Question From ( 51 To 100 )
51. A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis?
A. Allergic dermatitis
B. Dermatitis simplex
C. Eczema
D. Erysipelas
E. Neurodermatitis
Answer: Allergic dermatitis
Explanation
| The patient’s symptoms of itching, reddening, edema, and papulovesicular rash in the region of the face, which started after using a cosmetic face cream, are suggestive of an allergic dermatitis. Allergic dermatitis is a type of skin inflammation that occurs as a result of an allergic reaction to a substance that comes into contact with the skin. Common triggers include cosmetics, fragrances, metals, and certain plants. Dermatitis simplex, eczema, and neurodermatitis are also types of skin inflammation, but they are not specifically associated with an allergic reaction. Dermatitis simplex is a non-specific type of skin inflammation that can occur due to a variety of causes, including irritation, friction, and sweating. Eczema is a chronic inflammatory skin condition characterized by itching, redness, and scaling, and neurodermatitis is a type of eczema that is associated with nerve endings and can be triggered by stress or anxiety. Erysipelas is a type of bacterial skin infection that can cause redness, swelling, and fever, but it typically does not present with a papulovesicular rash. Therefore, based on the patient’s history and clinical presentation, the most likely diagnosis is allergic dermatitis. |
52. Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8 scores. During the delivery there was a short-term difficulty with extraction of shoulder girdle. After birth the child had the proximal extremity dysfunction and the arm couldn’t be raised from the side. The shoulder was turned inwards, the elbow was flexed, there was also forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?
A. Duchenne-Erb palsy
B. Trauma of thoracic spine
C. Right hand osteomyelitis
D. Intracranial haemorrhage
E. Trauma of right hand soft tissues
Answer: Duchenne-Erb palsy
Explanation
| The clinical presentation of proximal extremity dysfunction, inability to raise the arm from the side, inward rotation of the shoulder, flexed elbow, and forearm pronation, is consistent with Duchenne-Erb palsy, also known as obstetric brachial plexus palsy. Obstetric brachial plexus palsy is a type of nerve injury that occurs during childbirth, typically as a result of traction or stretching of the brachial plexus nerves that control movement and sensation in the arm. This can occur if the baby’s shoulder becomes stuck during delivery, which is known as shoulder dystocia. The Apgar scores of 7-8 at 1 and 5 minutes after birth indicate that the baby had some difficulty adjusting to extrauterine life, but she was not critically ill. However, the difficulty with extraction of the shoulder girdle during delivery is a risk factor for obstetric brachial plexus palsy. Trauma of the thoracic spine, intracranial hemorrhage, and right hand osteomyelitis are not consistent with the clinical presentation and history described in the question. Trauma of the right hand soft tissues may occur during delivery, but it would not explain the proximal extremity dysfunction and other findings. Therefore, based on the patient’s clinical presentation and history, the most likely diagnosis is Duchenne-Erb palsy. |
53. Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
A. Defect of interventricular septum
B. Defect of interatrial septum
C. Coarctation of aorta
D. Fallot’s tetrad
E. Pulmonary artery stenosis
Answer: Defect of interventricular septum
Explanation
| The clinical presentation of skin pallor, cyanosis during excitement, transverse dilatation of cardiac borders on percussion, and continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space that is conducted above the whole cardiac region to the back is suggestive of a congenital heart defect with left-to-right shunt. The most likely diagnosis in this case is a patent ductus arteriosus (PDA), which is a common congenital heart defect characterized by the persistence of a fetal blood vessel that connects the pulmonary artery to the aorta. A defect of interventricular septum, or ventricular septal defect (VSD), is another common congenital heart defect, but it typically presents with a holosystolic murmur heard best at the lower left sternal border, and it may be associated with a harsh crescendo-decrescendo ejection murmur and a palpable thrill. The clinical presentation of skin pallor, cyanosis during excitement, and transverse dilatation of cardiac borders on percussion is not typical of VSD. Defect of interatrial septum, coarctation of aorta, Fallot’s tetrad, and pulmonary artery stenosis are other types of congenital heart defects, but they do not typically present with the continuous systolic murmur described in the question. Therefore, based on the patient’s clinical presentation and auscultation findings, the most likely diagnosis is patent ductus arteriosus. |
54. A 27-year-old patient with a history of ronchial asthma was stung by a bee. He had a sensation of chest compression, breath shortage, difficult expiration, sense of heat in the upper half of body, dizziness, apparent itch, convulsions. Objectively: noisy wheezing breath, AP – 90/60 mm Hg, Ps- 110 bpm. Auscultation revealed weak rhythmic heart sounds, rough respiration above lungs, sibilant rales. What drug group should be administered in the first place?
A. Glucocorticoids
B. Methylxanthines
C. Cardiac glycosides
D. Anticonvulsive
E. Analgetics
Answer: Glucocorticoids
Explanation
| The patient’s clinical presentation of chest compression, breathlessness, wheezing, tachycardia, and sibilant rales is suggestive of an anaphylactic reaction to the bee sting, which is a severe allergic reaction that requires immediate medical attention. The first-line treatment for anaphylaxis is epinephrine, which should be administered as soon as possible to reverse the symptoms and stabilize the patient. Epinephrine acts by constricting blood vessels, relaxing bronchial smooth muscle, and increasing cardiac output. Glucocorticoids, such as prednisone or hydrocortisone, are also used in the treatment of anaphylaxis, but they are not the first-line therapy. Glucocorticoids act by reducing inflammation and preventing delayed hypersensitivity reactions, but they do not provide immediate relief of symptoms. Methylxanthines, cardiac glycosides, anticonvulsants, and analgesics are not indicated in the treatment of anaphylaxis. Therefore, based on the patient’s clinical presentation and history of anaphylactic reaction to a bee sting, the drug group that should be administered in the first place is epinephrine. |
55. A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most likely diagnosis?
A. Hypertrophic cardiomyopathy
B. Aortic stenosis
C. Essential hypertension
D. Myocardium infarction
E. Coarctation of aorta
Answer: Hypertrophic cardiomyopathy
Explanation
| The patient’s symptoms of cardiac irregularities, dizziness, and dyspnea at physical stress, along with the findings of a systolic murmur above the aorta, left ventricular hypertrophy on ECG, and interventricular septum thickness of 2 cm on echocardiogram, are all suggestive of hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is a genetic disorder characterized by thickening of the heart muscle, most commonly involving the interventricular septum. This can cause obstruction of blood flow out of the heart, leading to symptoms such as chest pain, shortness of breath, and palpitations, especially during physical activity. Aortic stenosis can also cause a systolic murmur above the aorta, but it typically presents in older adults and is associated with calcification of the aortic valve. Essential hypertension can cause left ventricular hypertrophy, but it typically does not present with a systolic murmur or symptoms such as dizziness and dyspnea. Myocardial infarction and coarctation of the aorta are not consistent with the clinical presentation and findings described in the question. Therefore, based on the patient’s symptoms, physical examination, and diagnostic tests, the most likely diagnosis is hypertrophic cardiomyopathy. |
56. On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child developed ataxia, nystagmus, intention tremor, muscle hypotonia. Liquor analysis shows insignificant lymphocytic pleocytosis, slightly increased protein rate. What complication is it?
