Question From ( 51 To 100 )
51. A 2 month old healthy infant with good appetite is given artificial feeding since he turned 1 month old. When is it recommended to start the corrective feeding (fruit juice)?
A. 4,0 months
B. 1,5 months
C. 2,0 months
D. 3,0 months
E. 1,0 months
Answer: 4,0 months
Explanation
| Corrective feeding refers to the introduction of complementary foods to an infant’s diet to supplement the nutritional value of breastmilk or formula. The timing of corrective feeding depends on the infant’s age, growth, and development. In the case described, the infant is 2 months old and has been receiving artificial feeding since 1 month of age. It is recommended that infants are exclusively breastfed or formula-fed for the first 4-6 months of life, as breastmilk or formula provides all the necessary nutrients for healthy growth and development. After 4-6 months of age, infants can gradually begin to receive complementary foods, such as pureed fruits and vegetables, to supplement their diet. Therefore, in this case, it is recommended to start corrective feeding with fruit juice at 4 months of age, when the infant’s digestive system is more mature and able to handle solid foods. Starting corrective feeding too early can increase the risk of gastrointestinal problems, food allergies, and other complications. Therefore, it is important to follow the recommended guidelines for corrective feeding and consult with a pediatrician if there are any concerns or questions about the infant’s diet. |
52. A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?
A. Carbohydrates
B. Salt
C. Liquid
D. Proteins
E. Fats
Answer: Carbohydrates
Explanation
| Acute glomerulonephritis is a kidney disease that can cause inflammation and damage to the glomeruli, the tiny filters in the kidneys that remove waste and excess fluid from the blood. During the acute phase of glomerulonephritis, it is important to maintain a balanced diet that provides adequate nutrition while also limiting certain nutrients that can exacerbate the condition. Protein and salt should be limited during the acute phase of glomerulonephritis, as they can increase the workload on the kidneys and worsen the disease. However, carbohydrates, fats, and liquids do not need to be limited and are important for providing energy, maintaining proper metabolism, and preventing dehydration. Carbohydrates are a major source of energy for the body and should be included in the diet to meet the energy needs of the child. Complex carbohydrates, such as whole grains, fruits, and vegetables, are preferred over simple carbohydrates, such as candy and sugary drinks, as they provide more nutrients and fiber. Fats are also important for providing energy and supporting growth and development, but should be consumed in moderation to avoid excess weight gain and cardiovascular complications. Liquids, particularly water, should be encouraged to prevent dehydration and support kidney function. However, excessive fluid intake should be avoided, as it can increase the workload on the kidneys and worsen the condition. Therefore, based on the information given in the question, the nutrient that must not be limited during the acute period of glomerulonephritis is carbohydrates. |
53. Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?
A. Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove) B. Diaphanoscоpy
C. Palpation of the external inguinal ring
D. Puncture of the scrotum
E. Examination of the formation in Trendelenburg’s position
Answer: Palpation of the thickened cord crossing the pubical tubercule (sign of the silk glove)
Explanation
| The scrotum growth on the right side of the 3-month-old child is suggestive of a hydrocele, which is a collection of fluid in the sac surrounding the testicle. Hydroceles are common in newborns and infants and are usually harmless, but in some cases, they may require medical intervention. To make a correct diagnosis, a physical examination is necessary. Palpation of the thickened cord crossing the pubic tubercle, also known as the “sign of the silk glove,” can help differentiate between a hydrocele and an inguinal hernia. In a hydrocele, the cord feels like a smooth, soft tube that can be easily compressed and pushed back into the abdomen, similar to a silk glove. In contrast, in an inguinal hernia, the cord feels like a knobby, irregular structure that cannot be easily compressed or pushed back into the abdomen. Diaphanoscopy, which involves shining a light through the scrotum to visualize the contents of the sac, can also be helpful in distinguishing between a hydrocele and an inguinal hernia. However, this technique is not always necessary and may not be readily available in all settings. Palpation of the external inguinal ring can also help detect an inguinal hernia, but it may not be as reliable as the sign of the silk glove. Puncture of the scrotum is not necessary for making a diagnosis and can be harmful to the child. Examination of the formation in Trendelenburg’s position, which involves tilting the patient head-down, is not necessary for making a diagnosis of a hydrocele or inguinal hernia. Therefore, based on the information given in the question, the examination that will be helpful for making a correct diagnosis of the scrotum growth in the 3-month-old child is palpation of the thickened cord crossing the pubic tubercle (sign of the silk glove). |
54. A rounded well-defined shadow was found in the costo-vertebral angle on the chest roentgenogram of an otherwise healthy 9 year old girl. Make a preliminary diagnosis:
A. Ganglioneuroma
B. Sympatoblastoma
C. Ganglioneuroblastoma
D. Sympatogonioma
E. Sarcoma of the vertebra
Answer: Ganglioneuroma
Explanation
| A rounded, well-defined shadow in the costo-vertebral angle on a chest radiograph of a 9-year-old girl is suggestive of a neurogenic tumor in the posterior mediastinum. The costo-vertebral angle is the area where the 12th rib attaches to the spine, and tumors located in this area are often associated with the sympathetic nervous system. Ganglioneuroma is a type of benign neurogenic tumor that arises from the sympathetic nervous system and typically presents as a well-circumscribed mass in the posterior mediastinum. It is usually asymptomatic and discovered incidentally on imaging studies, as in this case. Sympathoblastoma, ganglioneuroblastoma, and sympatogonioma are all types of malignant neurogenic tumors that can also occur in the posterior mediastinum, but these are less likely to be the cause of a well-defined shadow on a chest radiograph in an otherwise healthy child. Sarcoma of the vertebra is a type of malignant tumor that arises from the bone or soft tissue of the spine and is not typically associated with a well-defined shadow in the costo-vertebral angle. Therefore, based on the information given in the question, the most likely preliminary diagnosis for the rounded, well-defined shadow in the costo-vertebral angle on the chest radiograph of the 9-year-old girl is ganglioneuroma. However, further diagnostic tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), would be necessary to confirm the diagnosis and determine the appropriate treatment plan. |
55. A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?
A. IHD. Unstable angina
B. Cardialgia due to spine problem
C. IHD. Functional Class II angina
D. Myocarditis
E. Myocardial dystrophy
Answer: IHD. Unstable angina
Explanation
| The patient’s history of functional Class II angina, along with the recent onset of intense and prolonged retrosternal pains, decreased exercise tolerance, and less responsiveness to nitroglycerine, suggests an acute exacerbation of their underlying ischemic heart disease (IHD). Specifically, the symptoms are consistent with unstable angina, which is a type of acute coronary syndrome characterized by new or changing angina symptoms that occur at rest or with minimal exertion and are not relieved by nitroglycerin. Cardialgia due to spine problem, myocarditis, and myocardial dystrophy are less likely diagnoses, as they do not typically present with the characteristic symptoms of angina, such as retrosternal chest pain that is brought on by exertion and relieved by rest or nitroglycerin. Therefore, based on the information given in the question, the most probable diagnosis for the patient’s symptoms is IHD, specifically unstable angina. This is a serious condition that requires immediate medical attention and treatment to prevent further complications, such as myocardial infarction or sudden cardiac death. |
56. A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
A. Hypothiazid
B. Dibazol
C. Clonidine
D. Kapoten
E. Nifedipin
Answer: Hypothiazid
Explanation
| Hypertension can be classified into different types based on the underlying cause and pathophysiology. Hypervolemic hypertension is a type of hypertension that is caused by an increase in blood volume, often due to excess sodium intake or impaired sodium excretion by the kidneys. Treatment of hypervolemic hypertension involves reducing blood volume and managing sodium balance. Hydrochlorothiazide (HCTZ) is a diuretic medication that is commonly prescribed for the treatment of hypertension, including hypervolemic hypertension. HCTZ works by increasing the excretion of sodium and water by the kidneys, which reduces blood volume and lowers blood pressure. HCTZ can be used as monotherapy or in combination with other antihypertensive medications, depending on the patient’s individual needs and response to treatment. Dibazol, clonidine, kapoten, and nifedipine are other types of antihypertensive medications, but they are not typically used as first-line therapy for hypervolemic hypertension. Dibazol is a vasodilator medication that is sometimes used to treat hypertension, but it is less effective than other antihypertensive medications and is not commonly used in current practice. Clonidine is an alpha-agonist medication that can be effective for some types of hypertension, but it is not typically used for hypervolemic hypertension. Kapoten is an ACE inhibitor medication that is effective for some types of hypertension, but it is not typically used for hypervolemic hypertension. Nifedipine is a calcium channel blocker medication that is effective for some types of hypertension, but it is not typically used as first-line therapy for hypervolemic hypertension. Therefore, based on the information given in the question, the medication that is most appropriate for the treatment of hypervolemic hypertension is hydrochlorothiazide (HCTZ), also known as Hypothiazid. |
57. A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps – 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
A. CHF- 2 B
B. CHF- 1
C. CHF- 2 А
D. CHF- 0
E. CHF- 3
Answer: CHF- 2 B
Explanation
| The patient’s symptoms and physical examination findings suggest the presence of chronic heart failure (CHF). CHF is a condition in which the heart is unable to pump enough blood to meet the body’s needs, leading to a variety of symptoms and complications. The patient’s history of myocardial infarction, along with the symptoms of dyspnea and chest pain, suggest underlying coronary artery disease as the cause of CHF. The presence of orthopnea, acrocyanosis, swollen cervical veins, and liver enlargement are all signs of elevated venous pressure, which is a hallmark of CHF. The patient’s peripheral oxygen saturation (Ps) of 92% is lower than normal, indicating reduced oxygen delivery to the tissues. The total heart enlargement, as well as the liver enlargement of 7 cm, suggest significant cardiac remodeling and dysfunction. The presence of shin edema is also a sign of fluid overload, which is a common complication of CHF. Based on the New York Heart Association (NYHA) functional classification system, which categorizes CHF based on the degree of functional limitation, the patient’s symptoms and physical examination findings suggest that the stage of CHF is 2A. This stage is characterized by mild symptoms and slight limitation of physical activity, such as dyspnea on exertion. Therefore, based on the information given in the question, the stage of chronic heart failure (CHF) in the 62-year-old patient is most likely to be CHF- 2A. |
58. A patient, aged 49, complains of fever of 37, 5oC, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur can be auscultated. What is the most effi- cient examination for valvular disorder assessment?
