings of low hemoglobin (Hb) levels (70 g/L), low red blood cell count (RBC) (2.3 × 10^12/L), and low hematocrit (Ht) (20) indicate anemia, specifically posthemorrhagic anemia resulting from the excessive and prolonged uterine bleeding. It is important to note that other causes of abnormal uterine bleeding should also be considered and evaluated by a healthcare professional to rule out any underlying conditions.

86. A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?

A. Right shin osteomielitis

B. Right shin tuberculosis

C. Right shin syphilis

D. Bone cyst of tibia

E. Right shin trauma

Answer: Right shin osteomielitis


Given the information provided, the most likely diagnosis in this case is A. Right shin osteomyelitis. Osteomyelitis refers to an infection of the bone and bone marrow, often caused by bacteria. The symptoms described, including high fever and acute pain in the right shin, along with the X-ray findings of translucent spaces (destructive foci) with uneven contours in the middle third of the tibia diaphysis and a narrow line of shadow (periostitis) along the bone edge, are consistent with the diagnosis of osteomyelitis. 

The presence of destructive foci on the X-ray suggests bone involvement, and the periostitis indicates inflammation of the periosteum, which is the outer layer of the bone. These findings are commonly seen in osteomyelitis. To confirm the diagnosis and determine the specific cause of the infection, further tests such as blood cultures and bone biopsy may be necessary. Treatment typically involves antibiotics to eliminate the infection and may also require surgical intervention in some cases.

87. A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6×8 cm. In blood: alkaline phosphatase – 2,0 mmol/(hour*L), general bilirubin – 60 mkmol/L, cholesterol – 8,0 mmol/L. What is the leading syndrome in the patient?

A. Сholestatic

B. Сytolytic

C. Mesenchymal inflammatory

D. Asthenic

E. Liver-cells insufficiency

Answer: Сholestatic


The leading syndrome in the patient is A. Cholestatic. Cholestasis refers to a reduction or blockage of bile flow from the liver to the small intestine. It can occur due to various underlying conditions. In this case, the patient presents with skin itching, jaundice (yellowing of the skin), and discomfort in the right subcostal area, which are typical symptoms of cholestasis. 

The examination findings of jaundiced skin, scratches (due to itching), an enlarged liver (+5 cm), and an enlarged spleen (6×8 cm) further support the diagnosis of cholestasis. The laboratory results of elevated alkaline phosphatase, elevated total bilirubin, and elevated cholesterol are consistent with impaired liver function and disrupted bile flow. Cholestasis can result from different causes, such as liver diseases, gallstone obstruction, or bile duct disorders.

Further investigations, such as imaging studies and additional blood tests, may be necessary to determine the underlying cause of cholestasis in this patient. Please note that a complete evaluation by a healthcare professional is essential for an accurate diagnosis and appropriate management of the patient’s condition.

88. A 43 y.o. patient had cholecystectomy 6 years ago due to chronic calculous cholecystitis. Lately he has suffered from pain in the right subcostal area and recurrent jaundice. During last 2 weeks jaundice hasn’t gone. Stenoutic papillitis 0,5 cm in length has been revealed. What is the best way of treatment?

A. To perform endocsopic papillosphincterotomy

B. To treat conservatively: antibiotics, spasmolytics, antiinflammatory drugs

C. To perform external choledoch drain

D. To perform choledochoduodenostomy

E. –

Answer: To perform endocsopic papillosphincterotomy


The best way of treatment for this patient with stenotic papillitis and recurrent jaundice is A. To perform endoscopic papillosphincterotomy. Stenotic papillitis refers to the narrowing or blockage of the papilla of Vater, which is the opening of the common bile duct into the duodenum.

This condition can lead to impaired bile flow and recurrent jaundice. Endoscopic papillosphincterotomy is a minimally invasive procedure performed using an endoscope. It involves making a small incision in the sphincter of the papilla to widen the opening and improve bile flow.

This procedure is effective in relieving the obstruction caused by stenotic papillitis and restoring normal bile flow. Conservative treatment with antibiotics, spasmolytics, and anti-inflammatory drugs may help manage the symptoms but would not address the underlying cause of the stenosis.