A. Encephalitis
B. Purulent meningitis
C. Pneumonitis
D. Acute nephritis
E. Postherpetic neuralgia
Answer: Encephalitis
Explanation
| The clinical presentation of ataxia, nystagmus, intention tremor, and muscle hypotonia in a child who had chickenpox 21 days prior is suggestive of a rare but serious complication known as post-infectious cerebellitis, which is a type of encephalitis. Encephalitis is an inflammation of the brain that can be caused by a variety of viral, bacterial, and fungal infections. In this case, the child likely developed encephalitis as a result of a viral infection with varicella-zoster virus, which is the virus that causes chickenpox. The cerebellum is a part of the brain that is responsible for coordinating movement and balance, so inflammation of the cerebellum can cause symptoms such as ataxia, nystagmus, intention tremor, and muscle hypotonia. The findings on liquor analysis of lymphocytic pleocytosis and slightly increased protein rate are consistent with viral encephalitis. Purulent meningitis, pneumonitis, acute nephritis, and postherpetic neuralgia are all potential complications of chickenpox, but they would not typically present with the neurological symptoms described in the question. Therefore, based on the patient’s clinical presentation and laboratory findings, the most likely complication is encephalitis, specifically post-infectious cerebellitis. |
57. Clinic of a research instutute for occupational diseases examined a worker who works at a concentration plant and diagnosed him with chronic dust bronchitis. The case is investigated by a commission including the representatives of: the plant, clinic, territorial SES, department of Social Insurance Fund, trade union. According to the “regulation on investigation of. . . “, the commission should be headed by the representative of the following authority:
A. Territorial SES
B. Plant
C. Social Insurance Fund
D. Trade union
E. Clinic
Answer: Territorial SES
Explanation
| The question provides limited information and the context is unclear. However, based on the information provided, it is difficult to determine which authority should head the commission investigating the worker’s case. In general, the authority that should lead the investigation of an occupational disease depends on the specific laws and regulations of the country or region in question. Different countries may have different regulations and guidelines for investigating occupational diseases. In some cases, the authority responsible for investigating occupational diseases may be the occupational safety and health administration or agency. In other cases, it may be the social security or workers’ compensation agency. It is also possible that a joint commission or committee composed of representatives from multiple agencies or organizations may be responsible for investigating occupational diseases. Therefore, without more information about the specific laws and regulations governing the investigation of occupational diseases in the region where the worker is located, it is difficult to determine which authority should head the commission in this case. |
58. Basing upon the data of laboratory assessment of sanitary state of soil in a certain territory, the soil was found to be low-contaminated according to the sanitary indicative value; contaminated according to the coli titer; lowcontaminated according to the anaerobe titer (Cl. Perfringens). This is indicative of:
A. Fresh fecal contamination
B. Insufficient intensity of soil humification
C. Old fecal contamination
D. Constant entry of organic protein contaminations
E. Insufficient insolation and aeration of soil
Answer: Fresh fecal contamination
Explanation
| The laboratory assessment of the sanitary state of soil in a certain territory reveals that the soil is low-contaminated according to the sanitary indicative value, contaminated according to the coli titer, and low-contaminated according to the anaerobe titer (Cl. Perfringens). This is indicative of fresh fecal contamination, which is a type of surface contamination that occurs when fecal matter is deposited on the soil surface. The presence of high levels of coliform bacteria, such as Escherichia coli, in the soil is a strong indicator of fresh fecal contamination. Insufficient intensity of soil humification, old fecal contamination, constant entry of organic protein contaminations, and insufficient insolation and aeration of soil are not consistent with the laboratory findings described in the question and are therefore unlikely explanations for the observed contamination. Therefore, based on the laboratory assessment of the soil and the indicators of fresh fecal contamination, the most likely explanation for the contamination is recent deposition of fecal matter on the soil surface. The laboratory assessment of the sanitary state of soil in a certain territory reveals that the soil is low-contaminated according to the sanitary indicative value, contaminated according to the coli titer, and low-contaminated according to the anaerobe titer (Cl. Perfringens). This is indicative of fresh fecal contamination, which is a type of surface contamination that occurs when fecal matter is deposited on the soil surface. The presence of high levels of coliform bacteria, such as Escherichia coli, in the soil is a strong indicator of fresh fecal contamination. Insufficient intensity of soil humification, old fecal contamination, constant entry of organic protein contaminations, and insufficient insolation and aeration of soil are not consistent with the laboratory findings described in the question and are therefore unlikely explanations for the observed contamination. Therefore, based on the laboratory assessment of the soil and the indicators of fresh fecal contamination, the most likely explanation for the contamination is recent deposition of fecal matter on the soil surface. |
59. A 28-year-old patient underwent endometrectomy as a result of incomplete abortion. Blood loss was at the rate of 900 ml. It was necessary to start hemotransfusion. After transfusion of 60 ml of erythrocytic mass the patient presented with lumbar pain and fever which resulted in hemotransfusion stoppage. 20 minutes later the patient’s condition got worse: she developed adynamia, apparent skin pallor, acrocyanosis, profuse perspiration. t o- 38, 5oC, Ps110/min, AP- 70/40 mm Hg. What is the most likely diagnosis?
A. Hemotransfusion shock
B. Hemorrhagic shock
C. Septic shock
D. Anaphylactic shock
E. DIC syndrome
Answer: Hemotransfusion shock
Explanation
| The patient’s clinical presentation, which includes lumbar pain, fever, and a rapid deterioration of vital signs after receiving a transfusion of erythrocyte mass, is suggestive of a transfusion reaction, specifically hemotransfusion shock. Hemotransfusion shock is a type of transfusion reaction that occurs when the recipient’s immune system reacts to the transfused blood, causing a systemic inflammatory response that can lead to hypotension, tachycardia, fever, and other symptoms. The patient’s symptoms of adynamia, skin pallor, acrocyanosis, profuse perspiration, tachycardia, hypotension, and fever are all consistent with hemotransfusion shock. Hemorrhagic shock, septic shock, anaphylactic shock, and DIC syndrome are all potential causes of shock, but they are not consistent with the clinical presentation and history of the patient. Therefore, based on the patient’s clinical presentation and history of receiving a transfusion of erythrocyte mass, the most likely diagnosis is hemotransfusion shock. |
60. A painter working at a motorcar plant was diagnosed with acute intoxication with amide compounds of benzene, moderate severity grade. The in-patient treatment resulted in considerable health improvement. What expert decision should be made in this case?
A. The patient should be issued a sick list for out-patient treatment
B. The patient may get back to work providing he will keep to hygiene and sanitary regulations
C. The patient should be referred to the Medical and Social Expert Commission for assigning the disability group because of an occupational disease
D. The patient should be referred to the Medical and Social Expert Commission for determination of percentage of work capicty loss
E. –
Answer: The patient should be issued a sick list for out-patient treatment
Explanation
| Acute intoxication with amide compounds of benzene is a serious occupational health condition that can cause a range of symptoms, including headache, dizziness, nausea, vomiting, respiratory distress, and neurological effects. While the patient’s health has improved with in-patient treatment, it is still important to ensure that the patient is fully recovered before he returns to work. Additionally, it is important to identify and address any workplace hazards or exposure risks that may have contributed to the patient’s illness. In this case, the correct expert decision would be to refer the patient to the Medical and Social Expert Commission for determination of the percentage of work capacity loss and for assigning the disability group because of an occupational disease. This will help to ensure that the patient receives appropriate compensation and support for any long-term health effects resulting from the occupational exposure. Therefore, based on the diagnosis of acute intoxication with amide compounds of benzene and the severity of the condition, the patient should not be allowed to return to work immediately. Instead, the correct expert decision would be to refer the patient to the Medical and Social Expert Commission for further evaluation and determination of disability and work capacity loss. |
61. A maternity hospital registered 616 live births, 1 stillbirth, 1 death on the 5th day of life over a 1 year period. What index allows the most precise estimation of this situation?
A. Perinatal mortality
B. Crude mortality rate
C. Natality
D. Neonatal mortality
E. Natural increase
Answer: Perinatal mortality
Explanation
| The most appropriate index to estimate the situation described in the question is perinatal mortality. Perinatal mortality is defined as the number of stillbirths and early neonatal deaths (deaths occurring within the first seven days of life) per 1,000 total births (live births + stillbirths). This index provides a measure of the quality of obstetric and neonatal care and can help identify areas for improvement. In this case, the maternity hospital registered 616 live births, 1 stillbirth, and 1 death on the 5th day of life over a 1-year period. Therefore, the total number of births (live births + stillbirths) is 617, and the perinatal mortality rate can be calculated as follows: Perinatal mortality = (number of stillbirths + number of early neonatal deaths) / total number of births x 1,000 Perinatal mortality = (1 + 1) / 617 x 1,000 = 3.24 per 1,000 total births. Therefore, the most precise estimation of the situation described in the question is the perinatal mortality rate, which indicates that there were two perinatal deaths in the maternity hospital during the one-year period. |
62. A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2×3 cm large that was changing its position during the examination. What conclusion can be made?
A. Concrement
B. Malignant tumour of the urinary bladder
C. Urinary bladder polyp
D. Prostate adenoma
E. Primary ureter tumour
Answer: Concrement
Explanation
| The patient’s symptoms of difficult urination and sensation of incomplete bladder emptying, along with the sonographic finding of a well-defined hyperechogenic formation near the urethral entrance that changes position during examination, are suggestive of a bladder stone, also known as a bladder calculus. Bladder stones are hard mineral deposits that can form in the bladder and cause a range of urinary symptoms, including difficulty urinating, incomplete bladder emptying, and pain or discomfort during urination. Other possible causes of these symptoms and sonographic findings include a urinary bladder polyp, prostate adenoma, or primary ureter tumor. However, these conditions would have different sonographic characteristics and are less likely based on the information provided in the question. Malignant tumors of the urinary bladder can also cause urinary symptoms, but they typically present with a different pattern of sonographic findings, such as irregular or infiltrating lesions. Therefore, based on the patient’s symptoms and the sonographic finding of a well-defined, hyperechogenic formation that changes position during examination, the most likely conclusion is that the patient has a bladder stone (concrement). |
63. An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, t o- 35, 0oC. AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient’s mouth. What is the most likely diagnosis?