A. Echocardiography+DopplerEchocardiography
B. Phonocardiography
C. Ballistocardiogram
D. Chest X-ray
E. ECG
Answer: Echocardiography+DopplerEchocardiography
Explanation
| The patient’s symptoms of fever, heart pain, dyspnea, and abnormal heart sounds on auscultation suggest the presence of a valvular disorder. The specific findings of a clapping S1, accentuated S2 in the aortic area, opening snap, and presystolic murmur are suggestive of aortic stenosis. Echocardiography with Doppler imaging is the most efficient and accurate diagnostic tool for assessing valvular disorders, including aortic stenosis. Echocardiography can provide detailed information about the structure and function of the heart and its valves, including the degree of stenosis, the size and function of the heart chambers, and the presence of any associated complications, such as regurgitation. Doppler echocardiography is a specialized type of echocardiography that uses sound waves to measure blood flow through the heart and its valves. This can help determine the severity of the valve stenosis and identify any associated regurgitation or other abnormalities. Phonocardiography and ballistocardiography are older, less commonly used diagnostic tools for assessing heart sounds and cardiac function. Chest X-ray and ECG can provide some information about the size and shape of the heart and the presence of any electrical abnormalities, but they are not as specific or sensitive as echocardiography for diagnosing valvular disorders. Therefore, based on the information given in the question, the most efficient examination for assessing the valvular disorder in the 49-year-old patient is echocardiography with Doppler imaging. |
59. A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied by collapse?
A. Septic shock
B. Exudative pleuritis
C. Bronchial obstruction
D. Toxic hepatitis
E. Emphysema
Answer: Septic shock
Explanation
| Nosocomial pneumonia is a type of pneumonia that occurs in patients who are hospitalized for other reasons. It is often caused by bacteria that are resistant to multiple antibiotics and can be associated with a high rate of complications. One of the most serious complications of pneumonia is sepsis, which can progress to septic shock. Septic shock is a life-threatening condition that occurs when sepsis causes a significant drop in blood pressure and organ dysfunction, leading to collapse and other severe symptoms. While exudative pleuritis and bronchial obstruction can also occur as complications of pneumonia, they are less likely to cause collapse than septic shock. Exudative pleuritis is inflammation of the pleural lining of the lungs, which can cause chest pain and difficulty breathing, but it is not typically associated with systemic symptoms such as collapse. Bronchial obstruction can occur if pneumonia causes inflammation and swelling of the airways, but again, this is not typically associated with collapse unless it is severe enough to cause significant respiratory distress. Toxic hepatitis and emphysema are not direct complications of pneumonia and are unlikely to cause collapse in this setting. Therefore, based on the information given in the question, the pneumonia complication that is most likely to be accompanied by collapse is septic shock. |
60. A patient, aged 48, complains of heaviness in the right hypochondrium, itching of the skin. Repeatedly he had been treated in infectious diseases hospital because of icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall veins, protruding navel, spleen enlargement. Diagnosis is:
A. Liver cirrhosis
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
Answer: Liver cirrhosis
Explanation
| The patient’s symptoms of heaviness in the right hypochondrium, itching of the skin, icterus, and a history of multiple hospitalizations for these symptoms are suggestive of chronic liver disease. The presence of meteorism, ascites, dilation of abdominal wall veins, protruding navel, and spleen enlargement are all signs of advanced liver disease. Liver cirrhosis is a chronic liver disease characterized by progressive fibrosis and scarring of the liver tissue, which can lead to impaired liver function and a variety of complications, including ascites, portal hypertension, and spleen enlargement. Cancer of the liver and cancer of the head of pancreas can also cause similar symptoms and physical examination findings, but they are less likely in this case because the patient’s symptoms and history suggest a chronic liver disease, rather than a recent onset of symptoms. Gallstones can cause symptoms of right upper quadrant pain and nausea, but they are not typically associated with advanced liver disease and the presence of ascites, portal hypertension, and spleen enlargement. Viral hepatitis B can cause acute or chronic liver inflammation, but it is less likely in this case because the patient’s symptoms and physical examination findings suggest a more advanced and chronic liver disease. Therefore, based on the information given in the question, the most likely diagnosis for the patient’s symptoms and physical examination findings is liver cirrhosis. |
61. A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
A. Gastritis of type B
B. Gastritis of type A
C. Reflux-gastritis
D. Menetrier’s gastritis
E. Rigid antral gastritis
Answer: Gastritis of type B
Explanation
| The patient’s symptoms of epigastric pain that are relieved by food intake, along with the findings of antral erosive gastritis and biopsy showing Helicobacter pylori, are suggestive of gastritis of type B. Gastritis of type B, also known as H. pylori-associated gastritis, is a type of chronic gastritis that is caused by infection with the bacterium Helicobacter pylori. This type of gastritis typically affects the antral region of the stomach and can cause erosive changes in the mucosa, along with symptoms of epigastric pain, nausea, and bloating. The pain is often relieved by food intake because the presence of food in the stomach can help buffer the acid and reduce inflammation. Gastritis of type A, also known as autoimmune gastritis, is a less common type of chronic gastritis that is caused by an autoimmune reaction against the parietal cells of the stomach. This type of gastritis typically affects the body of the stomach and can cause anemia and other complications. Reflux gastritis is a type of gastritis that is caused by the reflux of stomach acid into the esophagus, often due to a weak or dysfunctional lower esophageal sphincter. This type of gastritis can cause symptoms of heartburn, regurgitation, and chest pain. Menetrier’s gastritis is a rare type of chronic gastritis that is characterized by hypertrophy of the gastric mucosa, resulting in thickened rugae and reduced acid secretion. This type of gastritis can cause symptoms of abdominal pain, nausea, and diarrhea. Rigid antral gastritis is not a recognized medical term or condition. Therefore, based on the information given in the question, the diagnosis for the 27-year-old patient with epigastric pain, antral erosive gastritis, and Helicobacter pylori infection is most likely gastritis of type B. |
62. A 62 year old patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. The patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be chosen?
A. Prescribe fast-acting insulin
B. Give Glurenorm instead of Maninilum
C. Continue with the current therapy
D. Prescribe long-acting insulin
E. Prescribe guanyl guanidines
Answer: Prescribe fast-acting insulin
Explanation
| The patient’s age, diagnosis of type 2 diabetes mellitus, and current treatment with diet and Maninilum suggest that the patient has mild to moderate diabetes. However, the stress of surgery can cause changes in blood glucose levels and increase the risk of hypoglycemia or hyperglycemia. In this case, it is recommended to switch from oral hypoglycemic agents to insulin therapy during the perioperative period to achieve better glycemic control. Fast-acting insulin, such as regular insulin, can be used to achieve tight glycemic control during the perioperative period. This type of insulin is effective in controlling postprandial hyperglycemia and can be given before meals to help prevent postprandial spikes in blood glucose levels. Glurenorm and Maninilum are both oral hypoglycemic agents that stimulate insulin secretion from pancreatic beta cells. However, they may not be as effective in controlling blood glucose levels during the perioperative period, when the stress response can cause insulin resistance and hyperglycemia. Continuing with the current therapy of diet and Maninilum may not be sufficient to achieve tight glycemic control during the perioperative period. Long-acting insulin, such as basal insulin, may be useful for maintaining glycemic control in patients with diabetes, but it may not be effective in controlling postprandial hyperglycemia during the perioperative period. Guanyl guanidines, such as metformin, are oral hypoglycemic agents that reduce hepatic glucose production and improve insulin sensitivity. However, they may not be appropriate for use during the perioperative period, when the risk of hypoglycemia may be increased. Therefore, based on the information given in the question, the most appropriate tactic for hypoglycemic therapy during the perioperative period for the 62-year-old patient with type 2 diabetes and an inguinal hernia is to prescribe fast-acting insulin. |
63. Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?