In this case, as the patient has persistent jaundice and the presence of a stenotic papilla, endoscopic papillosphincterotomy is the most appropriate and effective treatment option. Please note that the final decision on the treatment approach should be made by a healthcare professional after considering the patient’s individual condition and conducting a thorough evaluation.

89. A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrom during first days of the disease. What is the role of angiotesin II in the pathogenesis?

A. Intensifies production and secretion of aldosterone

B. Increases heart output

C. Infibits deppresive action of prostaglandins

D. Increases erythropoetin production

E. Increases renine level

Answer:  Intensifies production and secretion of aldosterone


A. Intensifies production and secretion of aldosterone.   Angiotensin II plays a significant role in the pathogenesis of acute glomerulonephritis, particularly in relation to the development of hypertensive syndrome. Angiotensin II is a potent vasoconstrictor that acts on the blood vessels and has several effects on the renal system.   One of the main actions of angiotensin II is to stimulate the production and secretion of aldosterone from the adrenal glands.

Aldosterone is a hormone that regulates the reabsorption of sodium and water in the kidneys, leading to increased blood volume and elevated blood pressure. In acute glomerulonephritis, the release of angiotensin II contributes to the development of hypertension by promoting aldosterone production, which leads to sodium and water retention.  

It’s important to note that while angiotensin II plays a role in the pathogenesis of acute glomerulonephritis, it is not the sole factor involved. Acute glomerulonephritis is a complex immune-mediated disease with various contributing factors.

90. On physiologic-sanitary examination of railway department work it was revealed that loaders work is of III degree of difficulty. They unload vagons with sand, manually break coagulated mass by shovel and shift it. What criteria was used to evaluate work of loaders?

A. Maximun load weigh which is shifted

B. Value of static loading for the shift

C. Time of active activities, % to the shift duration

D. Time of passive observation, % to the shift duration

E. Intellectual efforts

Answer: Maximun load weigh which is shifted


The correct answer in this case is actually A. Maximum load weight which is shifted. When evaluating the work of loaders, one of the criteria used is the maximum load weight that they are required to shift. In this scenario, the loaders are unloading wagons with sand and manually breaking coagulated mass by shovel.

The weight of the load they are handling is an important factor in determining the difficulty and physical exertion involved in their work. By assessing the maximum load weight, the evaluation takes into account the physical strength and capabilities required to handle and shift the load.

The higher the weight of the load, the more physically demanding and difficult the work becomes for the loaders. Therefore, in this context, the criteria used to evaluate the work of loaders is the maximum load weight that is shifted.

91. A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?

A. Esophagogastroduodenoscopy with biopsy

B. Ultrasound examination of abdomen

C. pH-metry

D. Ureatic test

E. Stomach X-ray

Answer: Esophagogastroduodenoscopy with biopsy


In the given clinical scenario, the most useful method of investigation would be A. Esophagogastroduodenoscopy (EGD) with biopsy. The patient’s symptoms, history of gastric peptic ulcer, and the presence of diffuse tenderness and resistance of muscles on palpation raise concerns about a possible underlying gastrointestinal pathology, such as gastric cancer. To further evaluate the condition, an EGD with biopsy is recommended. 

Esophagogastroduodenoscopy allows direct visualization of the esophagus, stomach, and duodenum using a flexible endoscope. It enables the doctor to examine the mucosal lining of these organs, identify any abnormalities or lesions, and obtain tissue samples (biopsy) for further analysis.

Biopsy is particularly important for the evaluation of suspicious lesions, as it helps in confirming the diagnosis and determining the nature of the tissue, such as whether it is cancerous or benign. While other investigation methods, such as ultrasound examination of the abdomen or stomach X-ray, may provide additional information, they are less likely to provide a definitive diagnosis or evaluate the specific changes within the gastrointestinal tract. Therefore, in this case, an esophagogastroduodenoscopy with biopsy would be the most useful and appropriate method of investigation.

92. A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: WBC – 35 ∗ 109/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

A. Chronic lympholeucosis

B. Chronic myeloleucosis

C. Lymphogranulomatosis

D. Acute leucosis

E. Tuberculous lymphadenitis

Answer: Chronic lympholeucosis


The most probable diagnosis in this case is A. Chronic lymphocytic leukemia (CLL). The patient’s symptoms, such as tiredness, sweating, and lymph node enlargement, along with the blood test results showing an elevated white blood cell count (WBC) with a predominance of lymphocytes, suggest a lymphoproliferative disorder.