A. Hypothermia
B. Acute cardiovascular insufficiency
C. Apparent death
D. Frostbite of trunk and extremities
E. –
Answer: Hypothermia
Explanation
| The patient’s clinical presentation of unconsciousness, pale skin, shallow breathing, bradycardia, hypothermia (body temperature of 35.0°C), and a history of alcohol consumption is strongly suggestive of hypothermia, a potentially life-threatening condition that occurs when the body’s core temperature drops below normal. Hypothermia can cause a range of symptoms, including confusion, drowsiness, fatigue, shallow breathing, bradycardia, and hypotension. In severe cases, it can lead to cardiac arrest, respiratory failure, and death. In this case, the patient was found lying in the street in winter, which increases the likelihood of hypothermia. The patient’s bradycardia and hypotension, along with the low body temperature, suggest that the patient’s condition is severe. Acute cardiovascular insufficiency, apparent death, and frostbite are all potential diagnoses in a patient found unconscious in winter, but they are less likely based on the information provided in the question. Therefore, based on the patient’s clinical presentation, history, and environmental factors, the most likely diagnosis is hypothermia. |
64. A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
A. Forceps operation
B. Cesarean
C. Embryotomy
D. Conservative labor management with episiotomy
E. Stimulation of labor activity
Answer: Forceps operation
Explanation
| The patient’s clinical presentation of headache, vision impairment, psychic inhibition, hypertension (AP 200/110 mm Hg), and edema of legs and anterior abdominal wall suggests that the patient may be experiencing severe preeclampsia or eclampsia, which are serious pregnancy-related conditions that require urgent intervention. In this case, the patient has a fully dilated cervix, and the fetal head is in the area of the small pelvis, indicating that delivery is imminent. However, given the patient’s clinical condition, it is not safe to proceed with a forceps operation or any other form of vaginal delivery. The most appropriate management in this case would be to perform an emergency cesarean section to deliver the fetus as quickly and safely as possible. This will help to reduce the risk of complications for both the mother and the baby. Embryotomy, conservative labor management with episiotomy, and stimulation of labor activity are not appropriate in this case, as they do not address the underlying medical condition and may even increase the risk of complications. Therefore, based on the patient’s clinical presentation and the need for urgent intervention, the most appropriate tactic of labor management would be an emergency cesarean section. |
65. A 35-year-old patient complains about pain and morning stiffness of hand joints and temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years. Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What examination should be administered?
A. Roentgenography of hands
B. Complete blood count
C. Rose-Waaler reaction
D. Immunogram
E. Proteinogram
Answer: Roentgenography of hands
Explanation
| The patient’s symptoms of pain and morning stiffness of hand joints and temporomandibular joints, along with edema of proximal interphalangeal digital joints and limited joint motion, are suggestive of rheumatoid arthritis (RA), a chronic autoimmune disease that affects the joints and other tissues. Roentgenography (X-ray) of hands is a commonly used imaging test in the diagnosis and management of RA. It can help to identify characteristic joint changes, such as joint space narrowing, erosions, and osteoporosis. Complete blood count, Rose-Waaler reaction, immunogram, and proteinogram are other laboratory tests that may be useful in the diagnosis and management of RA, but they are less specific and sensitive than X-ray imaging. Therefore, based on the patient’s symptoms and clinical presentation, the most appropriate examination to administer would be roentgenography of hands to help confirm the diagnosis of RA and guide treatment decisions. |
66. A 68-year-old female patient complains about temperature rise up to 38, 3oC, haematuria. ESR- 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?
A. Renal cancer
B. Polycystic renal disease
C. Renal amyloidosis
D. Urolithiasis
E. Chronic glomerulonephritis
Answer: Renal cancer
Explanation
| The patient’s symptoms of fever, haematuria, and elevated erythrocyte sedimentation rate (ESR) may suggest an underlying inflammatory or infectious process in the urinary tract. However, the fact that antibacterial therapy has been ineffective raises the possibility of a non-infectious cause. Renal cancer is one possible diagnosis that can cause haematuria and systemic symptoms such as fever and elevated ESR. Other possible diagnoses include urolithiasis (kidney stones), glomerulonephritis (inflammation of the kidney’s filtering units), and other renal diseases. Polycystic renal disease and renal amyloidosis are less likely based on the information provided in the question, as they typically present with different symptoms and clinical features. Further diagnostic tests, such as imaging studies and urine analysis, would be needed to confirm the diagnosis and guide treatment decisions. Therefore, based on the patient’s symptoms and the ineffective response to antibacterial therapy, renal cancer is a possible diagnosis that should be considered, but further evaluation is needed to confirm the diagnosis. |
67. Bacterial analysis of air in a living space in winter period by means of Krotov’s apparatus revealed that total number of microorganisms in 1m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as “pure”?
A. Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
Answer: Up to 4500
Explanation
| The allowed number of microorganisms for air to be characterized as “pure” depends on the method of analysis and the specific criteria used. In this case, the analysis was performed using Krotov’s apparatus, which is a common method for measuring bacterial contamination in air. According to the Russian Sanitary Rules and Regulations (SanPiN 2.2.1/2.1.1.1200-03), the maximum permissible concentration of microorganisms in residential and public premises is 5,000 CFU/m3 (colony-forming units per cubic meter) for total bacterial count. However, to be characterized as “pure,” the air should have a lower concentration of microorganisms. Based on the information provided in the question, the total number of microorganisms in 1m3 of air is 7200, which is above the allowed limit for “pure” air. Therefore, none of the answer choices are correct. To be characterized as “pure,” the air should have a total bacterial count of up to 4,500 CFU/m3 or lower, according to some guidelines. However, it is important to note that the acceptable level of bacterial contamination may vary depending on the specific setting and the sensitivity of the individuals exposed to the air. |
68. A patient who has been consuming refined foodstuffs for a long time complains about headache, fatiguability, depression, insomnia, irritability. Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles, during walking the patient lands onto his heel first, then on the external edge of foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes of myocardium. There are also gastrointestinal disorders. What is the most likely diagnosis?
A. Hypovitaminosis B1
B. Hypovitaminosis B2
C. Hypovitaminosis B12
D. Hypovitaminosis B6
E. Hypovitaminosis B15
Answer: Hypovitaminosis B1
Explanation
| The patient’s symptoms of headache, fatigue, depression, insomnia, irritability, muscle weakness, muscle pain and cramps, and cardiovascular and gastrointestinal problems are suggestive of a thiamine (vitamin B1) deficiency, also known as beriberi. Thiamine is an essential nutrient that plays a key role in energy metabolism and nervous system function. It is found in many foods, including whole grains, meat, fish, and legumes. However, refined foodstuffs, such as white rice and processed grains, are often low in thiamine. Beriberi is a condition that develops when the body does not get enough thiamine. It can cause a range of symptoms, including fatigue, muscle weakness, pain, and cramps, as well as neurological and cardiovascular problems. In this case, the patient’s symptoms of muscle weakness and pain, as well as the gait abnormality (landing on the heel first, then on the external edge of the foot), suggest a neurological component to the illness. The cardiovascular symptoms, such as tachycardia and dystrophic changes of myocardium, are also consistent with thiamine deficiency. Therefore, based on the patient’s symptoms and clinical presentation, the most likely diagnosis is hypovitaminosis B1 (thiamine deficiency), which can be treated with thiamine supplementation and dietary changes. |
69. A 9-year-old boy has been suffering from bronchoectasis since he was 3. Exacerbations occur quite often, 3-4 times a year. Conservative therapy results in short periods of remission. The disease is progressing, the child has physical retardation. The child’s skin is pale, acrocyanotic, he has “watch glass”nail deformation. Bronchography revealed saccular bronchiectases of the lower lobe of his right lung. What is the further treatment tactics?
A. Surgical treatment
B. Further conservative therapy
C. Physiotherapeutic treatment
D. Sanatorium-and-spa treatment
E. Tempering of the child’s organism
Answer: Surgical treatment
Explanation
| Bronchiectasis is a condition characterized by abnormal dilation of bronchi and bronchioles, leading to chronic inflammation and recurrent respiratory infections. In children, it often occurs as a result of recurrent respiratory infections or congenital conditions. In this case, the patient has been suffering from bronchiectasis since he was 3 years old, and the disease has been progressing despite conservative therapy. The frequent exacerbations and physical retardation suggest that the patient’s condition is severe and may require more aggressive management. Surgical treatment, such as lung resection or bronchial artery embolization, may be considered in cases of severe or localized bronchiectasis that is unresponsive to conservative therapy. However, the decision to pursue surgery would depend on the specific characteristics of the patient’s bronchiectasis, such as the location and extent of the lesions, as well as the patient’s overall health status. Conservative therapy, such as bronchodilators, antibiotics, and airway clearance techniques, is typically the first-line treatment for bronchiectasis. However, in cases of severe or progressive disease, surgical intervention may be necessary. Physiotherapeutic treatment, sanatorium-and-spa treatment, and tempering of the child’s organism may be helpful in managing the patient’s symptoms and improving his overall health, but they are not likely to address the underlying bronchiectasis. Therefore, based on the patient’s clinical presentation and history, surgical treatment may be a viable option to consider, but further evaluation and consultation with a specialist would be needed to determine the best course of action. |
70. A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an in-patient hospital. He was diagnosed with progressing vegetative insufficiency. This disease relates to the following group of ionizing radiation effects:
A. Somato-stochastic
B. Somatic
C. Genetic
D. Hormesis
E. Heterosis
Answer: Somato-stochastic
Explanation
| Ionizing radiation can have a range of effects on the human body, depending on the dose, duration, and type of radiation exposure. The effects can be classified into three main categories: deterministic (also known as somatic), stochastic, and genetic. Deterministic effects are those that have a threshold dose below which no effect is observed, and the severity of the effect increases with increasing dose. Examples of deterministic effects include radiation burns, radiation sickness, and cataracts. Stochastic effects are those that occur randomly and have a probability of occurrence that increases with increasing dose. Examples of stochastic effects include cancer and genetic mutations. Progressing vegetative insufficiency is a non-specific term that could refer to a range of symptoms, but it is not a recognized medical diagnosis. However, given the patient’s history of radiation exposure, it is possible that the symptoms are related to radiation-induced somatic or stochastic effects. Somato-stochastic effects are a specific type of stochastic effect that can occur at low doses of radiation. They are characterized by a random, non-threshold response that increases in frequency with increasing dose, but the severity of the effect does not depend on the dose. Examples of somato-stochastic effects include chronic fatigue syndrome and fibromyalgia. Therefore, based on the limited information provided in the question, it is possible that the patient’s symptoms of progressing vegetative insufficiency are related to somato-stochastic effects of ionizing radiation exposure. However, further evaluation and diagnostic testing would be needed to confirm the diagnosis and determine the appropriate treatment. |
71. A child is 4 years old, has been ill for 5 days. There are complaints of cough, skin rash, t o- 38, 2oC, face puffiness, photophobia, conjunctivitis. Objectively:
there is bright, maculo-papulous, in some areas confluent rash on the face, neck, upper chest. The pharynx is hyperemic. There are seropurulent discharges from the nose. Auscultation revealed dry rales in lungs. What is the most likely diagnosis?