A. Focal
B. Disseminated
C. Miliary
D. Fibro-cavernous
E. Tuberculoma
Answer: Focal
Explanation
| The presence of focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung on prophylactic photoroentgenography examination in a 25-year-old man suggests a localized or focal form of lung disease. Focal lung disease refers to a localized area of lung pathology that can be seen on imaging studies such as chest X-ray or CT scan. This can include conditions such as pneumonia, lung abscess, or a solitary pulmonary nodule. Disseminated lung disease refers to multiple areas of lung pathology that are widely distributed throughout the lung tissue. This can include conditions such as metastatic cancer or disseminated tuberculosis. Miliary lung disease refers to the presence of multiple small nodules throughout the lung tissue, which can be seen on imaging studies as a “miliary” pattern. This can be caused by conditions such as tuberculosis, fungal infections, or metastatic cancer. Fibro-cavitary lung disease refers to the presence of multiple cavities or cysts in the lung tissue, which can be seen on imaging studies as irregularly shaped areas of low density surrounded by thickened or fibrotic tissue. This can be caused by conditions such as tuberculosis, fungal infections, or certain types of lung cancer. Tuberculoma refers to a localized area of granulomatous inflammation in the lung tissue caused by tuberculosis. This can be seen on imaging studies as a well-defined nodule or mass. Therefore, based on the information given in the question, the clinical form that can be suspected in the 25-year-old man with focal shadowings in the 1st and 2nd segments of the right lung on prophylactic photoroentgenography examination is focal lung disease. |
64. A triad of symptoms (“stearing spot”, “terminal film”, “blood dew”) has been revealed on examination of a patient. What disease should you think about?
A. Psoriasis
B. Lichen ruber planus
C. Vasculitis
D. Seborrhea
E. Ritter’s disease
Answer: Psoriasis
Explanation
| The triad of symptoms described, including “stearing spot,” “terminal film,” and “blood dew,” is often associated with psoriasis. The “stearing spot” refers to a small area of scaling and erythema that occurs in the early stages of psoriasis. The “terminal film” refers to the characteristic silvery-white scale that develops on top of the erythematous plaques of psoriasis. The “blood dew” refers to the appearance of small droplets of blood that can be seen on the surface of the plaques when the scale is removed. Psoriasis is a chronic skin condition that is characterized by erythematous plaques with silvery-white scales, usually on the extensor surfaces of the body. The condition can be associated with a range of symptoms, including itching, burning, and pain. Lichen ruber planus is a chronic inflammatory skin condition that is characterized by pruritic, polygonal, flat-topped papules with a violaceous color. Vasculitis is a condition that involves inflammation of the blood vessels, which can cause a range of symptoms depending on the location and severity of the inflammation. Seborrhea is a common skin condition that is characterized by oily, flaky skin, usually on the scalp, face, and chest. Ritter’s disease, also known as staphylococcal scalded skin syndrome, is a rare bacterial skin infection that is characterized by widespread blistering and peeling of the skin. Therefore, based on the information given in the question, the triad of symptoms described is most suggestive of psoriasis. |
65. A female 28 years old patient became depressed, her mood is melancholic; this state is accompanied by hypobulia, hypokinesia, slow speed of thinking. Her attitude towards her past, present and future is pessimistic. The pathogenetic mechanism of this state is supposed to involve dysfunction in the:
A. Hypothalamus
B. Frontal lobes
C. Pituitary
D. Hippocampus
E. Corpus callosum
Answer: Hypothalamus
Explanation
| The patient’s symptoms of depression, including a melancholic mood, hypobulia (reduced motivation), hypokinesia (reduced movement), and slow thinking, suggest a dysfunction in the hypothalamus. The hypothalamus is a region of the brain that plays a key role in regulating a range of physiological and behavioral processes, including mood and motivation. Dysfunction in the hypothalamus can disrupt the balance of neurotransmitters and hormones that regulate these processes, leading to symptoms of depression. The frontal lobes of the brain are involved in a range of cognitive processes, including decision-making and planning, but are not typically implicated in the pathogenesis of depression. The pituitary gland is a small gland located in the brain that plays a key role in regulating a range of hormonal processes, but is not typically implicated in the pathogenesis of depression. The hippocampus is a region of the brain that plays a key role in memory formation and emotional regulation, but is typically more closely associated with anxiety disorders than with depression. The corpus callosum is a large bundle of nerve fibers that connects the two hemispheres of the brain, but is not typically implicated in the pathogenesis of depression. Therefore, based on the information given in the question, the most likely dysfunction that is involved in the pathogenesis of the patient’s depression is the hypothalamus. |
66. The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stays in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:
A. Catatonic stupor, schizophrenia
B. Depressive stupor, bipolar disorder
C. Apathetic stupor, schizophrenia
D. Psychogenic stupor, stress disorder
E. Dissociative stupor, dissociative psychosis
Answer: Catatonic stupor, schizophrenia
Explanation
| The patient’s symptoms of retarded movements, lack of response to questions, and spontaneous adoption of strange postures suggest a catatonic stupor, which is a type of catatonic schizophrenia. Catatonic stupor is a type of schizophrenia in which the patient experiences a profound decrease in motor activity and responsiveness to external stimuli. The patient may adopt unusual postures, resist attempts to move them, or remain immobile for long periods of time. The patient may also display waxy flexibility, in which the limbs can be manipulated and held in unusual positions for extended periods without any resistance. Depressive stupor is a severe form of depression in which the patient experiences a profound decrease in motor activity and responsiveness to external stimuli, but there is typically no waxy flexibility or other catatonic features. Apathetic stupor is a state of reduced responsiveness and lack of interest or motivation, which can occur in a range of psychiatric and neurological conditions. Psychogenic stupor is a type of conversion disorder in which the patient experiences a sudden loss of voluntary movement and responsiveness, which cannot be explained by physical or neurological causes. Dissociative stupor is a type of dissociative disorder in which the patient experiences a sudden loss of consciousness or awareness, often in response to severe stress or trauma. Therefore, based on the information given in the question, the probable disorder that the patient is experiencing is catatonic stupor, which is a type of catatonic schizophrenia. |
67. A 50 year old patient has been admitted to the clinics with atrophic gastritis. Blood count: erythrocytes – 3, 8 · 1012/l, Hb – 68 g/l, c.i. – 1, macroanisocytosis, poikilocytosis. There is megaloblastic type of haemopoesis. A number of leukocytes, reticulocytes and thrombocytes is lreduced. Which pathology is suspected?
A. B12-deficiency anemia
B. Irondeficiency anemia
C. Hemolytic anemia
D. Post-hemorrhagic anemia
E. Thalassaemia
Answer: B12-deficiency anemia
Explanation
| The patient’s blood count shows a number of abnormalities that are consistent with B12-deficiency anemia. These include a low hemoglobin level, macrocytic anemia with megaloblastic type of hematopoiesis, poikilocytosis, and macro anisocytosis. In addition, the patient’s leukocyte, reticulocyte, and thrombocyte counts are reduced. B12-deficiency anemia can occur as a result of atrophic gastritis, which can lead to impaired absorption of vitamin B12 from the diet. Vitamin B12 is necessary for the production of red blood cells, and a deficiency can lead to impaired hematopoiesis and the development of anemia. Iron deficiency anemia is another common type of anemia, but it is typically characterized by microcytic anemia and hypochromia, rather than macrocytic anemia. Hemolytic anemia is a type of anemia that occurs as a result of the destruction of red blood cells, which can be caused by a range of factors, including autoimmune disorders, infections, or genetic conditions. Post-hemorrhagic anemia occurs as a result of blood loss, and is typically characterized by a low hemoglobin level and a reduced red blood cell count. Thalassemia is a genetic condition that affects the production of hemoglobin, leading to a range of symptoms, including anemia, but the blood count findings described in the question are not consistent with this diagnosis. Therefore, based on the information given in the question, the most likely diagnosis for the patient’s anemia is B12-deficiency anemia. |
68. A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39, 0oC, headache, weakness, constipation on the 9th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?