Additionally, the presence of Botkin and Gumprecht bodies, as well as lymphocytes accounting for 40% of the myelogram, further support the diagnosis of CLL. CLL is a type of leukemia characterized by the accumulation of abnormal lymphocytes in the blood, bone marrow, and lymphoid tissues. It typically presents in older individuals and is often associated with fatigue, lymphadenopathy (enlarged lymph nodes), and other systemic symptoms. The disease course is usually indolent, with slow progression over time. 

Chronic myeloid leukemia (CML) (option B) is less likely in this case, as the blood test results and myelogram findings are more indicative of a lymphoid disorder rather than a myeloid disorder. Lymphogranulomatosis (option C) refers to Hodgkin’s lymphoma, which typically presents with specific histological features and is not consistent with the provided information.

Acute leukemia (option D) is characterized by a rapid onset and would typically exhibit more severe symptoms and abnormal blood cell counts. Tuberculous lymphadenitis (option E) may present with lymph node enlargement, but the blood test results and myelogram findings do not support this diagnosis. Therefore, based on the given information, the most probable diagnosis is chronic lymphocytic leukemia (CLL).

93. Examination of placenta, which has just been born, reveals defect 2×3 cm in size. There is no bleeding. What tactics is the most reasonable?

A. Manual uretus cavity revision

B. Administration of uterotonic medicines

C. External uterus massage

D. Parturient supervision

E. Instrumental uterus cavity revision

Answer: Manual uretus cavity revision


The most reasonable tactic in this case would be A. Manual uterine cavity revision. A defect in the placenta indicates that a portion of the placenta has remained attached to the uterine wall after delivery. This condition is known as retained placental tissue or placental retention. It can lead to postpartum hemorrhage and other complications if not managed appropriately. 

Manual uterine cavity revision involves manually exploring the uterine cavity with a gloved hand to identify and remove any retained placental tissue or blood clots. This procedure is performed to ensure the complete removal of any remaining placental fragments and to prevent potential complications such as infection or excessive bleeding. 

Administration of uterotonic medicines (option B) may be used in combination with manual uterine cavity revision to help the uterus contract and reduce the risk of bleeding. External uterine massage (option C) can also assist in promoting uterine contractions. However, in this case, manual uterine cavity revision is necessary to directly address the retained placental tissue. 

Parturient supervision (option D) is a general term and does not provide a specific intervention for managing the placental defect. Instrumental uterine cavity revision (option E) refers to using instruments to remove placental fragments and is typically considered if manual revision is unsuccessful. Therefore, the most reasonable tactic in this situation is to perform a manual uterine cavity revision to ensure the complete removal of any retained placental tissue and prevent potential complications.

94. A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?

A. To place suture on the uterus cervix

B. To administer tocolytic therapy

C. To interrupt pregnancy

D. To administer hormonal treatment

E. To perform amniocentesis

Answer: To place suture on the uterus cervix


The most appropriate doctor’s tactics in the case of isthmico-cervical insufficiency in a 27-year-old pregnant woman at 17 weeks of gestation would be A. To place a suture on the cervix. Isthmico-cervical insufficiency, also known as cervical incompetence, is a condition characterized by the premature dilation and effacement of the cervix during pregnancy, leading to the risk of preterm delivery or miscarriage.

In this case, the enlarged uterus, shortened cervix, and the ability to pass a finger tip through the isthmus suggest cervical insufficiency. To address this condition, a procedure called cervical cerclage is commonly performed. It involves the placement of a suture or stitch around the cervix to provide mechanical support and prevent further dilation. This helps to maintain the integrity of the cervix and reduce the risk of premature delivery.

The cerclage is usually placed between 12 and 14 weeks of gestation, but in some cases, it can be performed later, as in this scenario. Tocolytic therapy (option B) is the use of medications to suppress uterine contractions and is typically employed in cases of preterm labor.

However, in isthmico-cervical insufficiency, the main issue is cervical dilation rather than uterine contractions, so tocolytics may not be effective. Interrupting the pregnancy (option C) may be considered if there are severe complications or risks to the mother or fetus, but it is not the first-line approach for isthmico-cervical insufficiency. Hormonal treatment (option D) may be used in some cases to help support the pregnancy, but it is not the primary treatment for isthmico-cervical insufficiency. 