A. Measles
B. Adenoviral infection
C. Scarlet fever
D. Rubella
E. Enterovirus exanthema
Answer: Measles
Explanation
| The patient’s symptoms of cough, skin rash, fever, facial puffiness, photophobia, conjunctivitis, and hyperemic pharynx are suggestive of a viral infection. The bright, maculo-papular rash on the face, neck, and upper chest is a characteristic feature of measles, also known as rubeola. Measles is a highly contagious viral infection that is transmitted through respiratory droplets. It typically starts with non-specific symptoms such as fever, cough, and runny nose, followed by the development of a characteristic rash that spreads from the head to the trunk and extremities. Other symptoms may include conjunctivitis, photophobia, and facial puffiness. In this case, the patient’s symptoms are consistent with a diagnosis of measles. The dry rales in the lungs may indicate the presence of a secondary bacterial infection, which is a common complication of measles. Adenoviral infection, rubella, scarlet fever, and enterovirus exanthema can cause similar symptoms, but the presence of rash and conjunctivitis, as well as the specific features of the rash, make measles the most likely diagnosis in this case. Therefore, based on the patient’s symptoms and clinical presentation, the most likely diagnosis is measles, which can be confirmed by laboratory testing. Treatment is typically supportive and focused on managing the patient’s symptoms and preventing complications. Vaccination is the most effective way to prevent measles. |
72. A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37, 6oC. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall – 0,4 cm, choledochus – 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most likely diagnosis?
A. Alveolar echinococcus of liver
B. Liver cancer
C. Liver abscess
D. Cystous liver cancer
E. Paravesical liver abscesses
Answer: Alveolar echinococcus of liver
Explanation
| The patient’s symptoms of pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting, and weight loss, as well as the imaging findings of a hypoechoic formation in the liver, suggest a possible liver pathology. Alveolar echinococcosis is a parasitic infection caused by the larvae of the tapeworm Echinococcus multilocularis. It can lead to the development of a slow-growing, infiltrative mass in the liver, which can cause symptoms such as abdominal pain, weight loss, and jaundice. Liver cancer, either hepatocellular carcinoma or metastatic liver cancer, can also cause similar symptoms and imaging findings. However, the presence of multiple hypoechoic formations, as described in the question, may be more suggestive of metastatic liver cancer rather than hepatocellular carcinoma. Liver abscess, either pyogenic or amebic, can also cause similar symptoms and imaging findings. However, the presence of multiple hypoechoic formations with thick walls may be more suggestive of a parasitic or neoplastic etiology. Therefore, based on the limited information provided in the question, alveolar echinococcus of the liver is a possible diagnosis. However, further evaluation and diagnostic testing, such as serologic testing or biopsy, would be needed to confirm the diagnosis and determine the appropriate treatment. |
73. A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3,0 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed a stripe of hyperemia, skin edema and a painful cord. What complication is it?
A. Acute thrombophlebitis
B. Vein puncture and edema of paravenous cellular tissue
C. Necrosis of paravenous cellular tissue
D. Acute lymphangitis
E. Phlegmon of paravenous cellular tissue
Answer: Acute thrombophlebitis
Explanation
| The patient’s symptoms of tensive pain in the region of the right shoulder, hyperemia, skin edema, and a painful cord on examination are suggestive of acute thrombophlebitis, which is a common complication of intravenous infusion therapy. Acute thrombophlebitis is inflammation of a vein, often accompanied by the formation of a blood clot. It can cause symptoms such as pain, swelling, redness, and warmth along the affected vein. In this case, the hyperemia, skin edema, and painful cord on the interior brachial surface are consistent with acute thrombophlebitis of the right lunar vein, which may have been caused by the intravenous infusion therapy. Vein puncture and edema of paravenous cellular tissue, necrosis of paravenous cellular tissue, acute lymphangitis, and phlegmon of paravenous cellular tissue are other possible complications of intravenous infusion therapy, but they would present with different symptoms and signs. Therefore, based on the patient’s symptoms and clinical presentation, the most likely complication is acute thrombophlebitis, which should be confirmed by further evaluation, such as ultrasonography or venography. Treatment may involve anticoagulant therapy and/or surgical intervention, depending on the severity and extent of the thrombophlebitis. |
74. A children’s health camp received a party of tinned food. External examination of the tins revealed that they had deep dents; formed a concavity when pressed and didn’t immediately return to the initial state; rust was absent; the tins were greased with inedible fat. Specify the bloat type:
A. Physical
B. Chemical
C. Biological
D. Combined
E. Physicochemical
Answer: Physical
Explanation
| The given description of the tins suggests that the dents are deep and do not immediately return to their initial state when pressed. This indicates that there is a reduction in the internal pressure of the tins, which is a characteristic of physical bloating. Therefore, the bloat type in this case is Physical. |
75. In autumn a 25-year-old patient developed stomach ache that arose 1,5-2 hours after having meals and at night. He complains about pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Diaphragmatic hernia
D. Stomach ulcer
E. Chronic pancreatitis
Answer: Duodenal ulcer
Explanation
| Based on the symptoms and objective findings described, the most likely diagnosis for this patient is Duodenal Ulcer. Duodenal ulcer is a type of peptic ulcer that develops in the first part of the small intestine called the duodenum. The symptoms of duodenal ulcer typically include epigastric pain that arises 1.5-2 hours after eating, pyrosis (heartburn), and constipation. The pain can be exacerbated by spicy, salty, and sour foods, and can be relieved by taking antacids such as soda. The patient’s history of experiencing these symptoms for a year is also consistent with a diagnosis of duodenal ulcer. The objective findings of a furred moist tongue, epigastric pain on the right, and resistance of abdominal muscles in the same region are also consistent with a diagnosis of duodenal ulcer. However, it is important to note that other conditions such as chronic cholecystitis and stomach ulcer can also present with similar symptoms and signs. Therefore, further investigation such as endoscopy may be needed to confirm the diagnosis. |
76. On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?
A. The second intercostal space along the medioclavicular line
B. The eighth intercostal space along the posterior axillary furrow
C. The seventh intercostal space along the anterior axillary furrow
D. The sixth intercostal space along the anterior axillary furrow
E. The fifth intercostal space along the medioclavicular line
Answer: The second intercostal space along the medioclavicular line
Explanation
| The best place for pleural drainage in a patient with spontaneous pneumothorax depends on the size and location of the pneumothorax. However, in general, the most commonly used site for pleural drainage is the second intercostal space along the midclavicular line. Therefore, the correct answer to this question is A. The second intercostal space along the medioclavicular line. This site is preferred because it is relatively easy to locate, has a relatively low risk of damaging underlying structures, and is close to the apex of the lung where air tends to accumulate in cases of spontaneous pneumothorax. However, it is important to note that the choice of the drainage site may vary depending on the individual patient’s anatomy and the size and location of the pneumothorax. A chest X-ray or other imaging studies may be necessary to determine the most appropriate site for pleural drainage. |
77. A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR – 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
Answer: Ankylosing spondylitis
Explanation
| The symptoms described in this patient – pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine, elevated ESR, the presence of HLA B27 antigen, and radiographic evidence of bilateral sacroileitis – are highly suggestive of Ankylosing Spondylitis (AS). Therefore, the most likely diagnosis for this patient is AS. AS is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints, causing pain, stiffness, and limited mobility. The condition may also affect other joints such as the hips and shoulders. The presence of HLA B27 antigen is strongly associated with the development of AS, and radiographic imaging may reveal characteristic changes such as sacroiliitis, which is inflammation of the sacroiliac joints. Other conditions such as Reiter’s disease (reactive arthritis) may also present with similar symptoms, but the presence of HLA B27 antigen and radiographic evidence of sacroiliitis make AS the most likely diagnosis in this case. |
78. A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
A. Ihibitor of angiotensin converting enzyme
B. β-blocker
C. Calcium channel antagonist
D. Thiazide diuretic
E. α-blocker
Answer: Ihibitor of angiotensin converting enzyme
Explanation
| For the treatment of arterial hypertension in a patient with diabetes mellitus and proteinuria, the most appropriate drug choice would be an inhibitor of angiotensin-converting enzyme (ACE inhibitor). Therefore, the correct answer to this question is A. Inhibitor of angiotensin-converting enzyme. ACE inhibitors are a class of drugs that work by blocking the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor. By inhibiting this process, ACE inhibitors help to dilate blood vessels and reduce blood pressure. In addition, ACE inhibitors have been shown to have a renoprotective effect in patients with diabetes mellitus and proteinuria, which makes them an ideal choice for treating hypertension in this patient population. In contrast, beta-blockers, calcium channel antagonists, and thiazide diuretics are also commonly used to treat hypertension, but they may not have the same renoprotective effects as ACE inhibitors. Alpha-blockers are generally less effective in reducing blood pressure and are not commonly used as first-line therapy for hypertension. Therefore, in this case, an ACE inhibitor would be the most appropriate drug choice for treating hypertension and protecting the kidneys in a patient with diabetes mellitus and proteinuria. |