A. Typhoid fever
B. Leptospirosis
C. Brucellosis
D. Sepsis
E. Malaria
Answer: Typhoid fever
Explanation
| The symptoms described, including a high fever, headache, weakness, constipation, and roseola on the skin, are classic signs of typhoid fever, which is caused by the bacterium Salmonella typhi. The pulse rate of 78 bpm is within the normal range, but the enlargement of the liver by 2 cm suggests that the patient may be experiencing some degree of hepatic involvement, which is a common complication of typhoid fever. Leptospirosis is a bacterial infection that is typically characterized by fever, muscle pain, and conjunctivitis, but is not typically associated with roseola or hepatic involvement. Brucellosis is a bacterial infection that is typically characterized by fever, joint pain, and fatigue, but is not typically associated with roseola or constipation. Sepsis is a potentially life-threatening condition that occurs as a result of a systemic infection, and is typically characterized by fever, rapid heart rate, and low blood pressure. Malaria is a parasitic infection that is typically characterized by fever, chills, and headache, but is not typically associated with roseola or constipation. Therefore, based on the information given in the question, the most probable diagnosis for the patient’s symptoms is typhoid fever. |
69. A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease.The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?
A. Hepatic encephlopathy
B. Meningitis
C. Relapse of viral hepatitis
D. Cholangitis
E. Infectious-toxic shock
Answer: Hepatic encephlopathy
Explanation
| The patient’s symptoms, including nausea, vomiting, dark urine, acholic stools, and jaundice, are consistent with viral hepatitis. The protrusion of the liver and subsequent diminution in size suggest that the patient is experiencing some degree of liver damage or inflammation. Hepatic encephalopathy is a serious complication of liver disease that can occur as a result of impaired liver function. It is characterized by a range of neurological symptoms, including confusion, disorientation, and cognitive impairment. In severe cases, it can progress to seizures, coma, and even death. Meningitis is a condition characterized by inflammation of the protective membranes that surround the brain and spinal cord, and is typically characterized by symptoms such as headache, fever, and stiff neck. Relapse of viral hepatitis is a recurrence of the symptoms of the disease after a period of improvement or resolution, and is typically characterized by a recurrence of jaundice, fatigue, and other symptoms. Cholangitis is a condition characterized by inflammation of the bile ducts, and is typically characterized by symptoms such as abdominal pain, fever, and jaundice. Infectious-toxic shock is a potentially life-threatening condition that can occur as a result of a severe infection, and is typically characterized by symptoms such as fever, low blood pressure, and organ dysfunction. Therefore, based on the information given in the question, the most likely complication of viral hepatitis causing the deterioration of the patient’s condition is hepatic encephalopathy. |
70. An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen – by 1 cm. In blood: leukocytosis, atypical lymphocytes – 15%. What is the most probable diagnosis?
A. Infectious mononucleosis
B. Acute lymphoid leukosis
C. Diphtheria
D. Angina
E. Adenoviral infection
Answer: Infectious mononucleosis
Explanation
| The symptoms described, including headache, weakness, high temperature, sore throat, and enlargement of lymph nodes, liver, and spleen, are consistent with the diagnosis of infectious mononucleosis. The presence of atypical lymphocytes in the blood is also a common finding in this condition. Acute lymphoid leukemia is a type of cancer that affects the white blood cells, and is typically characterized by symptoms such as fatigue, easy bruising or bleeding, and recurrent infections. The presence of atypical lymphocytes in the blood is not specific for leukemia, and can also be seen in other conditions. Diphtheria is a bacterial infection that can cause symptoms such as sore throat, fever, and enlargement of lymph nodes, but is typically characterized by the formation of a thick, grayish coating on the back of the throat. Angina, or tonsillitis, is a common infection that can cause symptoms such as sore throat, fever, and enlargement of lymph nodes, but typically does not cause enlargement of the liver and spleen. Adenoviral infection is a type of viral infection that can cause symptoms such as sore throat, fever, and enlargement of lymph nodes, but typically does not cause enlargement of the liver and spleen. Therefore, based on the information given in the question, the most probable diagnosis for the patient’s symptoms is infectious mononucleosis. |
71. A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:
A. Carcinoma of the head of the pancreas
B. Infectious hepatitis
C. Haemolytic jaundice
D. Malignant biliary stricture
E. Metastatic disease of liver
Answer: Carcinoma of the head of the pancreas
Explanation
| The patient’s age, history of diabetes, and presentation with jaundice and weight loss are all suggestive of pancreatic cancer. The presence of a hard, globular mass in the right upper quadrant that moves during respiration is also consistent with this diagnosis. Infectious hepatitis and hemolytic jaundice are conditions that can cause jaundice, but are not typically associated with the development of a visible mass in the abdomen. Malignant biliary stricture is a condition in which a tumor obstructs the bile ducts, causing jaundice and other symptoms. However, the presence of a visible mass in the abdomen suggests that the tumor is located in the pancreas, rather than in the bile ducts. Metastatic disease of the liver can cause jaundice, but would typically present with multiple filling defects on imaging studies, rather than with a single mass. Therefore, based on the information given in the question, the most likely diagnosis for the patient’s symptoms is carcinoma of the head of the pancreas. |
72. A 33 year old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP – 60/30 mm Hg, Ps – 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb – 80 g/l, red blood cell count – 2, 5 · 1012/l. The reduction of blood volume averages:
A. 30-40%
B. 10-15%
C. 15-20%
D. 20-25%
E. 25-30%
Answer: 30-40%
Explanation
| The patient presents with signs of cardiovascular collapse, including low blood pressure, high heart rate, pale and moist skin, low urine output, and low hemoglobin and red blood cell count. These symptoms suggest a significant loss of blood volume, which could be due to acute hemorrhage or other causes. A reduction of blood volume of 30-40% is considered a severe loss, which can lead to shock and organ failure. The symptoms described in the question are consistent with this level of blood loss. Reductions of blood volume of 10-15%, 15-20%, 20-25%, or 25-30% are considered moderate to severe losses, but may not necessarily lead to cardiovascular collapse and shock. Therefore, based on the information given in the question, the most likely range for the reduction of blood volume in the patient is 30-40%. |
73. A 19 year old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:
A. Controlled respiration
B. Gastric lavage
C. Oxygen inhalation
D. Caffeine injection
E. Cordiamine injection
Answer: Controlled respiration
Explanation
| The patient is presenting with unconsciousness, cyanosis, myotic pupils, and a low respiratory rate, which suggests respiratory depression. The low blood pressure and heart rate may also be a result of inadequate oxygenation. Controlled respiration, also known as assisted ventilation, involves providing respiratory support to the patient using a bag-valve-mask device or a mechanical ventilator. This will help to improve oxygenation and prevent further deterioration of the patient’s condition. Gastric lavage, caffeine injection, and cordiamine injection are not appropriate interventions for this patient, as they do not address the underlying respiratory distress and may even be harmful in this situation. Oxygen inhalation is important for the patient’s treatment, but controlled respiration should be initiated first to ensure proper oxygenation. Therefore, based on the information given in the question, the immediate action necessary in this clinical situation is controlled respiration. |
74. A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:
A. SGOT (ALT)
B. Sedimentation rates
C. WBCs
D. Alkaline phosphatase
E. BUN
Answer: SGOT (ALT)
Explanation
| Hepatitis refers to inflammation of the liver, which can be caused by viral infections, drug toxicity, or other factors. In pregnant women, hepatitis can have serious consequences for both the mother and the baby. The diagnosis of hepatitis is typically made by assessing liver function tests, which include measurements of serum levels of various enzymes and proteins produced by the liver. One of the most important of these enzymes is serum glutamic-oxaloacetic transaminase (SGOT), also known as alanine aminotransferase (ALT), which is typically elevated in cases of liver inflammation or injury. Sedimentation rates, WBCs, alkaline phosphatase, and BUN are not specific markers for hepatitis, and may be elevated in a variety of other conditions. Therefore, based on the information given in the question, the presence of elevated SGOT (ALT) levels would be an important diagnostic criterion for hepatitis in a pregnant woman. |
75. An endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage:
A. IIIA
B. IC
C. IIA
D. IIB
E. IV AB
Answer: IIIA
Explanation
| Endometrial adenocarcinoma is a type of cancer that affects the lining of the uterus. The stage of the cancer is determined based on the extent of its spread within the uterus and to other parts of the body. In the TNM staging system, which is commonly used for endometrial cancer, T refers to the size and extent of the primary tumor, N refers to the involvement of nearby lymph nodes, and M refers to the presence of distant metastases. In the FIGO staging system, which is another commonly used system for endometrial cancer, stage IIIA is defined as cancer that has spread from the uterus to the serosa, which is the outermost layer of the uterus, but has not spread to the pelvic sidewall or beyond. Stages IC, IIA, and IIB refer to cancers that are confined to the uterus, but have different degrees of invasion into the muscle layer or involvement of the cervix. Stage IV refers to cancers that have spread beyond the uterus to other parts of the body. Therefore, based on the information given in the question, an endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage IIIA. |
76. A 56 year old woman has an acute onset of fever up to 39oC with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR – 90/min, BP- 95/60 mm Hg, RR26/min. There is dullness over the right lung on percussion. On X-ray: infiltrate in the right middle lobe of the lung. What is the diagnosis?
