1. The parents complain that from the first weeks of life, their 11-month-old child had a constant cough with difficult expectoration. Objectively, the child lags behind in physical development, and cyanosis of the nasolabial triangle is observed. Laboratory testing results: neutrophilic leukocytosis, blood electrolytes (Na 130 mmol/L, CI-88 mmol/L), sweat chlorides 80 mmol/L. What is the most likely diagnosis in this case?
A. Congenital lung defect
B. Pneumonia
C. Bronchiolitis
D. Mucoviscidosis
E. Acute obstructive bronchitis
Correct Answer D. Mucoviscidosis
| Explanation: Mucoviscidosis, also known as cystic fibrosis, is characterized by chronic cough, difficulty in expectoration, delayed physical development, and cyanosis. The elevated sweat chloride levels (80 mmol/L) are particularly indicative of cystic fibrosis. The electrolyte imbalances, such as low sodium and chloride levels in blood, further support this diagnosis. Why other options are incorrect: Congenital lung defect usually presents with symptoms shortly after birth, and the specific symptoms of difficulty in expectoration and high sweat chloride levels are not typical. Pneumonia would typically present with an acute illness, fever, and possibly localized lung findings, and sweat chloride levels would not be elevated. Bronchiolitis primarily affects infants under 2 years and is usually caused by viral infections with symptoms including wheezing and respiratory distress, rather than elevated sweat chloride levels. Acute obstructive bronchitis is generally a temporary condition with acute symptoms, whereas cystic fibrosis is a chronic condition with persistent symptoms and specific diagnostic findings like elevated sweat chloride. |
2. A 20-year-old woman complains of a fever of 39°C, headache in the frontal region, pain in the eyes, photosensitivity, muscle pain, and dry cough. According to the patient’s medical history, she became acutely ill the day before. Objectively, her condition is severe, her face is hyperemic, her eyes are shiny, with injected sclera. Pulse 96/min., rhythmic. Heart sounds are muffled. Scattered dry crackles can be heard in the lungs. The oropharyngeal mucosa is hyperemic, and granular, with dilated vessels. There are no meningeal symptoms. Complete blood count: leukocytes-3-109/L, eosinophils-1%, band neutrophils-6%, segmented neutrophils 51%, lymphocytes 35%, monocytes 7%. What is the most likely diagnosis in this case?
A. Meningococcal infection
B. Influenza
C. Pneumonia
D. Measles
E. Epidemic typhus
Correct Answer: B. Influenza
| Explanation: Influenza presents with high fever, headache, muscle pain, dry cough, and photophobia. The patient’s symptoms of a severe illness with fever, myalgias, dry cough, and hyperemic oropharyngeal mucosa align with influenza. The presence of scattered dry crackles in the lungs and a leukocyte count showing a slight neutrophil predominance (with relative lymphocytosis) supports this diagnosis. Why other options are incorrect: Meningococcal infection typically presents with more severe meningeal symptoms like neck stiffness, photophobia, and altered mental status, which are absent here. Pneumonia would generally present with more pronounced lung findings and symptoms like purulent sputum, and it would likely show a different white blood cell profile. Measles usually involves a characteristic rash and Koplik spots, which are not mentioned in the symptoms described. Epidemic typhus typically involves a history of exposure, and symptoms include rash, fever, and often signs of systemic infection, which are not fully described in this case. |
3.A 24-year-old man complains of pain in the epigastrium that occurs 1-1.5 hours after eating, night pain, and frequent vomiting that brings relief. According to the patient’s medical history, he abuses alcohol and is a heavy smoker. Objectively, the tongue is clean, Superficial palpation of the abdomen detects pain on the right above the navel. A fecal occult blood test is positive. What is the most likely diagnosis in this case?
A. Chronic cholecystitis
B. Chronic enteritis
C. Chronic gastritis
D. Peptic ulcer disease
E. Chronic colitis
Correct Answer: D. Peptic ulcer disease
| Explanation: Peptic ulcer disease is characterized by pain in the epigastrium occurring 1-1.5 hours after eating, night pain, and relief of pain with vomiting. The positive fecal occult blood test indicates gastrointestinal bleeding, which is consistent with ulceration. The patient’s history of alcohol abuse and smoking further supports this diagnosis, as these are risk factors for peptic ulcers. Why other options are incorrect: Chronic cholecystitis typically presents with pain in the right upper quadrant, especially after fatty meals, but it doesn’t usually cause night pain or relief with vomiting. Chronic enteritis primarily affects the small intestine, leading to symptoms like diarrhea rather than epigastric pain and vomiting. Chronic gastritis can cause epigastric pain, but it typically doesn’t cause the same pattern of pain relief with vomiting and is less likely to present with a positive fecal occult blood test unless there is significant bleeding. Chronic colitis generally presents with lower abdominal pain and diarrhea, rather than the epigastric pain and vomiting seen here. |
4.One hour after being fed with a milk formula, the baby developed cyanosis of the lips, mucosa, nails, and face. Later the baby developed nausea, increased salivation, pain in the epigastric region, vomiting, and diarrhea. The pediatrician detected signs of cardiopulmonary failure in the baby. Investigation determined that the milk formula was prepared using the water from a well. What is the most likely diagnosis in this case?
A. Foodborne toxic infection
B. Food poisoning caused by organochlorine pesticides
C. Nitrate-nitrite intoxication
D. Food poisoning caused by heavy metals
E. Staphylococcal toxicosis
Correct Answer: C. Nitrate-nitrite intoxication
| Explanation: Nitrate-nitrite intoxication results from consuming water with high levels of nitrates, which can convert to nitrites. Nitrites interfere with hemoglobin’s ability to carry oxygen, leading to cyanosis. The symptoms of nausea, vomiting, diarrhea, and signs of cardiopulmonary failure are consistent with this type of poisoning. Why other options are incorrect: Foodborne toxic infection generally involves bacterial toxins causing gastrointestinal symptoms but does not typically cause cyanosis or cardiopulmonary failure. Organochlorine pesticides would cause symptoms such as neurological effects and are less likely to cause cyanosis with the described clinical picture. Heavy metal poisoning typically presents with neurological or gastrointestinal symptoms but not usually with cyanosis and the specific presentation of cardiopulmonary failure described. Staphylococcal toxicosis typically causes rapid onset of vomiting and diarrhea, but not cyanosis or signs of cardiopulmonary failure. |
5.A 2-year-old child with an acute respiratory viral infection acutely developed a hoarse voice and noisy inhalation. When the child cries, depression of the supraclavicular and subclavian fossa and increasing inspiratory dyspnea are observed. When the child is at rest, these signs disappear. What is the most likely diagnosis in this case?