79. A 50-year-old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?
A. Bacteriological study
B. Antibiotic prophylaxis
C. Isolation
D. Dispensary surveillance
E. Vaccination
Answer: Bacteriological study
Explanation
| In the case of a patient diagnosed with typhoid fever, actions should be taken to prevent the spread of the disease to other people. One of the most important steps in this regard is to identify and test people who have come into contact with the patient. Therefore, the correct answer to this question is A. Bacteriological study. Bacteriological study involves testing the stool, blood, or urine of individuals who have been in close contact with the patient to determine if they are carriers of the bacteria that cause typhoid fever. This is important because carriers of the bacteria may not show any symptoms of the disease but can still spread it to others. By identifying carriers, appropriate measures such as antibiotic treatment or vaccination can be taken to prevent further spread of the disease. Antibiotic prophylaxis may also be considered in some cases, particularly for individuals who have had close contact with the patient. Isolation may be necessary in certain situations, such as in hospital settings or for patients who cannot adequately maintain personal hygiene. Dispensary surveillance may be recommended for individuals who have been identified as carriers of the bacteria to ensure that they receive appropriate treatment and follow-up care. Vaccination may also be recommended as a preventive measure for individuals who are at high risk of exposure to the bacteria. |
80. A child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and ill-defined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother’s side has bronchial asthma. What is the most likely diagnosis?
A. Atopic dermatitis
B. Contact dermatitis
C. Seborrheal eczema
D. Strophulus
E. Urticaria
Answer: Atopic dermatitis
Explanation
| Based on the symptoms and history provided, the most likely diagnosis for this child is Atopic Dermatitis. Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition that is characterized by dry, itchy skin and the presence of papules, vesicles, and lichenification in skin folds. The condition is often accompanied by a personal or family history of allergic diseases such as exudative diathesis, asthma, or hay fever. The fact that the child’s symptoms are worse in the winter and improve in the summer is also characteristic of atopic dermatitis, as dry winter air can exacerbate the condition, while warm and humid summer weather can provide relief. The child’s history of being artificially fed since 2 months of age may also increase the risk of developing atopic dermatitis, as breast milk has been shown to have a protective effect against the condition. Other conditions such as contact dermatitis, seborrheal eczema, strophulus, or urticaria may also present with similar symptoms, but the personal and family history of allergic diseases, along with the chronic and relapsing nature of the condition, make atopic dermatitis the most likely diagnosis in this case. |
81. 2 weeks after recovering from angina an 8-year-old boy developed edemata of face and lower limbs. Objectively: the patient is in grave condition, AP- 120/80 mm Hg. Urine is of dark brown colour. Oliguria is present. On urine analysis: relative density – 1,015, protein – 1,2 g/l, RBCs are leached and cover the whole vision field, granular casts – 1-2 in the vision field, salts are represented by urates (big number). What is the most likely diagnosis?
A. Acute glomerulonephritis with nephritic syndrome
B. Acute glomerulonephritis with nephrotic syndrome
C. Acute glomerulonephritis with nephrotic syndrome, hematuria and hypertension
D. Acute glomerulonephritis with isolated urinary syndrome
E. Nephrolithiasis
Answer: Acute glomerulonephritis with nephritic syndrome
Explanation
| The symptoms and objective findings described in this case are consistent with Acute Glomerulonephritis (AGN) with nephritic syndrome. Therefore, the most likely diagnosis for this patient is A. Acute Glomerulonephritis with nephritic syndrome. AGN is a type of kidney disease that is characterized by inflammation of the glomeruli, which are the tiny blood vessels in the kidneys that filter waste products from the blood. Nephritic syndrome is a type of kidney disease that is characterized by hematuria (presence of blood in the urine), proteinuria (presence of protein in the urine), oliguria (reduced urine output), and edema (swelling) of the face and lower limbs. The presence of dark brown urine, RBCs leached and covering the whole vision field, and granular casts on urine analysis are also indicative of AGN with nephritic syndrome. Nephrotic syndrome, which is characterized by heavy proteinuria, hypoalbuminemia, and edema, is less likely in this case because the proteinuria is not heavy (1.2 g/l) and the patient’s serum albumin level is not mentioned. Hypertension is also not a defining feature of nephrotic syndrome. Acute glomerulonephritis with isolated urinary syndrome is a rare subtype of AGN that is characterized by isolated hematuria and mild proteinuria, without significant edema or hypertension, which is not consistent with the findings in this case. Nephrolithiasis is also unlikely to cause the combination of symptoms and findings described in this patient. |
82. A 60-year-old female patient was admitted to a hospital for acute transmural infarction. An hour ago the patient’s contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate – 30/min, heart rate – 130/min, AP- 90/60 mm Hg. Heart sounds are muffled, diastolic shock on the pulmonary artery. There are medium moist rales in the lower parts of lungs on the right and on the left. Body temperature – 36, 4oC. What drug should be given in the first place?
A. Promedol
B. Aminophylline
C. Dopamine
D. Heparin
E. Digoxin
Answer: Promedol
Explanation
| The symptoms and findings described in this case suggest that the patient is experiencing acute left ventricular failure, which may be due to the acute transmural infarction. Therefore, the most appropriate drug to administer in the first place would be a medication to relieve the patient’s symptoms and alleviate her distress. The correct answer to this question is A. Promedol. Promedol, also known as meperidine, is an opioid analgesic that is commonly used to relieve pain and dyspnea in patients with acute heart failure. It can help to reduce respiratory rate, heart rate, and blood pressure, and improve oxygenation. Opioids are also effective in reducing anxiety and agitation, which can be beneficial in calming the patient and reducing the work of breathing. Aminophylline, dopamine, heparin, and digoxin are all medications that may be used in the treatment of acute heart failure, but they are not appropriate as the first-line drug in this case. Aminophylline is a bronchodilator that may improve bronchospasm and respiratory function in patients with acute heart failure, but it is unlikely to be effective in relieving the patient’s distress in the short-term. Dopamine is a vasopressor that may help to increase blood pressure, but it can also increase heart rate and oxygen demand, which may be detrimental in this case. Heparin is an anticoagulant that may be used to prevent thrombosis in patients with acute coronary syndrome, but it is not indicated as the first-line drug in the treatment of acute heart failure. Digoxin is a medication that may be used to improve cardiac function and reduce symptoms in patients with chronic heart failure, but it is not effective as the first-line drug in the treatment of acute heart failure. |
83. A 52-year-old male patient complains about attacks of asphyxia, pain in his right side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his side. Objectively: heart rate – 102/min, respiratory rate – 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?
A. Angiography of pulmonary vessels
B. Echocardioscopy
C. Study of external respiration function
D. ECG E. Coagulogram
Answer: Angiography of pulmonary vessels
Explanation
| The symptoms and findings described in this case suggest that the patient may be experiencing a pulmonary embolism, which is a potentially life-threatening condition that occurs when a blood clot blocks one of the pulmonary arteries. Therefore, the most informative examination method for a diagnosis would be a test to directly visualize the pulmonary vessels. The correct answer to this question is A. Angiography of pulmonary vessels. Angiography is a diagnostic procedure that involves injecting a contrast dye into the blood vessels and taking X-ray images to visualize the blood flow. Pulmonary angiography is the gold standard for diagnosing pulmonary embolism, as it allows for direct visualization of the pulmonary arteries and the thrombus that is causing the obstruction. However, this test is invasive and carries some risks, so it may not be appropriate for all patients. Other tests that may be useful in the diagnosis of pulmonary embolism include echocardiography, which can detect signs of right ventricular dysfunction and pulmonary hypertension, and ECG, which can reveal signs of right ventricular strain. A coagulogram, which is a blood test to assess coagulation parameters, may also be useful in identifying the underlying cause of the pulmonary embolism, such as a clotting disorder. However, in this case, given the sudden onset of symptoms and the presence of signs such as diastolic shock above the pulmonary artery, gallop rhythm, and pleural friction rub, which are suggestive of a pulmonary embolism, angiography of pulmonary vessels would be the most informative test to confirm the diagnosis and guide further management. |
84. A primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?
A. Incipient abortion
B. Risk of abortion
C. Abortion in progress
D. Incomplete abortion
E. Missed miscarriage
Answer: Incipient abortion
Explanation
| The symptoms and findings described in this case suggest that the patient may be experiencing an incipient abortion, which is a threatened miscarriage that has not yet progressed to the point of active bleeding. Therefore, the most likely diagnosis for this patient is A. Incipient abortion. The presence of pain in the lower abdomen, increased uterine tonus, and bloody discharge from the genital tract are all indicative of a threatened miscarriage. The fact that the cervix is contracted and the external orifice is open by 2 cm suggests that the process of cervical dilation has already begun. However, the fetus is still moving, and there is no active bleeding, which indicates that the miscarriage is not yet complete. A risk of abortion implies that there is a possibility of miscarriage occurring in the future, but there are no symptoms or signs that indicate that a miscarriage is currently in progress. Abortion in progress implies that the miscarriage has already begun, and there is active bleeding and products of conception are being expelled from the uterus. Incomplete abortion implies that only a portion of the products of conception have been expelled, while the rest remain in the uterus. Missed miscarriage implies that the fetus has died, but the products of conception have not been expelled from the uterus, and the patient may not have any symptoms or signs of miscarriage. Given the symptoms and findings described in this case, the most appropriate management would be to hospitalize the patient and monitor her closely for signs of progression, while providing supportive care and considering interventions such as cervical cerclage or administration of progesterone to help prevent the miscarriage from progressing. |
85. On the 4th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient’s condition is moderately severe. Respiratory rate – 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?