Amniocentesis (option E) is a procedure performed to obtain a sample of amniotic fluid for various diagnostic purposes. It is not typically indicated for the management of isthmico-cervical insufficiency. Therefore, in this case, the most appropriate tactic would be to place a suture on the cervix (cervical cerclage) to provide mechanical support and reduce the risk of further cervical dilation and pregnancy loss.

95. A district pediarician has carried out infant mortality rate analysis in his area. What data has been used?

A. Mortality of children under 1 y.o. structured by age, sex, causes

B. Mortality of children under 1 y.o., natimortality

C. Hospital mortality of children, structured by age

D. Mortality of district adolescents

E. Mortality of district newborn

Answer: Mortality of children under 1 y.o. structured by age, sex, causes


The data used for the analysis of infant mortality rate in the district would be: A. Mortality of children under 1 year old, structured by age, sex, and causes. Infant mortality rate refers to the number of deaths of infants under 1 year old per 1,000 live births in a given population.

To analyze this rate, it is essential to have data on the number of deaths among infants under 1 year old and the relevant demographic and cause-of-death information. By structuring the data by age (e.g., neonatal mortality and postneonatal mortality), sex, and causes of death, the district pediatrician can gain insights into the patterns and factors contributing to infant mortality in the area. 

B. Mortality of children under 1 year old, including natimortality. Natimortality refers to deaths that occur within the first 28 days of life, often referred to as neonatal deaths. Including natimortality in the analysis provides a more comprehensive understanding of infant mortality, as it focuses on the early stages of life. 

C. Hospital mortality of children, structured by age. While hospital mortality data for children may be valuable for assessing the quality of healthcare services, it is not specifically focused on infants under 1 year old. Infant mortality rate analysis typically focuses on the broader population of infants rather than just hospital-specific data. D. Mortality of district adolescents. Infant mortality rate analysis specifically looks at deaths among infants under 1 year old. Mortality data for adolescents, who are older than 1 year, would not be relevant to this particular analysis. 

E. Mortality of district newborns. Mortality data for newborns, particularly within the first year of life, would be essential for analyzing the infant mortality rate. Newborn mortality contributes to the overall infant mortality rate and can provide insights into the specific challenges faced by this vulnerable population. In summary, the most relevant data for the analysis of infant mortality rate in the district would be A. Mortality of children under 1 year old, structured by age, sex, and causes, and optionally B. including natimortality.

96. A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics.

A. To decrease thyroxine dosage

B. To increase thyroxine dosage

C. To administer betablockers

D. To add mercasolil to the treatment

E. To administer sedatives

Answer: To decrease thyroxine dosage


The symptoms described in the patient with postoperative hypothyroidism (tachycardia, sweating, irritability, sleep disorder) suggest a state of hyperthyroidism or excessive thyroid hormone replacement. In this case, the appropriate treatment tactic would be: A. To decrease thyroxine dosage. The symptoms described are consistent with thyrotoxicosis, which can occur when the thyroid hormone replacement dosage is too high.

By decreasing the dosage of thyroxine, the aim is to bring the thyroid hormone levels back into the normal range and alleviate the symptoms of hyperthyroidism. It is important to monitor the patient’s thyroid function closely and adjust the dosage of thyroxine as needed to achieve a balance and avoid both hypothyroidism and hyperthyroidism.

The adjustment of medication dosage should be done in consultation with a healthcare professional, such as an endocrinologist or primary care physician, who can evaluate the patient’s thyroid function test results and clinical symptoms to determine the appropriate dosage.

97. Body temperature of a 12 y.o. girl increased up to 39−400C in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Nikolsky syndrome is positive. What is the most probable diagnosis?

A. Acute epidermical necrolysis

B. Pemphigus vulgaris

C. Polymorphic exudative erythema

D. Bullous dermatitis

E. Duhring’s disease

Answer: Acute epidermical necrolysis


The most probable diagnosis based on the symptoms described is: A. Acute epidermical necrolysis (also known as Stevens-Johnson syndrome or toxic epidermal necrolysis) The symptoms described, such as a sudden increase in body temperature, general discomfort, dizziness, and the sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface, are characteristic of Stevens-Johnson syndrome.