A. Community-acquired lobar pneumonia of moderate severity
B. Community-acquired bronchopneumonia
C. Acute pleuritis
D. Acute lung abscess
E. Nosocomial lobar pneumonia
Answer: Community-acquired lobar pneumonia of moderate severity
Explanation
| The patient presents with fever, chills, cough, and pain on respiration in the right side of her chest, which are typical symptoms of pneumonia. The dullness over the right lung on percussion and the infiltrate in the right middle lobe of the lung seen on X-ray are also consistent with this diagnosis. Community-acquired lobar pneumonia is caused by bacterial infection, typically Streptococcus pneumoniae, and is characterized by the consolidation of an entire lobe of the lung. Bronchopneumonia, on the other hand, is a more diffuse infection involving multiple areas of the lung, which can be caused by a variety of bacterial and viral pathogens. Acute pleuritis is inflammation of the pleura, the membrane that covers the lungs, and can cause chest pain and difficulty breathing, but is not typically associated with fever or lung consolidation. Acute lung abscess is a localized collection of pus in the lung, which can cause symptoms similar to pneumonia, but is typically associated with a history of aspiration or other factors that predispose to infection. Nosocomial lobar pneumonia is a type of pneumonia that is acquired in a hospital or healthcare setting, typically caused by antibiotic-resistant bacteria, and is not likely the cause of the patient’s symptoms given the presentation described. Therefore, based on the information given in the question, the most likely diagnosis for the patient’s symptoms is community-acquired lobar pneumonia of moderate severity. |
77. A 26 year old man was admitted to the hospital because of stabbing back pain on inspiration and dyspnea. Examination results: BT of 37oC, Ps of 24/min, HR of 92/min, vesicular breath sounds. There is a dry, grating, low-pitched sound heard on both expiration and inspiration in the left inferior lateral part of the chest. What is the most likely diagnosis?
A. Acute fibrinous pleuritis
B. Myocarditis
C. Pneumonia
D. Acute bronchitis
E. Pneumothorax
Answer: Acute fibrinous pleuritis
Explanation
| The patient presents with stabbing back pain on inspiration and dyspnea, which are typical symptoms of pleuritic chest pain. The dry, grating, low-pitched sound heard on both expiration and inspiration in the left inferior lateral part of the chest, known as a pleural friction rub, is also consistent with pleuritis. Acute fibrinous pleuritis is a form of pleurisy in which there is inflammation and fibrin deposition on the pleural surfaces, which can cause pleural friction rub and chest pain. It can be caused by a variety of factors, including viral or bacterial infections, autoimmune disorders, or trauma. Myocarditis is inflammation of the heart muscle, which can cause chest pain, dyspnea, and other symptoms, but is not typically associated with pleural friction rub or vesicular breath sounds. Pneumonia is an infection of the lung tissue, which can cause chest pain, dyspnea, and abnormal breath sounds, but is typically associated with consolidation and other changes on chest X-ray or imaging studies, which are not described in this case. Acute bronchitis is inflammation of the bronchial tubes, which can cause cough, dyspnea, and wheezing, but is not typically associated with pleuritic chest pain or pleural friction rub. Pneumothorax is the presence of air in the pleural space, which can cause dyspnea and abnormal breath sounds, but is typically associated with decreased or absent breath sounds on the affected side, rather than vesicular breath sounds. Therefore, based on the information given in the question, the most likely diagnosis for the patient’s symptoms is acute fibrinous pleuritis. |
78. A 34 year old woman fell ill 3 months ago after cold exposure. She complained of pain in her hand and knee joints, morning stiffness and fever up to 38oC. Interphalangeal, metacarpophalangeal and knee joints are swollen, hot, with reduced ranges of motions; ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would you recommend the patient?
A. Nonsteroidal anti-inflammatory drugs
B. Cephalosporines
C. Tetracyclines
D. Sulfonamides
E. Fluorchinolones
Answer: Nonsteroidal anti-inflammatory drug
Explanation
| The patient’s symptoms, including joint pain, morning stiffness, fever, and swelling with reduced ranges of motion, are consistent with a diagnosis of rheumatoid arthritis (RA). The positive Vaaler-Rouse test, elevated ESR, and high CRP levels also support this diagnosis. NSAIDs are a first-line treatment for RA and are effective in reducing pain, inflammation, and stiffness. They work by inhibiting the production of prostaglandins, which are responsible for causing pain and inflammation. Cephalosporins, tetracyclines, sulfonamides, and fluoroquinolones are antibiotics and are not appropriate for the treatment of RA. While some antibiotics have been used in the treatment of RA, their use is generally limited to cases where there is evidence of bacterial infection, rather than as a first-line treatment. Therefore, based on the information given in the question, the most appropriate group of medicines to recommend for this patient is NSAIDs. However, it is important to note that the management of RA typically involves a multidisciplinary approach, including the use of disease-modifying antirheumatic drugs (DMARDs), physical therapy, and lifestyle modifications. The patient should be referred to a rheumatologist for further evaluation and management. |
79. A 50 year old woman complained of attacks of right subcostal pain after fatty meal she has been suffering from for a year. Last week the attacks repeated every day and became more painful. What diagnostic study would you recommend?
A. Ultrasound examination of the gallbladder
B. Liver function tests
C. X-ray examination of the gastrointestinal tract
D. Ultrasound study of the pancreas
E. Blood cell count
Answer: Ultrasound examination of the gallbladder
Explanation
| The patient’s symptoms, including attacks of right subcostal pain after a fatty meal that have been ongoing for a year and have recently become more frequent and severe, are consistent with a diagnosis of cholecystitis, which is inflammation of the gallbladder. The pain is typically caused by the contraction of the gallbladder in response to a fatty meal, which can cause the obstruction of the cystic duct and lead to inflammation. Ultrasound examination of the gallbladder is a non-invasive and cost-effective imaging study that is widely used for the diagnosis of cholecystitis. It can reveal the presence of gallstones, thickening of the gallbladder wall, and fluid accumulation in the gallbladder, which are all suggestive of cholecystitis. Liver function tests, X-ray examination of the gastrointestinal tract, ultrasound study of the pancreas, and blood cell count may be useful in certain contexts, but are not indicated as the initial diagnostic study for a patient with suspected cholecystitis. Therefore, based on the information given in the question, the most appropriate diagnostic study to recommend for this patient is ultrasound examination of the gallbladder. |
80. A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?
A. Penicillin OS
B. Heparin
C. Ceftriaxone
D. Dipyridamole
E. Ciprofloxacine
Answer: Penicillin OS
Explanation
| Based on the symptoms and urinalysis data provided, the most likely diagnosis for this woman is acute glomerulonephritis, which is an inflammation of the kidneys caused by an immune response to a recent infection. The presence of protein in the urine, high blood pressure, and edema are all common symptoms of this condition. The treatment for acute glomerulonephritis typically involves supportive care to manage symptoms, such as controlling blood pressure and reducing fluid retention. Antibiotics are not usually indicated unless there is an active infection present, which is not suggested in this case. Therefore, the correct option among the given choices is none of them. However, if there was an active infection present, such as streptococcal infection, then penicillin could be used to treat the infection and prevent further damage to the kidneys. But in this case, the use of penicillin is not indicated for the treatment of acute glomerulonephritis. It is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan. |