A. Acute pulmonary abscess
B. Exudative pleuritis
C. Acute focal pneumonia
D. Pleural empyema
E. Pyopneumothorax
Answer: Acute pulmonary abscess
Explanation
| The symptoms and findings described in this case suggest that the patient may be experiencing an acute pulmonary abscess, which is a localized collection of pus within the lung parenchyma. Therefore, the most likely diagnosis for this patient is A. Acute pulmonary abscess. The presence of solitary spittings of mucoid sputum followed by a large discharge of purulent blood-streaked sputum is indicative of an inflammatory process in the lungs. The respiratory rate and heart rate are elevated, which indicates respiratory distress. The asymmetric breath sounds and moist rales of different types above the lower lobe, as well as the amphoric breath near the angle of scapula, suggest the presence of a localized area of consolidation and destruction within the lung parenchyma. Exudative pleuritis, acute focal pneumonia, pleural empyema, and pyopneumothorax are all possible differential diagnoses that may present with similar symptoms and findings. Exudative pleuritis is an inflammation of the pleural cavity that can cause chest pain and dyspnea, but it typically does not cause the production of large amounts of purulent sputum. Acute focal pneumonia is a localized inflammation of the lung parenchyma that can cause cough, fever, and dyspnea, but it typically does not cause the production of large amounts of purulent sputum either. Pleural empyema is a collection of pus within the pleural cavity that can cause fever, chest pain, and dyspnea, but it typically does not cause the asymmetric breath sounds and moist rales that are present in this case. Pyopneumothorax is a combination of pleural empyema and pneumothorax, which can cause chest pain, dyspnea, and respiratory distress, but it typically presents with a larger air-fluid level on chest X-ray than what is described in this case. Therefore, based on the symptoms and findings described, the most likely diagnosis for this patient is acute pulmonary abscess. Further diagnostic tests such as chest X-ray, CT scan, and sputum culture may be helpful in confirming the diagnosis and guiding further management. |
86. 350 workers of a mettalurgical plant had to undergo a yearly preventive examination. A territorial polyclinic carried out preventive examination of 325 workers. As a result of it, 1 worker was recognized as temporarily disabled, 15 workers underwent further rehabilitation at an after-work sanatorium, 10 workers were provided with diet meal. What index characterizing the preventive work of the polyclinic should be applied in this case?
A. Coverage of preventive medical examinations
B. Frequency of case detection during examinations
C. Percentage of people who underwent rehabilitation at an after-work sanatorium
D. Percentage of people who were provided with diet meal
E. Percentage of temporarily disabled people
Answer: Coverage of preventive medical examinations
Explanation
| The index that characterizes the preventive work of the polyclinic in this case is A. Coverage of preventive medical examinations. Coverage of preventive medical examinations refers to the proportion of the target population that undergoes a specific preventive medical examination. In this case, the target population is the 350 workers of the metallurgical plant who were supposed to undergo a yearly preventive examination. The polyclinic carried out preventive examination of 325 workers, which means that the coverage of preventive medical examinations is 325/350 or approximately 93%. The other options listed in the question refer to different outcomes of the preventive examination, such as the frequency of case detection, the percentage of people who underwent rehabilitation at an after-work sanatorium, the percentage of people who were provided with a diet meal, or the percentage of temporarily disabled people. While these outcomes are important indicators of the effectiveness of the preventive work, they do not directly measure the coverage of preventive medical examinations, which is the main focus of the question. |
87. A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl didn’t undergo any treatment. The girl’s irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin got a waxen hue. What disease may be assumed?
A. Autoimmune thyroiditis
B. Diffuse toxic goiter
C. Thyroid carcinoma
D. Subacute thyroiditis
E. Juvenile basophilism
Answer: Autoimmune thyroiditis
Explanation
| The symptoms and findings described in this case suggest that the patient may be experiencing autoimmune thyroiditis, also known as Hashimoto’s thyroiditis, which is a chronic autoimmune disorder that causes inflammation of the thyroid gland and gradual destruction of thyroid tissue. Therefore, the most likely diagnosis for this patient is A. Autoimmune thyroiditis. The diffuse enlargement of the thyroid gland (II grade) and the presence of irritability and tearfulness in a 14-year-old girl are suggestive of a thyroid disorder. The progression of symptoms to apathy, puffy face, soft tissue pastosity, and bradycardia, as well as the skin pallor and waxen hue, suggest that the patient may be experiencing hypothyroidism, which occurs when the thyroid gland is unable to produce enough thyroid hormone to meet the body’s needs. Autoimmune thyroiditis is the most common cause of hypothyroidism in children and adolescents. The disease is characterized by the presence of autoimmune antibodies that attack the thyroid gland, leading to inflammation and destruction of thyroid tissue over time. The symptoms and findings described in this case, such as the diffuse enlargement of the thyroid gland, the progression of symptoms to hypothyroidism, and the waxen hue of the skin, are all typical of autoimmune thyroiditis. Diffuse toxic goiter, thyroid carcinoma, subacute thyroiditis, and juvenile basophilism are all possible differential diagnoses that may present with similar symptoms and findings. However, given the gradual onset and progression of symptoms and the presence of a diffuse enlargement of the thyroid gland, autoimmune thyroiditis is the most likely diagnosis. Therefore, based on the symptoms and findings described, the most likely diagnosis for this patient is autoimmune thyroiditis. Further diagnostic tests such as thyroid function tests and thyroid antibody tests may be helpful in confirming the diagnosis and guiding further management. |
88. A newborn’s head is of dolichocephalic shape, that is front-to-back elongated. Examination of the occipital region of head revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. The delivery tok place with the following type of fetus head presentation:
A. Posterior vertex presentation
B. Anterior vertex presentation
C. Presentation of the bregma
D. Brow presentation
E. Face presentation
Answer: Posterior vertex presentation
Explanation
| The newborn’s head shape and the location of the labour tumor suggest that the delivery took place with a posterior vertex presentation, which is option A. A dolichocephalic head shape is characterized by a longer front-to-back measurement than side-to-side, and it is a normal variation of head shape. A labor tumor, also known as caput succedaneum, is a swelling that forms on the baby’s head during labor due to the pressure of the birth canal. It typically appears on the part of the head that presents first and can be located between the anterior and posterior fontanels. In a posterior vertex presentation, the baby’s head is facing downward, and the occiput (back of the head) is presenting first. This is the most common presentation during labor, accounting for approximately 95% of all vaginal deliveries. The occiput is the largest and most compressible part of the fetal head, and it is designed to mold and adapt to the shape of the birth canal during labor. This can result in the formation of a labor tumor on the occipital region of the baby’s head. Anterior vertex presentation (option B) occurs when the baby’s head is facing downward, and the sinciput (forehead) is presenting first. Presentation of the bregma (option C) occurs when the baby’s head is facing upward, and the bregma (junction of the sagittal and coronal sutures) is presenting first. Brow presentation (option D) occurs when the baby’s head is partially extended, and the brow is presenting first. Face presentation (option E) occurs when the baby’s head is fully extended, and the face is presenting first. |
89. A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with mercazolil?
A. Propranolol
B. Radioactive iodine
C. Procaine hydrochloride
D. Verapamil
E. Corinfar
Answer: Propranolol
Explanation
| Diffuse toxic goiter, also known as Graves’ disease, is a condition in which the thyroid gland produces too much thyroid hormone, leading to hyperthyroidism. Ciliary arrhythmia, also known as atrial fibrillation, is a common complication of hyperthyroidism, and it can lead to an increased risk of stroke and heart failure. Arterial hypertension, or high blood pressure, is also a common feature of hyperthyroidism. Mercazolil, also known as methimazole, is an antithyroid medication commonly used to treat hyperthyroidism by blocking the production of thyroid hormone. However, it does not address the other symptoms and complications of hyperthyroidism, such as ciliary arrhythmia and hypertension. Propranolol is a beta-blocker medication that can be used to help control the symptoms of ciliary arrhythmia and hypertension in patients with hyperthyroidism. Beta-blockers work by blocking the effects of adrenaline on the heart and blood vessels, which can lower the heart rate and blood pressure and reduce the risk of complications such as stroke and heart failure. Therefore, in this case, propranolol should be administered along with mercazolil to help control the patient’s ciliary arrhythmia and hypertension. It is important to note that the use of beta-blockers in patients with hyperthyroidism should be carefully monitored, as they can mask some of the symptoms of hyperthyroidism and may need to be adjusted as the patient’s thyroid function improves with treatment. |
90. Over a current year among workers of an institution 10% haven’t been ill a single time, 30% have been ill once, 15% – twice, 5% – 4 times, the rest – 5 and more times. What is the percentage of workers relating to the I health group?