A. Acute pleurisy
B. Acute obstructive bronchitis
C. Pneumonia
D. Acute stenosing laryngotracheitis
E. Airway foreign body
Correct Answer: D. Acute stenosing laryngotracheitis
| Explanation: Acute stenosing laryngotracheitis, commonly known as croup, is characterized by a hoarse voice, stridor (noisy inhalation), and worsening symptoms with crying or agitation. The findings of depression in the supraclavicular and subclavian fossae and inspiratory dyspnea that improve at rest are typical of croup. Why other options are incorrect: Acute pleurisy causes sharp chest pain and pleuritic breathing pain rather than stridor and hoarseness. Acute obstructive bronchitis presents with a cough and wheezing but does not typically cause stridor or the pattern of symptoms described. Pneumonia usually presents with fever, cough, and lung findings but not specifically with hoarseness and stridor. An airway foreign body would more likely present with sudden onset of choking, persistent symptoms, and localized respiratory distress, rather than the described episodic worsening with crying. |
6. A 15-year-old girl complains of the absence of menstruations. Objectively, she has a short stature, a short neck with vertical skin folds on both sides, deformed auricles, and a low line of hair growth on her neck. Her chest is barrel-shaped, her elbow joints are deformed. There are multiple pigment spots on the skin of her torso and limbs. Her mammary glands are flat and the nipples are underdeveloped. Her intelligence is not impaired. There are no Barr bodies in the cells of her buccal epithelium. What is the most likely diagnosis in this case?
A. Patau syndrome
B. Down syndrome
C. Klinefelter syndrome
D. Turner syndrome
E. Edwards syndrome
Correct Answer: D. Turner syndrome
| Explanation: A constellation of features including short stature, a short neck with vertical skin folds, low-set auricles, and a barrel-shaped chest characterizes Turner syndrome. The absence of Barr bodies (due to a single X chromosome) and underdeveloped secondary sexual characteristics like flat mammary glands are also key indicators. The presence of multiple pigment spots and deformed joints further supports this diagnosis. Why other options are incorrect: Patau syndrome (trisomy 13) involves severe developmental anomalies and does not typically present with the described physical features. Down syndrome (trisomy 21) is associated with distinct facial features, intellectual disability, and other anomalies not matching the described presentation. Klinefelter syndrome (47,XXY) usually presents with tall stature, gynecomastia, and possible cognitive impairments, and it affects males, not females. Edwards syndrome (trisomy 18) involves severe developmental delays and physical abnormalities different from those described. |
7. A 26-year-old man has been hospitalized with complaints of a fever of 38°C, shortness of breath, and chest pain on the right during breathing and coughing. According to the patient’s medical history, the patient has been ill for more than 6 weeks and was self-treating himself. Objectively, cyanosis of the lips and a pale face are observed. Pulse 105/min. The heart sounds are weakened, the right half of the chest lags behind during breathing. Percussion detects a dull sound on the right, from the level of the fifth rib and lower, breathing on the right is markedly weakened. Pleural tap on the right yielded a turbid fluid. What is the most likely diagnosis in this case?
A. Lung cancer
B. Acute pericarditis
C. Right-sided exudative pleurisy
D. Hydrothorax
E. Pneumonia
Correct Answer: C. Right-sided exudative pleurisy
| Explanation: Right-sided exudative pleurisy is characterized by symptoms such as fever, shortness of breath, chest pain, and cyanosis. The physical findings of dullness to percussion, weakened breath sounds, and turbid fluid from the pleural tap are indicative of an exudative pleural effusion. This condition often results from an underlying infection or inflammation in the pleura. Why other options are incorrect: Lung cancer could cause a pleural effusion, but it typically would present with a more chronic history, potentially with other symptoms like weight loss, and often does not present acutely with fever and the described physical findings. Acute pericarditis usually presents with sharp chest pain that may improve when leaning forward, not with pleural effusion findings and the described physical exam findings. Hydrothorax (usually caused by systemic issues like heart failure or liver disease) would typically present with clear fluid, not turbid, and the physical exam findings would align differently. Pneumonia generally presents with localized lung findings such as crackles or bronchial breath sounds, not with a dull sound on percussion and turbid fluid from pleural tap. |
8. A 43-year-old patient complains of persistent pain in the epigastrium that cannot be relieved by taking antacids. Fibrogastroduodenoscopy detects multiple ulcerative lesions in the stomach and duodenum against the background of marked hyperacidity. Blood testing detects increased gastrin levels. What is the most likely diagnosis in this case?
A. Zollinger-Ellison syndrome
B. Crohn’s disease
C. Gilbert’s syndrome
D. Dubin-Johnson syndrome
E. Acute pancreatitis
Correct Answer: A. Zollinger-Ellison syndrome
| Explanation: Zollinger-Ellison syndrome is characterized by gastrin-secreting tumors (gastrinomas) that cause excessive gastric acid production, leading to multiple ulcerative lesions in the stomach and duodenum. The persistent pain unrelieved by antacids and elevated gastrin levels are consistent with this diagnosis. Why other options are incorrect: Crohn’s disease can cause gastrointestinal ulcers but typically involves inflammation throughout the gastrointestinal tract and would not specifically show elevated gastrin levels. Gilbert’s syndrome is a mild, benign liver condition affecting bilirubin metabolism, not associated with elevated gastrin or ulcerative lesions. Dubin-Johnson syndrome is a rare liver condition causing conjugated hyperbilirubinemia without elevated gastrin levels or gastrointestinal ulcers. Acute pancreatitis presents with severe abdominal pain and elevated pancreatic enzymes, not typically with elevated gastrin or multiple ulcers. |
9. Examination of a one-month-old child detected microphthalmia, microcephaly, hypotelorism, bilateral cleft lip and palate, polydactyly, and a ventricular septal defect. Genetic studies revealed trisomy 13. What is the most likely diagnosis in this case?
A. Patau syndrome
B. Down syndrome
C. Roberts syndrome
D. Arnold-Chiari syndrome
E. Lejeune syndrome
Correct Answer: A. Patau syndrome
| Explanation: Patau syndrome (trisomy 13) is associated with a range of severe congenital abnormalities, including microphthalmia, microcephaly, hypotelorism, bilateral cleft lip and palate, polydactyly, and congenital heart defects like ventricular septal defect. The presence of these features and the genetic finding of trisomy 13 confirm Patau syndrome. Why other options are incorrect: Down syndrome (trisomy 21) is associated with distinct features like hypotonia, a flat facial profile, and often a single transverse palmar crease, but not the full range of abnormalities described. Roberts syndrome involves limb and craniofacial abnormalities but not the specific combination of features seen here. Arnold-Chiari syndrome is a neurological condition involving cerebellar herniation and does not match the described congenital anomalies. Lejeune syndrome (cri du chat syndrome) typically presents with a cat-like cry, microcephaly, and developmental delays, not the specific features associated with trisomy 13. |
10. A 44-year-old woman complains of generally feeling unwell, chills, a fever of 39°C, and constant burning pain, skin redness, and edema in the area of her left lower leg. She associates the onset of the disease with a scratch on the skin of her left lower leg that she received two days ago. Objectively, in the middle third of the left lower leg, there is a bright area of skin hyperemia with clear borders that is raised above the unchanged skin. Moderate edema of soft tissues is observed, the soft tissues are painful during palpation. In the center of the hyperemic skin, there is a scab 2×0.2 cm in size that covers a small superficial wound. What complication of the microtrauma of the left lower leg is observed in the patient?