The positive Nikolsky sign, which refers to the ability to induce blistering or sloughing of the skin with slight pressure, is another indication of this condition. Stevens-Johnson syndrome is a severe and potentially life-threatening hypersensitivity reaction, often triggered by medications such as aspirin.

It involves the detachment and death of the skin’s top layer (epidermis) and can lead to significant skin and mucous membrane damage. It requires immediate medical attention and hospitalization. It is important for the patient to seek immediate medical care for proper diagnosis, management, and treatment of Stevens-Johnson syndrome.

98. A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, positions near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A. Right-sided direct inguinal hernia

B. Right-sided oblique inguinal hernia

C. Right-sided femoral hernia

D. Varicose veins of the right hip

E. Lipoma of the right inguinal area

Answer: Right-sided direct inguinal hernia


Based on the provided information, the most probable preliminary diagnosis is: A. Right-sided direct inguinal hernia In direct inguinal hernias, the hernial sac protrudes through the abdominal wall in the area of weakness called Hesselbach’s triangle, which is located just medial to the inferior epigastric vessels.

The description of a round-shaped lump in the right inguinal region, near the medial part of Poupart’s ligament, and situated inwards from the spermatic cord, is consistent with the presentation of a direct inguinal hernia. 

Direct inguinal hernias typically occur due to a weakness or defect in the transversalis fascia, allowing abdominal contents to bulge through. They tend to be more common in older individuals and are often associated with straining or increased intra-abdominal pressure, such as during exercise. 

However, it is important to note that a definitive diagnosis can only be made by a healthcare professional through a thorough examination and possibly imaging studies. Treatment for an inguinal hernia usually involves surgical repair to prevent complications like incarceration or strangulation of the herniated tissue. Once again, I apologize for the previous incorrect response, and I appreciate your understanding.

99. A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. АP- 180/100 mm Hg. Speeln is 4 cm below the rib arch edge. What is the most probable diagnosis?

A. Erythremia

B. Essential hypertension

C. Dermatomyositis

D. Allergic dermatitis

E. Systemic sclerodermia

Answer: Erythremia


Based on the provided information, the most probable diagnosis is:   A. Erythremia (also known as polycythemia vera)   Erythremia, or polycythemia vera, is a rare disorder characterized by an overproduction of red blood cells in the bone marrow.

The symptoms described in the case, such as weakness, painful itching after washing, sensation of heaviness in the head, and hyperemia of the skin, can be associated with erythremia.   The elevated blood pressure reading of 180/100 mm Hg may be due to increased blood volume resulting from the increased number of red blood cells.

The spleen being 4 cm below the rib arch edge is consistent with splenomegaly, which can occur in erythremia.   Other possible causes, such as essential hypertension, dermatomyositis, allergic dermatitis, and systemic scleroderma, may not fully explain the combination of symptoms and findings in this case.  

However, it’s important to note that a comprehensive evaluation by a healthcare professional, including further diagnostic tests and examination, would be needed to confirm the diagnosis and rule out other possible causes. Erythremia is a chronic condition that requires appropriate management and treatment.

100. A 55 y.o. patient complains of distended abdomen and rumbling, increased winds evacuation, liguid foamy feces with sour smell following the diary products consumption. What is the correct name of this syndrome?

A. Syndrome of fermentative dyspepsia

B. Syndrome of decayed dyspepsia

C. Syndrome of fatty dyspepsia

D. Dyskinesia syndrome

E. Malabsorption syndrome

Answer:  Syndrome of fermentative dyspepsia


The correct name for the described syndrome is:   A. Syndrome of fermentative dyspepsia   The syndrome of fermentative dyspepsia refers to a condition characterized by abdominal distension, increased flatulence, and the presence of liquid, foamy stools with a sour smell.

It occurs after the consumption of dairy products and is often associated with lactose intolerance.   Lactose intolerance is the inability to digest lactose, a sugar found in milk and dairy products, due to the deficiency of the enzyme lactase.

This leads to the fermentation of lactose by bacteria in the gut, resulting in the production of gas and the symptoms described.   Other options listed, such as the syndrome of decayed dyspepsia, syndrome of fatty dyspepsia, dyskinesia syndrome, and malabsorption syndrome, do not specifically match the symptoms and association with dairy product consumption as described in the case.

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