81. A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?
A. Chronic mercury intoxication
B. Neuroinfection
C. Parkinson syndrome
D. Acute mercury intoxication
E. Mercury encephalopathy
Answer: Chronic mercury intoxication
Explanation
| The most probable diagnosis in this case is chronic mercury intoxication. The patient’s occupational exposure to high concentrations of mercury fumes for 16 years, along with the presence of physical symptoms such as hand tremor, unstable pulse and blood pressure, asymmetric innervations of facial muscles and tongue, and positive subcortical reflexes, are all consistent with chronic mercury toxicity. Mercury is a toxic metal that can accumulate in the body over time, leading to a range of symptoms including neurological and psychological effects. The patient’s dental problems, including paradontosis and chronic stomatitis, could also be related to mercury exposure, as exposure to mercury vapors can cause damage to the teeth and gums. Neuroinfection and Parkinson’s syndrome are less likely in this case, as the patient’s symptoms are more consistent with chronic mercury toxicity. Acute mercury intoxication could also be a possibility, but the fact that the patient has been exposed to high concentrations of mercury fumes for 16 years suggests that this is a chronic condition. Mercury encephalopathy is a rare condition that can occur as a result of acute mercury exposure, and is characterized by symptoms such as tremors, ataxia, and cognitive impairment. However, in this case, the patient’s symptoms are more consistent with chronic mercury toxicity. It is important that the patient receives medical attention and a thorough evaluation to confirm the diagnosis and determine the appropriate treatment plan. |
82. A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical examination reveals tachypnea, bilateral inspiratory crackles and single expiratory wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no history of fever. White blood cell count is 15 · 109/l, with 28% of eosinophils. The most likely cause of this child’s symptoms is:
A. Clamydia trachomanis
B. Pneumocystis carinii
C. Mycoplasma pneumoniae
D. Visceral larva migrans
E. Varicella
Answer: Clamydia trachomanis
Explanation
| The most likely cause of the child’s symptoms is Chlamydia trachomatis infection. The presence of tachypnea, bilateral inspiratory crackles, and single expiratory wheezing along with bilateral pneumonia on chest X-ray, is highly suggestive of a respiratory tract infection. Chlamydia trachomatis is a common cause of respiratory tract infections in infants, particularly those between 1 and 3 months of age. The onset of conjunctivitis on the third day of life and lasting for about 2 weeks is also suggestive of chlamydial infection, as conjunctivitis is a common symptom of this infection in neonates. The elevated white blood cell count with 28% eosinophils is also consistent with a chlamydial infection, as eosinophilia is a common finding in this condition. Pneumocystis carinii, Mycoplasma pneumoniae, and Varicella are less likely in this case, as they are not common causes of respiratory tract infections in infants. Visceral larva migrans is also less likely, as it is a condition caused by the migration of parasitic larvae through the body and is not typically associated with respiratory symptoms. It is important that the child receives prompt medical attention and appropriate treatment for the chlamydial infection to prevent complications and reduce the risk of transmission to others. |
83. A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. Mitral stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
E. Aortic stenosis
Answer: Mitral stenosis
Explanation
| The most likely cause of heart failure in this case is mitral stenosis. The patient’s symptoms of dyspnea, edema of the legs, and tachycardia during minor physical exertion, along with the physical examination findings of leftward displacement of the heart borders, accentuated S1, and diastolic murmur on the apex, are all consistent with mitral stenosis. Mitral stenosis is a condition in which the mitral valve becomes narrowed, leading to decreased blood flow from the left atrium to the left ventricle, and eventually causing heart failure. The enlargement of the liver by 5 cm is also consistent with the diagnosis of mitral stenosis, as liver enlargement is a common finding in patients with chronic heart failure. Mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, and aortic stenosis are all less likely in this case, as they typically present with different symptoms and physical examination findings. Mitral regurgitation, for example, is characterized by a systolic murmur and a displaced apex beat, while tricuspid stenosis and regurgitation are associated with right-sided heart failure and may present with symptoms such as ascites and hepatomegaly. Aortic stenosis is also less likely, as it typically presents with symptoms such as chest pain and syncope, and physical examination findings such as a systolic ejection murmur and a weak or absent S2. It is important that the patient receives prompt medical attention and appropriate treatment for mitral stenosis to prevent complications and improve quality of life. |
84. A 60 year old man complains of fever, significant weight loss, bone and joint pain, bleeding gums. Examination revealed paleness, lymphadenopathy, hepato- and splenomegaly. CBC: WBC – 270 · 109/l with 13% lymphocytes, 1% monocytes, 21% basophiles, 29% neutrophils, 9% blasts, 12% promyelocytes, 12% myelocytes, 2% metamyelocytes, 1% eosinophils. ESR – 22 mm/h. Name the drug for treatment:
A. Myelosan
B. Prednisolone
C. Cytosar
D. Vinblastine
E. Blood transfusion
Answer: Myelosan
Explanation
| The most appropriate treatment for this patient would be chemotherapy with a drug such as Myelosan (also known as hydroxyurea). The patient’s symptoms and laboratory findings are consistent with a diagnosis of chronic myeloid leukemia (CML), a type of cancer that affects the white blood cells in the bone marrow. The patient’s symptoms of fever, significant weight loss, bone and joint pain, and bleeding gums are all common in CML. The laboratory findings of leukocytosis with a leftward shift, anemia, and thrombocytopenia are also consistent with the diagnosis of CML. Chemotherapy with Myelosan is the standard treatment for CML, as it works by inhibiting the growth and division of cancer cells in the bone marrow. Other chemotherapy drugs such as Cytosar (cytarabine) and Vinblastine may also be used in some cases. Prednisolone may be used in the treatment of some types of leukemia, but it is not typically used as a first-line treatment for CML. Blood transfusion may be necessary to manage symptoms such as anemia or thrombocytopenia, but it is not a primary treatment for CML. It is important that the patient receives prompt and appropriate treatment for CML to prevent complications and improve outcomes. |
85. A 54 year old woman complains of increasing fatigue and easy bruising of 3 weeks’ duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. Blood count: RBC- 2, 5 · 1012/l; Hb – 73 g/l; Ht – 20%; PLT- 23 · 109/l; and WBC162 · 109/l with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?
A. Acute leukemia
B. Chronic leukemia
C. Thrombocytopenia
D. Hemolytic anemia
E. Megaloblastic anemia
Answer: Acute leukemia
Explanation
| The most probable diagnosis in this case is acute leukemia, specifically acute myeloid leukemia (AML). The patient’s symptoms of increasing fatigue, easy bruising, and scattered ecchymoses and petechiae, along with the laboratory findings of severe anemia, thrombocytopenia, and leukocytosis with 82% blasts, are all consistent with AML. The presence of Auric rods and a positive peroxidase stain in the blasts are also suggestive of AML. Hepatosplenomegaly is a common finding in patients with AML, as the disease can cause the accumulation of leukemia cells in these organs. Chronic leukemia, thrombocytopenia, hemolytic anemia, and megaloblastic anemia are less likely in this case, as they typically present with different symptoms and laboratory findings. Chronic leukemia, for example, is characterized by a more gradual onset of symptoms and a higher percentage of mature cells in the blood. Thrombocytopenia is a condition characterized by low platelet counts, but it is not typically associated with anemia or leukocytosis. Hemolytic anemia is a condition in which the body destroys red blood cells, leading to anemia, but it does not typically cause thrombocytopenia or leukocytosis. Megaloblastic anemia is a type of anemia caused by a deficiency of vitamin B12 or folic acid, and is typically associated with macrocytic red blood cells, which are not present in this case. It is important that the patient receives prompt and appropriate treatment for AML to prevent complications and improve outcomes. Treatment typically involves chemotherapy and may also include a bone marrow transplant in some cases. |
86. The highest risk of congenital anomalies probably occurs when human embryos or fetuses are exposed to ionizing radiation. At what stage of gestational period does it occur?
A. 18-45 days after conception
B. The first 7 days
C. 10-14 days after conception
D. 90-120 days after conception
E. The third trimester
Answer: 18-45 days after conception
Explanation
| The highest risk of congenital anomalies due to exposure to ionizing radiation occurs during the period of organogenesis, which is approximately 18-45 days after conception. During this period, the major organs and structures of the developing embryo are forming, and are therefore most vulnerable to damage from exposure to ionizing radiation. Exposure to ionizing radiation during this critical period can result in a variety of congenital anomalies, depending on the timing and dose of exposure. These may include structural abnormalities of the brain, heart, limbs, and other organs, as well as intellectual disability and an increased risk of cancer later in life. Exposure to ionizing radiation during the first 7 days after conception is unlikely to cause congenital anomalies, as the embryo is still in the process of implantation and has not yet begun to form the major organs. Similarly, exposure during the third trimester is less likely to cause congenital anomalies, as the major organs have already developed and the fetus is primarily growing and maturing. Exposure to ionizing radiation during the period of organogenesis can be particularly harmful, and precautions should be taken to minimize exposure during this time. Pregnant women should avoid unnecessary exposure to radiation, and medical procedures that involve radiation should be avoided or minimized whenever possible. |
87. A 28 year old woman was admitted to the emergency room with a slightly reddened, painful “knot”8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. The most likely diagnosis is:
A. Superficial venous thrombosis
B. Early deep vein thrombosis
C. Insect bite
D. Cellulitis
E. Subcutaneous hematoma
Answer: Superficial venous thrombosis
Explanation
| The most likely diagnosis in this case is superficial venous thrombosis. The patient’s symptoms of a painful “knot” above the medial malleolus, along with the presence of a distended vein above and below the mass, are consistent with superficial venous thrombosis. Superficial venous thrombosis is a condition in which a blood clot forms in a vein close to the surface of the skin. It is typically characterized by redness, swelling, and pain in the affected area, and may be associated with a palpable cord-like vein. Early deep vein thrombosis (DVT) is less likely in this case, as it typically presents with different symptoms and physical examination findings. DVT is a condition in which a blood clot forms in a deep vein, typically in the legs or pelvis. Symptoms of DVT may include swelling, pain, and warmth in the affected area, but a palpable cord-like vein is typically not present. Insect bite, cellulitis, and subcutaneous hematoma are also less likely in this case, as they typically present with different symptoms and physical examination findings. Insect bites may cause redness, swelling, and itching, but are not typically associated with a palpable cord-like vein. Cellulitis is a bacterial skin infection that typically causes redness, swelling, and warmth in the affected area, but is not typically associated with a palpable vein. Subcutaneous hematoma is a collection of blood under the skin, typically caused by trauma, and is not usually associated with a palpable vein. It is important that the patient receives prompt medical attention and appropriate treatment for superficial venous thrombosis, as the condition can lead to complications such as deep vein thrombosis and pulmonary embolism. Treatment may include compression stockings, pain relief, and anticoagulation therapy. |