A. Phlegmon
B. Erysipelas
C. Gas gangrene
D. Acute purulent osteomyelitis
E. Acute deep vein thrombophlebitis
Correct Answer: B. Erysipelas
| Explanation: Erysipelas is a bacterial skin infection commonly caused by Streptococcus species, characterized by bright red skin with well-defined borders, raised lesions, and associated with fever and systemic symptoms. The description of a sharply defined area of skin hyperemia, edema, and a small scab over a superficial wound is consistent with erysipelas, particularly following a minor skin trauma. Why other options are incorrect: Phlegmon involves diffuse, spreading infection without well-defined borders and often involves deeper tissues, unlike the sharply demarcated erysipelas. Gas gangrene presents with rapid progression, severe pain, and gas production in tissues, which is not described here. Acute purulent osteomyelitis would typically involve deep bone infection with more severe systemic symptoms and would not present with a clearly defined erythematous border on the skin. Acute deep vein thrombophlebitis usually presents with pain, redness, and swelling along a vein but lacks the sharply demarcated border and systemic symptoms described. |
11.Microclimate parameters were measured in the operating room of a regional clinical hospital. Test results were as follows: average air temperature 23°C, relative air humidity 48%, air velocity 0.1 m/s. Make a hygienic assessment of the microclimate in the operating room.
A. Uncomfortable, with high humidity
B. –
C. Uncomfortable, cooling
D. Uncomfortable, with increased air velocity
E. Comfortable
Correct Answer: E. Comfortable
| Explanation: The given microclimate parameters in the operating room—an average air temperature of 23°C, relative humidity of 48%, and air velocity of 0.1 m/s are generally within the acceptable range for a comfortable environment. The temperature is within the typical range of 20-24°C, which is comfortable for most operating rooms.Relative humidity of 48% is also within the recommended range of 30-60% for indoor environments, avoiding both excessive dryness and dampness.Air velocity of 0.1 m/s is considered low and does not create discomfort or cooling effects. Why other options are incorrect: “Uncomfortable, with high humidity” is incorrect because the relative humidity is not high (it is within the acceptable range). “Uncomfortable cooling” is incorrect as the temperature is moderate and the air velocity is low, which would not create a cooling effect. “Uncomfortable, with increased air velocity” is incorrect since the air velocity is low and not increased. |
12. An 8-year-old boy is registered for regular check-ups due to chronic bronchitis. Into what group should this child be enrolled for physical training at school?
A. Treatment group
B. Special group
C. Preparatory group
D. Additional group
E. Main group
Correct Answer: B. Special group
| Explanation: For a child with chronic bronchitis, physical training should be tailored to their specific health needs to avoid exacerbating their condition. The “Special group” is designed for children with chronic health issues or specific medical conditions where physical activity needs to be adapted or monitored closely to ensure safety and effectiveness. Why other options are incorrect: “Treatment group” typically involves more intensive medical intervention and therapy rather than just physical education. “Preparatory group” is for children who need additional preparation or adjustment before joining regular physical activities but does not specifically address ongoing medical conditions. “Additional group” is not a standard classification in physical education contexts and does not specifically address the need for specialized care. “Main group” includes children participating in regular physical education activities, which may not be appropriate for those with chronic conditions requiring special consideration. |
13. A 3-month-old child developed vomiting, shrill crying for no reason, persistent intertrigo, rashes on the body, and a characteristic “mouse” smell of urine. Objectively. neurological symptoms are observed: muscle hypotonia and generalized seizures. What is the most likely diagnosis in this case?
A. Mucoviscidosis
B. Phenylketonuria
C. Coeliac disease
D. Diabetes mellitus
E. Tay-Sachs disease
Correct Answer: B. Phenylketonuria
| Explanation: The child’s symptoms of vomiting, shrill crying, persistent intertrigo (diaper rash), characteristic “mouse” smell of urine, muscle hypotonia, and seizures are indicative of phenylketonuria (PKU). PKU is an inborn error of metabolism where the body cannot properly metabolize phenylalanine, leading to these symptoms, including the distinct odor of urine and neurological issues. Why the other options are incorrect: Mucoviscidosis (cystic fibrosis) would primarily present with respiratory and digestive symptoms, including chronic cough and poor weight gain, rather than the specific symptoms and odor described. Coeliac disease presents with gastrointestinal symptoms like diarrhea and abdominal distension, not the neurological symptoms or “mouse” smell of urine. Diabetes mellitus can cause symptoms like polyuria, polydipsia, and weight loss but does not typically present with the distinctive “mouse” odor or neurological symptoms described. Tay-Sachs disease is a genetic disorder that leads to neurodegeneration and does not typically present with a “mouse” smell of urine or intertrigo. |
14. A 6-year-old child has been diagnosed with peptic ulcer disease of the duodenum. What antibacterial agent should be prescribed along with clarithromycin and omeprazole to eradicate the Helicobacter pylori infection?
A. Meropenem
B. Amoxicillin
C. Gentamicin
D. Vancomycin
E. Ciprofloxacin
Correct Answer: B. Amoxicillin
| Explanation: Amoxicillin is commonly used in combination with clarithromycin and a proton pump inhibitor like omeprazole to eradicate Helicobacter pylori infection in peptic ulcer disease. This combination is effective because amoxicillin targets the bacterial cell wall, while clarithromycin inhibits protein synthesis, and omeprazole reduces stomach acid, enhancing antibiotic efficacy. Why the other options are incorrect: Meropenem is a broad-spectrum carbapenem antibiotic and is not typically used for H. pylori eradication. Gentamicin is an aminoglycoside antibiotic that is not effective against H. pylori and is not used in this treatment regimen. Vancomycin is effective against Gram-positive bacteria but is not used for H. pylori infection. Ciprofloxacin is a fluoroquinolone antibiotic, which is sometimes used as an alternative in H. pylori treatment regimens, but it is not a standard part of the first-line triple therapy with clarithromycin and omeprazole. |
15. A 22-year-old woman complains of pain in her eye, lacrimation, photosensitivity, and decreased visual acuity. According to the patient’s medical history, the patient uses contact lenses. Objectively, she has pericorneal injection and a gray infiltrate in the center of the cornea. The deep structures are without changes. What is the most likely diagnosis in this case?