A. 55%
B. 10%
C. 40%
D. 60%
E. 22%
Answer: 55%
Explanation
| The workers can be divided into different health groups based on the number of times they were ill during the year. The percentage of workers in each health group can be calculated as follows: – Group I: workers who haven’t been ill a single time = 10% – Group II: workers who have been ill once = 30% – Group III: workers who have been ill twice = 15% – Group IV: workers who have been ill four times = 5% – Group V: workers who have been ill five or more times = 100% – (10% + 30% + 15% + 5%) = 40% The question asks for the percentage of workers in the I health group, which is the group of workers who haven’t been ill a single time. According to the given data, 10% of the workers fall into this group. Therefore, the percentage of workers in the I health group is 10%, and the correct answer is A. 55%, B. 10%, C. 40%, D. 60%, E. 22%. |
91. A 16-year-old boy was admitted to the hospital for the reason of intractable nasal haemorrhage and intolerable pain in the right cubital articulation. Objectively: the affected articulation is enlarged and exhibits defiguration and skin hyperaemia. There are manifestations of arthropathy in the other articulations. Ps- 90 bpm; colour index – 1,0, WBC – 5, 6 · 109/l, thrombocytes- 220 · 109/l, ESR – 6 mm/h. Lee-White coagulation time: start – 24’, finish – 27’10”. What drug will be the most effective for this patient treatment?
A. Cryoprecipitate
B. Calcium chloride
C. Erythromass
D. Aminocapronic acid
E. Vicasol
Answer: Cryoprecipitate
Explanation
| The patient presents with intractable nasal hemorrhage and arthropathy. The Lee-White coagulation time shows a prolonged clotting time, which suggests a clotting factor deficiency. The most likely diagnosis is Hemophilia A or B, which are X-linked recessive disorders characterized by a deficiency in clotting factor VIII or IX, respectively. Cryoprecipitate is a blood product that contains high concentrations of clotting factors, including factor VIII and fibrinogen. It is the most effective treatment for patients with hemophilia A or B who are experiencing bleeding or require prophylaxis before a surgical procedure. Cryoprecipitate can help to restore the patient’s clotting ability and control the bleeding. Calcium chloride (option B) is a medication used to treat hypocalcemia, hyperkalemia, and hypomagnesemia. It does not have a role in the treatment of hemophilia. Erythromass (option C) is not a known medication or treatment for hemophilia or bleeding disorders. Aminocapronic acid (option D) is an antifibrinolytic medication that can be used to help control bleeding in patients with hemophilia. However, it is not as effective as cryoprecipitate in treating acute bleeding episodes. Vicasol (option E) is a synthetic form of vitamin K that can be used to treat bleeding disorders caused by vitamin K deficiency. It is not effective in treating hemophilia. Therefore, in this case, the most effective treatment for the patient’s bleeding is cryoprecipitate. |
92. A 42-year-old woman complains about bruises on her both legs and prolonged menstruation; general weakness, tinnitus cerebri. Objectively: multiple macular haemorrhages on the legs and body. The patient presents with tachypnoe, tachycardia, systolic murmur in all auscultatory points. AP- 75/50 mm Hg. Blood count: RBC – 1, 9 · 1012/l, Нb- 60 g/l, colour index – 0,9, WBC – 6, 5 · 109/l, thrombocytes – 20 · 109/l, ESR- 12 mm/h. Duke bleeding time – 12 minutes. Bone marrow analysis revealed plenty of juvenile immature forms of megacaryocytes without signs of thrombocyte pinch-off. What is the most likely diagnosis?
A. True thrombocytopenic purpura
B. Type A haemophilia
C. Willebrand’s disease
D. Acute megacaryoblastic leukemia
E. Tupe B haemophilia
Answer: True thrombocytopenic purpura
Explanation
| True thrombocytopenic purpura. The key indicators that point to this diagnosis are: – The bruised appearance on the legs and body, due to multiple macular haemorrhages, which indicates low platelet count (thrombocytopenia). – The prolonged bleeding time of 12 minutes, which is evidence of impaired blood clotting due to a low platelet count. – The low platelet count of 20 · 109/l (the normal range is 150-400 · 109/l). – The bone marrow analysis showing plenty of immature megakaryocytes without platelet formation. This indicates the thrombocytopenia is due to impaired platelet production in the bone marrow, not peripheral destruction of platelets. The other options can be ruled out as follows: B. Type A haemophilia – There is no mention of abnormal blood clotting times for factors VIII or IX, which are deficient in haemophilia. C. Willebrand’s disease – This would show an elevated bleeding time, not a prolonged one as stated. D. Acute megakaryocytic leukaemia – There are no significant abnormalities in the white cell count to suggest leukaemia. E. Type B haemophilia – Again there is no evidence of deficiencies in clotting factors II, V, X, etc that cause this type of haemophilia. Hope this explanation helps! Let me know if you have any other questions. |
93. A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness, dizziness, memory impairment, sleepiness at daytime and insomnia at night, sense of hair in the mouth, colicky pains in the right subcostal region. What is the most likely diagnosis?
A. Chronic tetraethyl lead intoxication
B. Alcoholic delirium
C. Chronic mercury intoxication
D. Chronic manganese intoxication
E. Chronic lead intoxication
Answer: Chronic tetraethyl lead intoxication
Explanation
| The symptoms described are consistent with lead poisoning from exposure to ethyl gasoline, which contains tetraethyl lead as an anti-knocking agent. The main signs and symptoms that point to lead poisoning are: – General weakness and fatigue: A common symptom of chronic lead poisoning due to damage to red blood cells and the kidneys. – Memory impairment: Lead exposure can damage the brain and nervous system, causing cognitive issues. – Insomnia and daytime sleepiness: Disturbed sleep is a classic symptom of lead toxicity. – Paresethesia (feeling of hair in the mouth): A symptom of peripheral neuropathy, which is a complication of lead poisoning. – Colicky abdominal pains: A frequent symptom of chronic lead toxicity, thought to be due to spasm of smooth intestinal muscles. The other possible diagnoses: B. Alcoholic delirium – There is no mention of alcohol consumption in the history. C. Mercury intoxication – The symptom profile is not typical for mercury poisoning. D. Manganese intoxication – Similar symptoms but no exposure history to manganese. E. Lead intoxication – Correct in implicating lead as the cause, but the exposure is specifically to tetraethyl lead in ethyl gasoline. So in summary, the specific exposure to ethyl gasoline which contains tetraethyl lead, combined with the characteristic symptoms of chronic lead toxicity, makes option A the most likely diagnosis for this patient. |
94. A 30-year old woman taken by influenza has empty stomach glycemia at the rate of 11,3 millimole/l, glucosuria at the rate of 25 g/l. The patient is 168 cm tall and weighs 67 kg. What test would be the most informative for the diagnosis specifi- cation?
A. Insulinemia on an empty stomach
B. Daily glycemia variability
C. Daily glucosuria variability
D. Glycemia test an hour after taking meals
E. Glucose tolerance test
Answer: Insulinemia on an empty stomach
Explanation
| The most informative test given the information provided would be an insulin level on an empty stomach, option A. The key factors that point to this are: – The patient has high blood sugar levels (hyperglycemia) both on an empty stomach and with glucosuria, suggesting possible diabetes. – The acute influenza infection could be triggering a stress-induced hyperglycemic state. – Measuring the patient’s insulin level on an empty stomach would reveal whether they have adequate insulin production and secretion (normal insulinemia) or insulin deficiency (low insulinemia). This would help determine the cause of the hyperglycemia – whether due to insufficient insulin or insulin resistance. Options B, C and D (glycemia variability tests) would not provide as much useful information, as the key question is whether the patient has adequate insulin levels. Option E, a glucose tolerance test, would also be useful but is a more invasive test involving giving the patient a glucose drink and monitoring blood sugar over time. Measuring the baseline insulin levelfirst would give valuable initial information before proceeding to the glucose tolerance test. So in summary, measuring insulinemia on an empty stomach would be the most informative initial test to help determine the cause and nature of the patient’s hyperglycemia, and guide next steps in their diagnosis and management. |
95. A 52-year-old male patient has an 18 year history of diabetes mellitus. One year ago he had cystitis. The patient takes 0,005 g of maninil thrice a day. Objectively: height – 176 cm, weight – 82 kg. Glycemia variability on an empy stomach is at the rate of 10,3-12,4 millimole/l. Analyses revealed proteinuria at the rate of 0,033 g/l. The most efficient way to prevent diabetic nephropathy progress will be:
A. To replace maninil with insulin
B. To increase maninil dosage
C. To decrease daily caloric content
D. To supplement the present therapy with insulin
E. To administer antibacterial therapy
Answer: To replace maninil with insulin
Explanation
| The most effective way to prevent progression of diabetic nephropathy in this patient would be to replace the oral hypoglycemic medication (maninil) with insulin therapy, option A. The reasons for this are: 1. The patient has a long history of poorly controlled diabetes, as evidenced by the high and variable blood sugar levels over 18 years. This places him at high risk for diabetic complications like nephropathy. 2. Maninil monotherapy has not provided adequate blood sugar control, as seen by the ongoing hyperglycemia. Switching to insulin will allow for tighter and more consistent blood sugar control. 3. Tighter blood sugar control, especially with insulin, has been shown to help slow the progression of diabetic nephropathy and other complications. Options B and C (increasing maninil dose or reducing calories) would likely not provide enough improvement in glycemic control. Option D (supplementing maninil with insulin) may be considered but complete replacement of maninil with insulin would be most effective. Option E (antibiotic therapy) would not help with preventing progression of nephropathy, as this is primarily a consequence of long-term hyperglycemia, not infection. In summary, for this patient with a long history of poorly controlled type 2 diabetes and evidence of diabetic nephropathy, replacing oral medication with insulin therapy offers the best chance of achieving optimal blood sugar control and preventing further kidney damage. |
96. A 34-year-old female patient complains about weakness, 12 kg weight loss within 6 months, sweating, palpitation, irritability. Objectively: III grade thyroid gland is elastic, diffuse enlargement is present, there is also a node in the right lobe. Cervical lymph nodes are not enlarged. What treatment tactics would be the most rational?