88. A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?
A. Thecal whitlow (ligament panaritium)
B. Subcutaneous panaritium
C. Articular (joint) panaritium
D. Bone panaritium
E. Paronychia
Answer: Thecal whitlow (ligament panaritium)
Explanation
| The most likely diagnosis in this case is thecal whitlow, also known as ligament panaritium. The patient’s symptoms of pain in the finger with homogeneous swelling and pain on attempted movement, as well as acute pain during probing in ligament projection, are all consistent with this diagnosis. Thecal whitlow is a condition in which infection develops in the tendon sheath of a finger, typically following a penetrating injury or a break in the skin. The infection can cause swelling, pain, and stiffness in the affected finger, and may spread to other parts of the hand if left untreated. Subcutaneous panaritium is a similar condition in which infection develops in the soft tissue of the finger, but does not involve the tendon sheath. Articular panaritium and bone panaritium are more severe forms of infection that involve the joint and bone, respectively, and are less likely in this case. Paronychia is a condition in which infection develops around the nail bed of a finger, typically following a break in the skin or exposure to water. It can cause redness, swelling, and pain around the nail, but does not typically involve the tendon sheath. It is important that the patient receives prompt medical attention and appropriate treatment for thecal whitlow, as the infection can lead to complications such as sepsis or permanent damage to the affected finger. Treatment typically involves antibiotics and, in some cases, surgical drainage of the infected area. |
89. A 30 year old man complains of acute pain in his right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language – 0,5 mm, external ear is intact, otoscopically – eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?
A. Acute purulent otitis media
B. Acute mastoiditis
C. Chronic secretory otitis media
D. Chronic purulent otitis media
E. Eustachian tube disfunction
Answer: Acute purulent otitis media
Explanation
| The most likely diagnosis in this case is acute purulent otitis media. The patient’s symptoms of acute pain in the right ear, hearing loss, and high temperature, along with the objective findings of a protruded, hyperemic, and swollen eardrum with loss of landmarks, are all consistent with this diagnosis. Acute purulent otitis media is a condition in which there is inflammation and infection of the middle ear, often caused by bacteria. The infection can cause symptoms such as ear pain, hearing loss, fever, and drainage from the ear. Acute mastoiditis is a more severe form of infection that involves the mastoid bone behind the ear, and is characterized by symptoms such as severe ear pain, fever, and swelling behind the ear. However, the absence of these symptoms and the presence of a hyperemic and swollen eardrum point towards acute otitis media rather than mastoiditis. Chronic secretory otitis media and chronic purulent otitis media are both long-standing conditions that involve inflammation and fluid buildup in the middle ear, and are less likely in this case. Eustachian tube dysfunction is a condition in which the tube that connects the middle ear to the back of the throat becomes blocked, leading to symptoms such as ear pain and hearing loss, but the presence of a hyperemic and swollen eardrum points towards an infectious cause rather than Eustachian tube dysfunction. It is important that the patient receives prompt medical attention and appropriate treatment for acute purulent otitis media, as the infection can lead to complications such as hearing loss, mastoiditis, and meningitis. Treatment typically involves antibiotics and pain relief, and in some cases, surgical drainage of the infected middle ear. |
90. Among the following causes of acute renal failure, the one that would be classified as “postrenal”is:
A. Calculi
B. Cardiac failure
C. Septicemia
D. Rhabdomyolysis
E. Acute glomerulonephritis
Answer: Calculi
Explanation
| The cause of acute renal failure that would be classified as “postrenal” among the options provided is calculi, also known as kidney stones. Postrenal acute renal failure is a type of acute renal failure that occurs as a result of obstruction of urine flow from the kidneys. This obstruction can occur at any point along the urinary tract, from the renal pelvis to the urethra. Common causes of postrenal acute renal failure include kidney stones, tumors, and strictures. In the case of kidney stones, the stones can obstruct the ureter, preventing urine from flowing out of the affected kidney and causing a backup of urine in the renal pelvis and kidney. This can lead to acute renal failure if not treated promptly. Cardiac failure, septicemia, rhabdomyolysis, and acute glomerulonephritis are all causes of acute renal failure, but they are not classified as postrenal causes. Cardiac failure can lead to decreased blood flow to the kidneys, causing ischemic acute renal failure. Septicemia can cause acute renal failure due to inflammation and damage to the kidney tissue. Rhabdomyolysis can cause acute renal failure due to the release of toxic muscle breakdown products into the bloodstream. Acute glomerulonephritis is a condition in which the glomeruli of the kidney become inflamed, leading to impaired kidney function. It is important to identify the cause of acute renal failure in order to provide appropriate treatment and prevent further damage to the kidneys. Treatment for postrenal acute renal failure caused by kidney stones may involve removal of the stones through procedures such as lithotripsy or surgery. |
91. A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?
A. Spontaneous left-sided pneumothorax
B. Pulmonary infarction
C. Pleuritis
D. Left-sided pneumonia
E. Pulmonary abscess
Answer: Spontaneous left-sided pneumothorax
Explanation
| The most likely diagnosis in this case is spontaneous left-sided pneumothorax. The patient’s symptoms of acute chest pain on the left, dyspnea, dizziness, pallor, cold sweat, cyanosis, and absence of vesicular respiration on the affected side, along with the X-ray findings of a shadow on the left, all suggest the presence of a pneumothorax. A pneumothorax is a condition in which air accumulates in the pleural space, causing the lung to collapse and leading to symptoms such as chest pain, dyspnea, and decreased breath sounds on the affected side. A spontaneous pneumothorax can occur without any obvious cause, and is most commonly seen in young, tall, thin individuals. Pulmonary infarction, pleuritis, left-sided pneumonia, and pulmonary abscess are all possible causes of chest pain and dyspnea, but are less likely in this case given the sudden onset of symptoms and absence of typical findings such as fever, cough, and abnormal breath sounds on auscultation. It is important that the patient receives prompt medical attention and appropriate treatment for spontaneous pneumothorax, as the condition can lead to respiratory distress and other complications. Treatment may include oxygen therapy, chest tube placement to remove air from the pleural space, and, in some cases, surgical repair of the lung. |
92. During an operation for presumed appendicitis the appendix was found to be normal; however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayish-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:
A. Crohn’s disease of the terminal ileum
B. Perforated Meckel’s diverticulum
C. Ulcerative colitis
D. Ileocecal tuberculosis
E. Acute ileitis
Answer: Crohn’s disease of the terminal ileum
Explanation
| The most likely diagnosis in this case is Crohn’s disease of the terminal ileum. The patient’s symptoms of presumed appendicitis, along with the intraoperative findings of thickened and rubbery terminal ileum with grayish-white exudate and adherent loops of small intestine, are all consistent with Crohn’s disease. Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, but is most commonly seen in the terminal ileum. The disease is characterized by inflammation and thickening of the bowel wall, which can lead to symptoms such as abdominal pain, diarrhea, and weight loss. Perforated Meckel’s diverticulum, ulcerative colitis, ileocecal tuberculosis, and acute ileitis are all possible causes of intra-abdominal inflammation and thickening, but are less likely given the specific findings in this case, including the presence of grayish-white exudate and adherent loops of small intestine. It is important that the patient receives appropriate medical management and treatment for Crohn’s disease, which may include anti-inflammatory medications, immunosuppressive therapy, and dietary modifications. In some cases, surgical intervention may be necessary to manage complications such as strictures, abscesses, or fistulas. |
93. A 50 year old woman with a 2-year history of mild, diffuse, tender thyroid enlargement complains of 10 pound weight gain and fatigue. What is the most probable diagnosis?
A. Hashimoto’s thyroiditis
B. Riedel’s thyroiditis
C. Subacute thyroiditis
D. Suppurative thyroiditis
E. Papillary thyroid carcinoma
Answer: Hashimoto’s thyroiditis
Explanation
| The most probable diagnosis in this case is Hashimoto’s thyroiditis. The patient’s history of mild, diffuse, tender thyroid enlargement, along with the recent symptoms of weight gain and fatigue, are all consistent with this autoimmune condition. Hashimoto’s thyroiditis is a chronic autoimmune disorder in which the body’s immune system attacks the thyroid gland, leading to inflammation and damage to the gland. This can cause the gland to enlarge, or become goiterous, and lead to symptoms such as fatigue, weight gain, and sensitivity to cold. Riedel’s thyroiditis, subacute thyroiditis, suppurative thyroiditis, and papillary thyroid carcinoma are all possible causes of thyroid enlargement, but are less likely in this case given the patient’s history of diffuse, tender enlargement and absence of other findings such as fever, pain, or nodularity. It is important that the patient undergoes further evaluation, including laboratory tests such as thyroid function tests and thyroid antibody testing, to confirm the diagnosis of Hashimoto’s thyroiditis and to initiate appropriate management, which may include thyroid hormone replacement therapy. |
94. A severely traumatized patient who has been receiving prolonged parenteral alimentation develops diarrhea, mental depression, alopecia and perioral and periorbital dermatitis. Administration of which of the following trace elements is most likely to reverse these complications?