A. Blepharitis
B. Cataract
C. Iridocyclitis
D. Keratitis
E. Conjunctivitis
Correct Answer: D. Keratitis
| Explanation: The patient’s symptoms of eye pain, lacrimation, photosensitivity, and decreased visual acuity, combined with the presence of a gray infiltrate in the center of the cornea and pericorneal injection, are indicative of keratitis. Keratitis is an inflammation of the cornea often associated with contact lens use, leading to corneal infiltrates and pain. Why the other options are incorrect: Blepharitis involves inflammation of the eyelid margins, causing redness, irritation, and possible crusting but does not typically present with a gray infiltrate in the cornea or decreased visual acuity. Cataract causes progressive visual impairment due to lens opacity but does not present with corneal infiltrates or acute symptoms like pain and photosensitivity. Iridocyclitis (or anterior uveitis) affects the iris and ciliary body, presenting with eye pain, redness, and photophobia, but it typically does not feature a gray infiltrate in the cornea or specific findings like those described. Conjunctivitis generally causes redness, itching, and discharge from the conjunctiva but does not typically involve a gray corneal infiltrate or significant visual acuity changes. |
16. A 6-year-old child complains of a headache, weakness, and pain during chewing. Objectively, bilateral enlargement of the salivary glands is observed. The enlarged glands fill the retromandibular fossa. The skin over the glands is tense, glossy, and normal-colored. Body temperature 39°C, The oral mucosa is dry, with edematous external openings of the salivary gland ducts. What is the most likely diagnosis in this case?
A. Epidemic parotitis
B. Diphtheria
C. Infectious mononucleosis
D. Tumors of the salivary glands
E. Sialolithiasis
Correct Answer: A. Epidemic parotitis
| Explanation: The child’s symptoms of headache, weakness, pain during chewing, bilateral salivary gland enlargement, tense and glossy skin over the glands, high fever, and edematous external openings of the salivary ducts are characteristic of epidemic parotitis, also known as mumps. This viral infection primarily affects the parotid glands and causes the clinical presentation described. Why the other options are incorrect: Diphtheria generally presents with a sore throat, fever, and a characteristic pseudomembrane in the throat, not with bilateral salivary gland enlargement or the described symptoms. Infectious mononucleosis typically causes fever, sore throat, and swollen lymph nodes, and may lead to mild splenomegaly, but it does not usually cause bilateral salivary gland enlargement or the specific gland symptoms described. Tumors of the salivary glands would more commonly present as a unilateral mass rather than bilateral enlargement and would not usually be associated with acute symptoms like fever and pain during chewing. Sialolithiasis (salivary gland stones) typically causes localized pain and swelling, often more severe during or after eating, but is less likely to cause the widespread bilateral enlargement and systemic symptoms such as high fever seen in this case. |
17. A 34-year-old woman came to a doctor with complaints of muscle weakness, thirst, increased urination at night, paresthesias, and seizure attacks. Objectively, her general condition is satisfactory, her face and legs are doughy, her pulse is 80/min., her blood pressure is 200/110 mm Hg, the second heart sound is accentuated over the aorta. Blood test shows K levels of 3.1 mmol/L and Nat levels of 165 mmol/L. ECG shows inversion of T waves and depression of S-T segments. Ultrasound detects hyperplasia of the right adrenal gland. What is the most likely diagnosis in this case?
A. Hypoparathyroidism
B. Primary hyperaldosteronism
C. Essential hypertension
D. Pheochromocytoma
E. Glucosteroma
Correct Answer: B. Primary hyperaldosteronism
| Explanation: The patient’s symptoms of muscle weakness, thirst, increased urination at night, paresthesias, and seizure attacks, combined with the low potassium level (hypokalemia), high sodium level (hypernatremia), and hypertension, are indicative of primary hyperaldosteronism. The ECG findings of T-wave inversions and ST-segment depression also support hypokalemia. The hyperplasia of the adrenal gland further points to a primary aldosterone-secreting adenoma or adrenal hyperplasia. Why the other options are incorrect: Hypoparathyroidism typically presents with hypocalcemia, not hypokalemia, and would not be associated with hypertension or adrenal gland hyperplasia. Essential hypertension does not explain hypokalemia, hypernatremia, or the adrenal gland hyperplasia; it’s a diagnosis of exclusion after other causes are ruled out. Pheochromocytoma is characterized by episodic hypertension, palpitations, and sweating but typically does not present with hypokalemia and adrenal gland hyperplasia. Glucosteroma (a cortisol-secreting tumor) would usually cause symptoms related to Cushing’s syndrome, including weight gain, glucose intolerance, and sometimes hypertension, but would not typically cause hypokalemia or adrenal hyperplasia. |
18. A 53-year-old woman complains of pain in the right subcostal region that radiates into the right shoulder blade, shoulder, and right side of the neck. The pain significantly intensifies after eating fatty and fried foods. She has a bitter taste in her mouth. Objectively, sharp pain and mild muscle tension are observed in the right hypochondrium. Ortner, Murphy, and Mussy-Georgievsky signs are positive. Blood test results: leukocytes 9.3 10°/L, ESR 27 mm/hour, bilirubin 18.3 mcmol/L, urea 5.3 mmol/L, creatinine 86 mcmol/L. What is the most likely diagnosis in this case?
A. Acute appendicitis
B. Acute cholecystitis
C. Peptic ulcer disease of the stomach
D. Intestinal obstruction
E. Acute pancreatitis
Correct Answer: B. Acute cholecystitis
| Explanation: The patient’s symptoms of pain in the right subcostal region radiating to the right shoulder blade, the intensity of pain after eating fatty foods, and a bitter taste in the mouth, along with positive Ortner, Murphy, and Mussy-Georgievsky signs, are characteristic of acute cholecystitis. Elevated bilirubin and an elevated ESR also support this diagnosis. Why the other options are incorrect: Acute appendicitis typically presents with pain in the right lower abdomen rather than the right upper quadrant and does not usually cause radiation to the shoulder or neck. Peptic ulcer disease of the stomach usually causes epigastric pain and may be related to food intake, but does not typically radiate to the shoulder or involve positive signs for cholecystitis. Intestinal obstruction usually presents with abdominal distension, cramping pain, and changes in bowel movements, and does not have the characteristic pain radiation and signs described. Acute pancreatitis often presents with severe epigastric pain radiating to the back and is associated with elevated pancreatic enzymes, not the cholecystitis-specific signs or pain location described. |
19.A 23-year-old patient complains of swelling and pain in the knee and elbow joints, rapid heartbeat, and a fever of 38°C, The patient has a history of an acute respiratory viral infection that occurred 2 weeks ago. Objectively, swelling of knee and elbow joints is observed. Pulse 94/min., transverse cardiac diameter 14 cm. Auscultation detects weakening of the first heart sound and a systolic murmur at the apex. Complete blood count: leukocytes 9.1 • 10°/L, ESR 18 mm/hour. Urinalysis: protein 0.033 g/L, leukocytes 6-8 in sight. ECG shows sinus tachycardia, PQ interval 0.24 seconds. What is the most likely diagnosis in this case?