A. Operation after antithyroid therapy
B. Radioactive iodine administration
C. Immediate surgical intervention
D. Conservative antithyroid therapy
E. Immediate gamma-ray teletherapy
Answer: Operation after antithyroid therapy
Explanation
| The most rational treatment approach for this patient would be option A: operation after antithyroid therapy. The key factors that point to this are: 1. The patient’s symptoms of weight loss, palpitations, sweating and irritability are typical of hyperthyroidism, likely due to Graves’ disease given the diffuse enlargement and node found on exam. 2. Surgical removal of the thyroid gland (thyroidectomy) is a definitive treatment for Graves’ disease hyperthyroidism. 3. However, antithyroid drug therapy should be given first to help bring the patient’s thyroid hormone levels under control and minimize the risks of surgery. This includes medications like methimazole, propylthiouracil and iopanoic acid. 4. Once the patient is euthyroid on antithyroid drugs, thyroidectomy can then be performed electively to provide a lasting cure. In contrast, options B, C, D and E would not be as ideal: B) Radioactive iodine would not provide a rapid cure and may require multiple treatments. C) Immediate surgery poses risks while the patient is still hyperthyroid. D) Conservative drug therapy alone may not provide lasting control of symptoms. E) External beam radiation (gamma ray teletherapy) is no longer commonly used due to risks of damage to surrounding tissues. So in summary, for this patient with newly diagnosed hyperthyroidism likely due to Graves’ disease, initial treatment with antithyroid medications to stabilize the patient’s condition followed by elective thyroidectomy once euthyroid offers the best balance of efficacy and safety. |
97. On the next day after being taken by influenza a 46-year-old woman presented with intensified headache, dizziness, nausea. Objectively: the patient is conscious, psychomotor excitement is present; there is general hyperesthesia, moderate meningeal syndrome, nystagmus. Tendon teflexes are higher on the right, right extremities display muscle weakness, right-sided pathological Babinski’s sign is present. Liquor is transparent, pressure is 220 mm of water column; cytosis is 46/3 with prevailing lymphocytes. What is the most likely diagnosis?
A. Influenzal meningoencephalitis
B. Bacterial meningoencephalitis
C. Subarachnoidal haemorrhage
D. Parenchymatous subarachnoidal haemorrhage
E. Ischemic stroke
Answer: Influenzal meningoencephalitis
Explanation
| The key factors that point to this are: • The patient recently had influenza, which is a risk factor for developing secondary bacterial or viral infections like meningoencephalitis. • The symptoms of worsened headache, dizziness and nausea are consistent with meningitis or encephalitis. • The neurological exam findings of meningeal signs, nuchal rigidity, altered mental status, nystagmus and right-sided hemiparesis all suggest inflammation of the meninges and brain. • The cerebrospinal fluid shows increased white blood cells predominantly lymphocytes, which is typical for viral meningoencephalitis. • The acute onset shortly after influenza infection suggests the meningoencephalitis was triggered by the influenza virus. Options B through E can be ruled out as follows: B) Bacterial meningoencephalitis – CSF would show predominantly neutrophils rather than lymphocytes C) Subarachnoid hemorrhage – CSF would appear xanthochromic (yellowish), not clear as stated D) Parenchymal hemorrhage – No neurological deficits or exam findings to suggest this E) Ischemic stroke – Unlikely to develop this acutely after an influenza infection So in summary, given the acute onset following influenza, typical neurological and CSF findings, and absence of signs of hemorrhage or ischemia, influenzal meningoencephalitis is the most likely diagnosis for this patient. |
98. After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?
A. Radiation therapy + operation + chemotherapy
B. Operation only
C. Operation + radiation therapy
D. Radiation therapy only
E. Chemotherapy only
Answer: Radiation therapy + operation + chemotherapy
Explanation
| The recommended treatment plan for this breast cancer patient would be option A: radiation therapy + operation + chemotherapy. The reasons are: 1. The tumor is classified as T2N2M0, meaning it is a large tumor (size 2-5cm) that has spread to 4-9 lymph nodes but has not metastasized. This indicates a more advanced stage of disease. 2. The tumor is grade II, meaning it is somewhat differentiated but still aggressive. 3. For large, node-positive or higher grade breast cancers, a multimodality approach with surgery, radiation and chemotherapy provides the best chance of local control and long-term survival. 4. Surgery (mastectomy or lumpectomy) will remove as much of the primary tumor as possible. 5. Radiation therapy after surgery will help kill any remaining local cancer cells and reduce the risk of recurrence. 6. Chemotherapy, particularly with anthracyclines and taxanes, is highly effective for this subtype of breast cancer and helps destroy any micrometastases not detected. In contrast, options B through E would be incomplete approaches that are unlikely to adequately control the cancer given its size, nodal involvement and grade: B) Surgery alone would miss micrometastases and residual cancer cells C) Surgery and radiation only may not address possible distant dissemination D) Radiation alone cannot treat possible micrometastases E) Chemotherapy alone cannot fully resect the primary tumor So a multidisciplinary treatment approach with surgery, radiation and chemotherapy together provides the patient with the best chance of a positive outcome based on the described characteristics of her breast cancer. |
99. A 34-year-old male patient was delivered to the neurological department with complaints of intense headache, double vision, light and noise intolerance. The attack came suddenly while load lifting. Objectively: torpor, moderate divergent strabismus, diplonia. Bilateral Kernig’s symptoms. No paresises. Bloody liquor. What medication should be administered in the first line?
A. Epsilon-aminocapronic acid
B. Acetylsalicilic acid
C. Heparin
D. Nicotinic acid
E. Glutamic acid
Answer: Epsilon-aminocapronic acid
Explanation
| The first-line medication to administer for this patient would be epsilon-aminocapronic acid (option A). The key factors that point to this are: – The sudden, intense headache with symptoms of increased intracranial pressure like nausea, photophobia and phonophobia indicate an intracranial catastrophe likely a ruptured aneurysm or arteriovenous malformation. – The presence of blood in the cerebrospinal fluid is consistent with subarachnoid hemorrhage. – Epsilon-aminocapronic acid is a antifibrinolytic agent that helps stabilize blood clots and reduce bleeding. It can help prevent rebleeding from the ruptured blood vessel, which is a major risk in the immediate aftermath of subarachnoid hemorrhage. – Administration of epsilon-aminocapronic acid as soon as possible after the hemorrhage can improve outcomes by reducing the risk of a second, potentially fatal bleed. In contrast, the other medications would not be as appropriate as first-line treatment: B) Aspirin is a blood thinner and could worsen bleeding C) Heparin is also a blood thinner D) Nicotinic acid does not have an indicated use in subarachnoid hemorrhage E) Glutamic acid has no role in acute subarachnoid hemorrhage management So in summary, given the goal of stabilizing the initial bleed and preventing rebleeding in this patient, epsilon-aminocapronic acid is the best first-line medication to promptly administer. Additional evaluation and management can then be pursued based on the patient’s response and condition. |
100. A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a significant relief. Which of the following mechanisms of action provided antishock effect of morphine in this patient?
A. Stimulation of opiate receptors
B. Block of central cholinergic receptors
C. Stimulation of benzodiazepine receptors
D. Inhibition of dopamine mediation
E. Intensification of GABA-ergic reactions
Answer: Stimulation of opiate receptors
Explanation
| The mechanism by which morphine provided pain relief and antishock effects in this patient is option A: stimulation of opiate receptors. Morphine is an opioid agonist that works by activating μ-opioid receptors in the brain, spine and peripheral nervous system. This results in: 1. Inhibition of nociceptive neurons in the substantia gelatinosa of the spinal cord, blocking pain transmission. This provides the direct analgesic or pain relieving effect. 2. Stimulation of the autonomic nervous system, leading to peripheral vasodilation, reduced sympathetic outflow and decreased motor activity. These cardiovascular effects counteract shock states. 3. Release of endogenous opioids like enkephalins and endorphins that also bind to μ-opioid receptors and further enhance analgesia. Option B is incorrect because morphine does not block central cholinergic receptors. Options C and E are incorrect because morphine does not directly act on benzodiazepine or GABA receptors. And option D is incorrect – morphine does not inhibit dopamine. So in summary, the pain relief and antishock effects experienced by this patient after receiving morphine were mediated primarily through stimulation of μ-opioid receptors in the central and peripheral nervous systems. This provides potent analgesia as well as cardiovascular effects that help counteract shock states. |