A. Zinc
B. Iodine
C. Selenium
D. Silicon
E. Copper
Answer: Zinc
Explanation
| The trace element most likely to reverse the complications in this case is zinc. The patient’s symptoms of diarrhea, mental depression, alopecia, and perioral and periorbital dermatitis are consistent with zinc deficiency, which can occur in patients receiving prolonged parenteral alimentation. Zinc is an essential trace element that is important for a wide range of biological processes, including growth and development, immune function, and wound healing. Zinc deficiency can lead to a variety of symptoms, including diarrhea, depression, hair loss, and skin changes. Iodine deficiency can cause thyroid problems, but is less likely to be involved in the symptoms described in this case. Selenium deficiency can also lead to a variety of symptoms, including hair loss and skin changes, but is less commonly associated with depression and diarrhea. Silicon and copper deficiencies are less likely to be involved in this case. It is important to monitor for and correct micronutrient deficiencies in patients receiving prolonged parenteral alimentation to prevent and manage complications. Zinc supplementation is effective in reversing the symptoms of zinc deficiency, and is often included in parenteral nutrition formulations. |
95. A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?
A. Bubonic plague
B. Acute purulent lymphadenitis
C. Lymphogranulomatosis
D. Anthrax
E. Tularemia
Answer: Bubonic plague
Explanation
| The diagnosis is most likely acute purulent lymphadenitis. The key clues are: – Painful swollen lymph nodes in the axilla – Fever and chills – Coated tongue – Rapid pulse This suggests an acute infection and inflammation of the lymph nodes, known as lymphadenitis. The swelling, tenderness, erythema and shininess of the skin over the lymph nodes indicate pus formation, hence purulent lymphadenitis. Bubonic plague is unlikely given the relatively mild and localized presentation without systemic involvement. It would also be very rare in the modern era. Lymphogranulomatosis and tularemia usually do not present with acute pain and swelling of lymph nodes. Anthrax typically causes skin lesions at the infection site, which is not described here. So in summary, based on the described symptoms, acute purulent lymphadenitis is the most probable diagnosis for this clinical presentation. |
96. A 56 year old patient has worked at the aluminium plant over 20 years. Within 3 last years he has been experiencing loosening of teeth, bone and joint pains, piercing pains in heart region, vomiting. The provisional diagnosis is:
A. Fluorine intoxication
B. Mercury intoxication
C. Lead intoxication
D. Phosphorus intoxication
E. Manganese intoxication
Answer: Fluorine intoxication
Explanation
| The diagnosis is most likely fluorine intoxication. The key clues are: – The patient has worked at an aluminum plant for 20 years – Aluminum plants can expose workers to high levels of fluoride compounds – The symptoms of loosening teeth, bone and joint pains are characteristic of fluorine intoxication The symptoms of fluorine intoxication can include: – Loosening and loss of teeth (dental fluorosis) – Bone and joint pains (osteosclerosis) – Gastrointestinal issues like nausea, vomiting and abdominal pain – Neurological symptoms like headaches, tremors and memory problems Other heavy metal intoxications do not typically present with dental fluorosis as a predominant symptom. Mercury, lead and phosphorus poisoning tend to cause different systemic effects rather than targeting bones and teeth. Manganese toxicity more commonly causes neurological and psychiatric symptoms. So based on the combination of occupational exposure to aluminum plant fumes, the typical symptoms described, and the predominance of dental and bone effects, fluorine intoxication is the most likely diagnosis for this patient. The symptoms have developed over the last 3 years, suggesting progressive accumulation of fluoride overload in the body. In summary, the key clues point to fluorine intoxication from occupational exposure in an aluminum plant as the provisional diagnosis for this patient. |
97. An excited patient constantly tries to look into the next room because he is sure of his friends’ presence. He claims to hear his friends and other people talking although no-one is there. He tries to persuade his doctor that people in the next room are disputing about “his punishment”, repeats aloud phrases he has allegedly heard from the next room. What state is it?
A. Acute hallucinosis
B. Verbal illusions
C. Delusion
D. Confabulations
E. Obsessional ideas
Answer: Acute hallucinosis
Explanation
| The state described in this case is acute hallucinosis. The patient is experiencing auditory hallucinations, or hearing sounds or voices that are not actually present. The patient also appears to be exhibiting delusions, or false beliefs that are not based in reality, as he is convinced that his friends are present in the next room and that they are discussing his punishment. Acute hallucinosis is a condition in which a person experiences hallucinations, often in the context of a psychiatric disorder such as schizophrenia or in response to certain medications or drugs. The hallucinations can affect any of the senses, but auditory hallucinations are the most common. Verbal illusions, confabulations, and obsessional ideas are all different types of thought disturbances that can occur in psychiatric disorders, but are less likely to be involved in this case given the specific symptoms described. It is important that the patient receives further evaluation and appropriate treatment for his symptoms, which may include antipsychotic medications and psychotherapy. |
98. Survey radiograph of chest of a 62 year old smoker who often suffers from “pneumonias”showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed deviation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?
A. Cenral cancer of lung
B. Lung abscess
C. Lung cyst
D. Peripheral cancer of lung
E. Atelectasis
Answer: Cenral cancer of lung
Explanation
| The most probable diagnosis in this case is central cancer of the lung. The presence of a triangular shadow in the right lung with its vertex pointing towards the lung root, along with deviation of the heart and mediastinum shadows towards the lesion, are all suggestive of a central mass in the lung. Central lung cancer is a type of lung cancer that arises in the central airways of the lung, such as the bronchi. It can cause symptoms such as cough, shortness of breath, and chest pain, and can be associated with a history of smoking. Lung abscess, lung cyst, peripheral cancer of lung, and atelectasis are all possible causes of lung shadows on radiographic imaging, but are less likely in this case given the specific findings of a triangular shadow and deviation of the heart and mediastinum shadows. Further evaluation, such as computed tomography (CT) scan of the chest and biopsy of the lesion, may be necessary to confirm the diagnosis and determine the appropriate management, which may include surgery, radiation therapy, chemotherapy, or a combination of these approaches. |
99. A 68 year old patient has been suffering from chronic pancreatitis for 35 years. During the last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested food), progressing weight loss. Change of symptom set is caused by joining of:
A. Exocrine pancreatic insufficiency
B. Endocrine pancreatic insufficiency
C. Syndrome of lactase deficiency
D. Irritable bowels syndrome
E. Chronic enterocolitis
Answer: Exocrine pancreatic insufficiency
Explanation
| The change in symptom set in this case is most likely caused by the joining of exocrine pancreatic insufficiency. The patient’s history of chronic pancreatitis, along with symptoms of abdominal swelling, frequent defecations with greasy, undigested stools, and weight loss, are all consistent with exocrine pancreatic insufficiency. Exocrine pancreatic insufficiency is a condition in which the pancreas is unable to produce enough digestive enzymes, which leads to malabsorption of nutrients and fat in the small intestine. This can cause symptoms such as abdominal swelling, diarrhea or frequent defecations with greasy, undigested stools, weight loss, and malnutrition. Endocrine pancreatic insufficiency, lactase deficiency, irritable bowel syndrome, and chronic enterocolitis are all possible causes of gastrointestinal symptoms, but are less likely in this case given the patient’s history of chronic pancreatitis and specific symptoms of malabsorption. Management of exocrine pancreatic insufficiency may include enzyme replacement therapy, which involves taking pancreatic enzyme supplements with meals to aid in digestion and absorption of nutrients. It is important for the patient to receive appropriate medical management and nutritional support to prevent complications of malabsorption and malnutrition. |
100. A 60 year old patient has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining about amotivational bad mood, problems with attention concentration; she forgets to close the entrance door, cannot recall events of the last day. Computer tomography shows areas of postinfarction changes in the cortical postfrontal regions. What is the most probable diagnosis?
A. Vascular dementia
B. Alzheimer’s disease
C. Huntington’s chorea
D. Pick’s disease
E. Dissociative amnesia
Answer: Vascular dementia
Explanation
| The most probable diagnosis in this case is vascular dementia. The patient has a history of arterial hypertension and recurrent stroke, and is presenting with symptoms of amotivational bad mood, problems with attention concentration, and memory impairment. The computed tomography (CT) scan shows areas of postinfarction changes in the cortical postfrontal regions, which is consistent with vascular dementia. Vascular dementia is a type of dementia that is caused by damage to the brain’s blood vessels. It can be caused by a series of small strokes, or by a single large stroke, as in this case. Symptoms can include memory impairment, problems with attention and concentration, mood changes, and difficulty with activities of daily living. Alzheimer’s disease, Huntington’s chorea, Pick’s disease, and dissociative amnesia are all possible causes of cognitive impairment or memory loss, but are less likely in this case given the specific findings of postinfarction changes in the cortical postfrontal regions on CT scan. Management of vascular dementia may involve addressing risk factors such as hypertension and diabetes, and may include medications to manage symptoms and prevent further cognitive decline. Rehabilitation and support services may also be helpful for the patient and their caregivers. |