A. Osteoarthritis
B. Gout
C. Acute rheumatic fever
D. Reiter’s disease
E. Rheumatoid arthritis
Correct Answer: C. Acute rheumatic fever
| Explanation: The patient’s symptoms and history are consistent with acute rheumatic fever, particularly the recent viral infection followed by fever, joint swelling, heart murmurs, and an elevated ESR. The prolonged PQ interval on the ECG suggests a first-degree AV block, which is characteristic of acute rheumatic fever. Why the other options are incorrect: Osteoarthritis typically presents with joint pain and stiffness but not systemic symptoms like fever or heart involvement. Gout usually affects the big toe and presents with high uric acid levels; the joint swelling and pain described do not align with the typical presentation of gout. Reiter’s disease (Reactive arthritis) often follows a genitourinary or gastrointestinal infection and includes symptoms like urethritis, conjunctivitis, and arthritis, which are not present in this case. Rheumatoid arthritis generally involves chronic joint pain and morning stiffness with a symmetrical pattern and does not typically present with a recent viral infection or heart murmurs as seen here. |
20. A 26-year-old patient developed swelling of the lace, especially of the nose and lips, and hoarseness of the voice after eating strawberries. Objectively, the patient is agitated, cyanosis of the skin of the face and urticaria on the neck and chest can be observed. What is the most likely diagnosis in this case?
A. Urticaria
B. Anaphylactic shock
C. Bronchial asthma attack
D. Quincke’s edema
E. Cardiac asthma
Correct Answer: D. Quincke’s edema
| Explanation: Quincke’s edema (angioedema) is characterized by sudden, localized swelling of deeper tissues, such as the face, lips, and tongue, often associated with food allergies. It can lead to hoarseness and cyanosis due to airway involvement. The presence of urticaria and the described symptoms following strawberry consumption align with this diagnosis. Why other options are incorrect: Urticaria (hives) involves raised, itchy welts on the skin but typically does not cause significant swelling of deeper tissues or hoarseness. Anaphylactic shock involves a rapid, severe allergic reaction with symptoms such as hypotension, difficulty breathing, and loss of consciousness, which are more severe than the symptoms described here. Bronchial asthma attack primarily affects the respiratory system and would present with wheezing and shortness of breath rather than localized facial swelling and cyanosis. Cardiac asthma refers to symptoms of shortness of breath caused by heart failure, which does not align with the localized facial swelling and urticaria described. |
21. A 25-year-old woman complains of discomfort in the area of her external genitalia. The discomfort developed a few days ago. Objectively, in the area of the left labia, there is a painless red ulcerative skin lesion with clear and smooth edges, dense at its base. Painless enlargement of the right inguinal regional lymph node was detected. What is the most likely diagnosis in this case?
A. Bartholinitis
B. Candidiasis
C. Carbuncle
D. Primary syphilis
E. Genital herpes
Correct Answer: D. Primary syphilis
| Explanation: The patient’s symptoms of a painless red ulcerative lesion with clear, smooth edges on the external genitalia and painless enlargement of the inguinal lymph node are characteristic of primary syphilis. The ulcerative lesion described is known as a chancre, which is a hallmark of primary syphilis. Why the other options are incorrect: Bartholinitis involves inflammation of the Bartholin’s glands, leading to pain and swelling, but it would not present with a painless ulcerative lesion or regional lymphadenopathy. Candidiasis typically causes itching, redness, and a white discharge rather than a painless ulcerative lesion. Carbuncle is a type of abscess or infection of the skin that would be painful and not present with a smooth-edged ulcer or painless regional lymphadenopathy. Genital herpes usually presents with painful, vesicular lesions rather than a painless ulcerative lesion. The lesions are also often multiple rather than solitary. |
22. A 27-year-old woman, gravida 1, para 1, was hospitalized into the maternity ward. She had a 3-year-long history of primary infertility. Contractions started 9 hours ago, occur every 45 minutes, and last 20-25 seconds. The waters broke 2.5 hours ago. The fetal heartbeat is 136/min. The small segment of the fetal head lies in the plane of the inlet into the lesser pelvis. The cervix is smoothed out, its opening is 4 cm. The amniotic sac is absent. What complication occurred during the childbirth?
A. Secondary weakness of labor activity
B. Pathological preliminary period
C. Discoordinated labor activity
D. Primary weakness of labor activity
E. Normal labor activity
Correct Answer: A. Secondary weakness of labor activity
| Explanation: The patient’s contractions started 9 hours ago and are still occurring every 45 minutes, with each lasting 20-25 seconds, which indicates a slow progression of labor. The cervix is 4 cm dilated, and the fetal head is engaged in the pelvic inlet. The absence of the amniotic sac and the prolonged duration with minimal cervical change suggest that the labor has not progressed adequately. This is consistent with secondary weakness of labor activity, where labor initially progresses normally but then slows down or weakens after some time. Why the other options are incorrect: Pathological preliminary period refers to issues that occur before labor starts, such as prolonged or abnormal preliminary contractions, which is not described in this case. Discoordinated labor activity involves irregular contractions that are uncoordinated and may not effectively contribute to cervical dilation or fetal descent. However, the contractions here are regular but insufficient. Primary weakness of labor activity would be characterized by weak or ineffective contractions from the onset of labor. In this case, the contractions started normally but then weakened over time. Normal labor activity would typically involve contractions that progressively become more frequent and intense, leading to consistent cervical dilation, which is not occurring here. |
23.A 9-year-old girl complains of a fever, profuse sweating, and pain in the joints and heart. Objectively, the following is observed: livedo reticularis on the hips, buttocks and back, a polymorphic rash with fine punctate hemorrhages, small subcutaneous nodules along the course of the vessels in the limbs. On the third day after the onset of the disease, a cerebral crisis developed with headache, vomiting, and meningeal symptoms. Blood pressure 160/90 mm Hg. What is the most likely diagnosis in this case?
A. Dermatomyositis
B. Periarteritis nodosa
C. Systemic scleroderma
D. Systemic lupus erythematosus
E. Wegener’s granulomatosis
Correct Answer: B. Periarteritis nodosa
| Explanation: The patient’s symptoms of fever, joint pain, livedo reticularis, polymorphic rash with punctate hemorrhages, subcutaneous nodules, and a cerebral crisis with meningeal symptoms are indicative of periarteritis nodosa (PAN). PAN is a systemic vasculitis that affects medium-sized arteries, leading to skin, joint, and neurological symptoms, and can cause hypertension and neurological complications. Why the other options are incorrect: Dermatomyositis typically presents with a distinctive rash and muscle weakness, not with livedo reticularis, subcutaneous nodules, or significant neurological involvement. Systemic scleroderma is characterized by skin thickening and fibrosis, often with internal organ involvement, but does not typically present with the combination of symptoms described. Systemic lupus erythematosus can cause a range of systemic symptoms, including skin rashes and neurological manifestations, but livedo reticularis and the specific combination of findings are more typical of PAN. Wegener’s granulomatosis (Also known as granulomatosis with polyangiitis) primarily affects the respiratory tract, kidneys, and sinuses, and is associated with granulomatous inflammation, rather than the specific rash and nodules described. |
24.During a medical examination, a 19-year-old girl presents with a systolic tremor in the II intercostal space to the left of the sternum, expansion of the borders of the heart, accent of the second heart sound over the pulmonary artery, and a coarse and extended systolic murmur in the Il intercostal space to the left of the sternum, which transitions to diastole and weakens during an inhale. Heart rate — 80/min., blood pressure 120/50 mm Hg. What is the most likely diagnosis in this case?
A. Ventricular septal defect
B. Pulmonary artery stenosis
C. Patent ductus arteriosus
D. Atrial septal defect
E. Coarctation of the aorta
Correct Answer: C. Patent ductus arteriosus
| Explanation: The patient’s presentation of a systolic tremor, expansion of the heart borders, accentuated second heart sound over the pulmonary artery, and a characteristic continuous “machinery-like” murmur that extends into diastole and weakens with inspiration is consistent with patent ductus arteriosus (PDA). This condition results from the persistence of the ductus arteriosus, causing a continuous flow of blood from the aorta to the pulmonary artery, leading to the described murmur and signs. Why the other options are incorrect: Ventricular septal defect (VSD) typically presents with a holosystolic murmur, not continuous, and may have a smaller systolic tremor, with possible signs of heart failure. Pulmonary artery stenosis causes a systolic ejection murmur best heard in the left second intercostal space, but it does not produce a continuous murmur and typically does not present with a systolic tremor or diastolic component. Atrial septal defect (ASD) is characterized by a systolic ejection murmur due to increased blood flow across the pulmonary valve and a wide, fixed splitting of the second heart sound, but not a continuous murmur. Coarctation of the aorta presents with differential blood pressures between the upper and lower body and does not typically feature a continuous murmur. |
25. A 48-year-old patient developed sharp headache (“as if struck by a knife”) and vomiting after emotional stress. The patient has a history of arterial hypertension. Objectively, general agitation and facial hyperemia are observed, as well as marked meningeal symptoms: nuchal rigidity, Kernig’s sign, photosensitivity, and general hyperesthesia. The cranial nerves are without pathology. There are no pareses. Reflexes are brisk and uniform. What is the most likely diagnosis in this case?
A. Encephalitis
B. Subarachnoid hemorrhage
C. Ischemic stroke
D. Meningitis
E. Hemorrhagic stroke
Correct Answer: B. Subarachnoid hemorrhage
| Explanation: The patient’s symptoms of a sudden, sharp headache (“as if struck by a knife”), vomiting after emotional stress, and the presence of meningeal signs such as nuchal rigidity, Kernig’s sign, photosensitivity, and general hyperesthesia are characteristic of a subarachnoid hemorrhage (SAH). The sudden onset of a severe headache and the presence of meningeal signs suggest irritation of the meninges due to bleeding into the subarachnoid space. Why the other options are incorrect: Encephalitis typically presents with symptoms like fever, altered mental status, and focal neurological deficits, but it does not usually cause an abrupt onset of severe headache or the specific meningeal signs described. Ischemic stroke generally presents with sudden onset of focal neurological deficits, such as weakness or speech difficulties, rather than generalized headache and meningeal signs. Meningitis would present with symptoms such as fever, headache, and neck stiffness, but it usually develops over a period of time rather than a sudden, severe headache. Additionally, meningitis is often accompanied by fever and a more diffuse rash or signs of systemic infection. Hemorrhagic stroke typically causes sudden onset of severe headache, focal neurological deficits, and possible loss of consciousness, but it is more associated with deficits related to the area of the brain affected rather than generalized meningeal symptoms.
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26. After the introduction of semolina into the diet of a 6-month-old child, the child’s 51001s became copious, foamy, and dough-like. Despite having a good appetite, the chi-Id started losing weight, the abdomen became distended and the limbs became thin. What is the most likely diagnosis in this case?
A. Fructosemia
B. Coeliac disease
C. Galactosemia
D. Phenylketonuria
E. Mucoviscidosis
Correct Answer: B. Coeliac disease
Explanation: The symptoms described—copious, foamy, and dough-like stools, weight loss, abdominal distention, and thin limbs—are indicative of coeliac disease. This condition is characterized by an immune reaction to gluten, leading to malabsorption and gastrointestinal symptoms. The introduction of gluten-containing semolina into the child’s diet would trigger these symptoms in a child with coeliac disease. Why the other options are incorrect: Fructosemia (fructose intolerance) usually presents with symptoms like hypoglycemia and liver dysfunction upon ingestion of fructose, but not with the specific stool characteristics or weight loss described. Galactosemia results in symptoms such as jaundice, vomiting, and liver damage after the ingestion of galactose, not with the described stool changes and malabsorption. Phenylketonuria typically presents with developmental delays, a musty odor, and no significant gastrointestinal symptoms or specific stool changes. Mucoviscidosis (cystic fibrosis) often leads to steatorrhea (fatty stools) and respiratory symptoms, but the presentation is less likely to be associated with the specific changes in stool described.
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27. A 48-year-old woman complains of frequent unprovoked attacks of palpitations, headache, and dizziness, accompanied by chills, fear of death, skin pallor, and a blood pressure increase to 260-300/170-200 mm Hg, Hyperglycemia, glycosuria, and leukocytosis can be diagnosed during the attacks. What is the most likely diagnosis in this case?
A. Cushing syndrome
B. Primary hyperaldosteronism
C. Coarctation of the aorta
D. Pheochromocytoma
E. Essential arterial hypertension
Correct Answer D. Pheochromocytoma
Explanation: Pheochromocytoma is a rare tumor that can develop in the adrenal glands or other tissues in the body. These tumors cause the release of too much adrenaline and noradrenaline, which are hormones that raise blood pressure. The symptoms of pheochromocytoma are similar to those described in the question, including: 1. Frequent unprovoked attacks of palpitations, headache, and dizziness 2. Chills, fear of death, and skin pallor 3. Increased blood pressure 4. Hyperglycemia, glycosuria, and leukocytosis Cushing syndrome, primary hyperaldosteronism, coarctation of the aorta, and essential arterial hypertension are not associated with the symptoms described in the question. Cushing syndrome is a condition caused by the excess production of cortisol. It is not associated with unprovoked attacks of palpitations, headache, and dizziness.Primary hyperaldosteronism is a condition caused by the excess production of aldosterone. It is not associated with unprovoked attacks of palpitations, headache, and dizziness.Coarctation of the aorta is a narrowing of the aorta. It is not associated with unprovoked attacks of palpitations, headache, and dizziness.Essential arterial hypertension is a condition in which blood pressure is elevated for no known reason. It is not associated with unprovoked attacks of palpitations, headache, and dizziness. Therefore, the most likely diagnosis in this case is pheochromocytoma. |
28. Several chemical substances enter the human body from atmospheric air. What is the type of joint action, where the overall effect on the human body is more than the sum of the individual effects of each separate substance included in the combination?
A. Combined action
B. Antagonism
C. Complex action
D. Potentiation
E. Solated action
Correct Answer: D. Potentiation
Explanation:
Potentiation occurs when the combined effect of two or more substances is greater than the sum of their individual effects. In this context, when several chemical substances interact in the body, their combined effect can be more significant than what would be expected from each substance acting alone.
Why the other options are incorrect:
Combined action generally refers to the additive effects of multiple substances, where the total effect is the sum of the effects of each substance.
Antagonism occurs when one substance reduces or counteracts the effect of another.
Complex action is not a standard term in pharmacology or toxicology for describing interaction effects.
Isolated action describes the effect of a substance when it acts alone, without interaction with other substances.
29. A man complains of dizziness and vomiting. Vomitus is dark-colored, According to the patient’s history, he often drinks alcohol. Esophagogastroduodenoscopy shows that the contents of the stomach resemble “coffee grounds”. In the area of the cardia, there are four longitudinal fissures in the mucosa, from which a small amount of blood is leaking. What is the most likely diagnosis in this case?
A. Erosive gastritis
B. Mallory-Weiss syndrome
C. Zollinger-Ellison syndrome
D. Bleeding from gastric varices
E. Gastric cardia ulcer
Correct Answer: B. Mallory-Weiss syndrome
Explanation:
Mallory-Weiss syndrome is characterized by tears in the mucosa at the junction of the esophagus and stomach, often caused by vomiting or excessive coughing. This can lead to bleeding, which is consistent with the dark-colored vomitus and “coffee ground” appearance.
Why the other options are incorrect:
Erosive gastritis is typically associated with pain and discomfort, but not necessarily bleeding.
Zollinger-Ellison syndrome is characterized by excessive gastric acid secretion, which can lead to ulcers but not necessarily bleeding.
Bleeding from gastric varices is typically seen in patients with liver cirrhosis, which is not mentioned in the history.
Gastric cardia ulcer can cause bleeding, but the “coffee ground” appearance and the presence of longitudinal fissures in the mucosa are more consistent with Mallory-Weiss syndrome.
30. A 15-year-old girl complains of periodic pain in her lower abdomen, especially on the right. According to the patient’s medical history, her menstrual function is normal, she does not have a sexual life. Recto-abdominal examination detects an unchanged uterus, the appendages cannot be detected on the left, and an ovoid formation is palpable on the right. The formation is 10 x 11 cm in size, dense and elastic, mobile, painless, with a smooth surface. What is the most likely diagnosis in this case?
A. Tumor of the right ovary
B. Acute appendicitis
C. Ectopic pregnancy
D. Chronic salpingo-oophoritis
E. Ovarian apoplexy
Correct Answer: A. Tumor of the right ovary
Explanation:
The patient’s symptoms of periodic lower abdominal pain, normal menstrual function, and a large, dense, elastic, and mobile formation palpated on the right side suggest an ovarian mass. Given the size of the formation (10 x 11 cm) and its characteristics (smooth surface, painless), it is most consistent with a tumor of the right ovary.
Why the other options are incorrect:
Acute appendicitis would typically present with localized pain in the right lower abdomen, often with tenderness, rebound tenderness, and possibly fever, not a large, mobile, painless mass.
Ectopic pregnancy would usually present with more acute symptoms, such as severe abdominal pain, possible vaginal bleeding, and potentially signs of internal bleeding or shock. Additionally, the patient would be sexually active, which is not the case here.
Chronic salpingo-oophoritis (inflammation of the fallopian tubes and ovary) would present with chronic pelvic pain and potentially with tenderness, but not usually with a large, mobile mass.
Ovarian apoplexy (rupture of an ovarian cyst) typically causes sudden, severe abdominal pain and possible internal bleeding, not a large, non-tender mass.
31. A 42-year-old woman complains of general weakness and producing bloody discharge at the end of an act of defecation. Examination with a rectal speculum detects soft, painless, dark cherry-red protrusions with an eroded surface in the anal canal. What is the most likely diagnosis in this case?
A. Rectal tumor
B. Chronic paraproctitis
C. Crohn’s disease
D. Internal hemorrhoids
E. Rectal polyp
Correct Answer: D. Internal hemorrhoids
Explanation:
The patient’s symptoms of general weakness, bloody discharge at the end of defecation, and the presence of soft, painless, dark cherry-red protrusions with an eroded surface in the anal canal are indicative of internal hemorrhoids.
Internal hemorrhoids are located above the dentate line of the anal canal and can present with painless, dark red bleeding and protruding masses, particularly noticeable during or after bowel movements.
Why the other options are incorrect:
Rectal tumor typically presents with more persistent bleeding, possibly accompanied by other symptoms such as changes in bowel habits, weight loss, or a mass that may be irregular and not usually soft or protruding in the same manner.
Chronic paraproctitis involves infection and inflammation of the tissues around the rectum, often leading to painful swelling, abscesses, and sometimes fever, but not typically soft, protruding masses in the anal canal.
Crohn’s disease can affect the anal region with perianal disease, fistulas, and ulcers, but would more commonly present with painful lesions and additional systemic symptoms, not just protruding masses.
Rectal polyp would present as a growth in the rectum, often with a smoother appearance and typically not bleeding in the same manner as hemorrhoids.
32. In 2021, after the development and proper registration of vaccines, mass vaccination against the coronavirus began, which was aimed at stopping the epidemic. To study the effectiveness of different vaccines, the results of the studies conducted in different countries were combined, which allowed increasing the sample size. What kind of statistical analysis is it?
A. Meta-analysis
B. Randomized controlled trial
C. Blind study
D. Case-control study
E. Case series
Correct Answer: A. Meta-analysis
Explanation:
Meta-analysis is a statistical technique that combines results from multiple studies to increase the overall sample size and improve the reliability of conclusions about the effectiveness of interventions, such as vaccines. It involves synthesizing data from different studies to provide a more comprehensive estimate of the effect.
Why the other options are incorrect:
Randomized controlled trial (RCT) is an experimental study where participants are randomly assigned to different groups to test the effects of an intervention. It is not a method for combining results from multiple studies.
Blind study refers to a study design where participants (single-blind) or both participants and researchers (double-blind) do not know which treatment or intervention is being given. This helps reduce bias but does not involve combining multiple studies.
Case-control study is an observational study that compares individuals with a particular condition (cases) to those without it (controls) to identify factors associated with the condition. It does not involve synthesizing data from multiple studies.
Case series is a descriptive study that follows a group of patients with a similar diagnosis or treatment to observe outcomes, without a control group. It does not involve combining results from multiple studies.
33. A 35-year-old woman complains of general weakness, weight loss, a feeling of discomfort in the area of her left hypochondrium, a fever of 38°C, and excessive sweating. Objectively, she has pale skin and mucosa, hepatosplenomegaly is observed. Complete blood count: erythrocytes 3.96 • 1012/L, hemoglobin 100 g/L, leukocytes 130. 10°/L, basophils 4%, eosinophils 7%, myeloblasts 2%, promyelocytes 8%, myelocytes 14%, juvenile 6%, band neutrophils 12%, segmented neutrophils 23%, lymphocytes 24%, platelets 640 10°/L, ESR 36 mm/hour. What is the most likely diagnosis in this case?
A. Agranulocytosis
B. Acute myeloid leukemia
C. Chronic lymphocytic leukemia
D. Erythroleukemia
E. Chronic myeloid leukemia
Correct Answer: E. Chronic myeloid leukemia
Explanation:
The patient’s symptoms of general weakness, weight loss, discomfort in the left hypochondrium, fever, and sweating, along with findings of hepatosplenomegaly, elevated leukocytes (130 × 10^9/L), elevated basophils (4%), eosinophils (7%), and the presence of immature myeloid cells (myeloblasts, promyelocytes, myelocytes) indicate a myeloproliferative disorder.
The high white blood cell count with a predominance of myeloid lineage cells and elevated platelets is characteristic of chronic myeloid leukemia (CML).
Why the other options are incorrect:
Agranulocytosis is a condition with very low neutrophil counts, which is not consistent with the elevated leukocyte count and presence of immature cells in this case.
Acute myeloid leukemia (AML) typically presents with a higher proportion of myeloblasts and promyelocytes, and the patient would more commonly present with a more severe acute presentation rather than chronic symptoms.
Chronic lymphocytic leukemia (CLL) is characterized by elevated lymphocytes rather than myeloid cells and typically does not present with such high levels of immature myeloid cells or elevated platelets.
Erythroleukemia is a type of acute myeloid leukemia with a significant proliferation of erythroid precursors, which is not consistent with the findings in this case.
34. A 59-year-old woman complains of general weakness, rapid fatigability, paresthesias in the fingers and toes, and a fever of 37.5° C. Objectively, her sclerae are subicteric, the liver protrudes 1 cm from under the costal arch. Blood test results: erythrocytes 2.5 1012/L, hemoglobin 90 g/L, color index 1.1, leukocytes 2.5-10°/L, platelets 152-10°/L, reticulocytes with the predominance of indirect bilirubin. The Patient’s myelogram shows a megaloblastic type of hematopoiesis. What is the most likely diagnosis in this case?
A. Acquired hemolytic anemia
B. Viral hepatitis A
C. B12 deficient anemia
D. Leptospirosis
E. Iron deficiency anemia
Correct Answer: C. B12 deficient anemia
Explanation: The patient’s symptoms of general weakness, rapid fatigability, paresthesias in the fingers and toes, subicteric sclerae, and the presence of megaloblastic hematopoiesis on the myelogram suggest vitamin B12 deficiency anemia.
This condition often results in megaloblastic anemia, where large, immature red blood cells are produced. The high color index (which indicates more hemoglobin per cell) and the presence of indirect bilirubin further support the diagnosis, as these findings are consistent with hemolysis and ineffective erythropoiesis seen in B12 deficiency.
Why the other options are incorrect:
Acquired hemolytic anemia typically shows signs of hemolysis, such as elevated reticulocytes and elevated indirect bilirubin, but it does not usually present with megaloblastic hematopoiesis.
Viral hepatitis A would more commonly present with liver inflammation and jaundice but would not typically cause megaloblastic anemia or show megaloblastic hematopoiesis in the myelogram.
Leptospirosis is a bacterial infection that usually presents with fever, muscle aches, and jaundice, but not with megaloblastic anemia or the specific blood findings described.
Iron deficiency anemia is characterized by microcytic, hypochromic red blood cells and does not show megaloblastic hematopoiesis.
35. A 38-year-old woman complains of increased blood pressure, headache, muscle weakness, and a sensation of “ants crawling” on her legs. Objectively, her pulse is 82/min., her blood pressure is 160/100 mm Hg. ECG shows signs of myocardial hypertrophy in the left ventricle. Blood test results: K+ 3.2 mmol/L, Nat 150 mmol/L, elevated levels of aldosterone. Computed tomography of the retroperitoneal organs reveals an enlarged right adrenal gland. What drug should be prescribed for the patient to correct the arterial hypertension?
A. Doxazosin
B. Amlodipine
C. Torasemide
D. Spironolactone
E. Indapamide
Correct Answer: D. Spironolactone
Explanation: The patient presents with symptoms consistent with primary hyperaldosteronism (Conn’s syndrome), including elevated aldosterone levels, hypokalemia (low potassium), and hypertension.
Spironolactone is a potassium-sparing diuretic and an aldosterone antagonist, which helps to manage both the hypertension and correct the hypokalemia associated with primary hyperaldosteronism by counteracting the effects of excess aldosterone.
Why the other options are incorrect:
Doxazosin is an alpha-1 blocker used for hypertension but does not address the underlying cause of primary hyperaldosteronism or correct hypokalemia.
Amlodipine is a calcium channel blocker used for hypertension but does not affect aldosterone levels or hypokalemia.
Torasemide is a loop diuretic that would further decrease potassium levels, which is not suitable for a patient with hypokalemia.
Indapamide is a thiazide-like diuretic and may worsen hypokalemia, making it unsuitable for correcting the hypokalemia associated with primary hyperaldosteronism.
36. A 40-year-old man complains of a rash all over his body and slight itching. According to the patient’s medical history, he has been ill for 3 months and associates his rash with a neuropsychic trauma. Objectively, he has multiple pink papules covered with silvery scales on the skin of his torso, scalp, and extensor surfaces of the limbs. What is the most likely diagnosis in this case?
A. Disseminated psoriasis
B. Lichen ruber planus
C. Pityriasis rosea Gibert
D. Papular syphilide
E. Seborrheic derm
Correct Answer: A. Disseminated psoriasis
Explanation: The patient’s symptoms—multiple pink papules covered with silvery scales, affecting the torso, scalp, and extensor surfaces of the limbs—are characteristic of disseminated psoriasis.
Psoriasis is known for its distinct silvery scaling on pink or red plaques and commonly affects the scalp and extensor surfaces. The chronic nature and association with neuropsychic trauma do not alter the fundamental presentation of psoriasis.
Why the other options are incorrect:
Lichen ruber planus typically presents with purple, polygonal papules that are often itchy, but the papules are usually flat-topped and do not have the characteristic silvery scales.
Pityriasis rosea Gibert usually begins with a single, large “herald” patch followed by a diffuse rash of smaller papules and plaques. The rash is often described as having a “Christmas tree” pattern on the back and does not typically present with silvery scales.
Papular syphilide is associated with secondary syphilis and usually presents with reddish-brown papules that are not covered with silvery scales and tend to appear on the trunk and extremities.
Seborrheic dermatitis typically presents with greasy, yellowish scales on red, inflamed skin, often affecting the scalp, face, and body folds, rather than the extensor surfaces and not presenting with silvery scales.
37. A 35-year-old man complains of nosebleeds, bleeding gums, drowsiness, and dizziness. The patient abuses alcohol and has a 6-year-long history of hepatic cirrhosis. Objectively, an unpleasant sweet smell can be detected from his mouth, the patient has ascites, jaundice, ataxia, and hyperreflexia. The liver is not palpable. Laboratory testing results are as follows: bilirubin 150 mcmol/L, ALT 2.0 mmol/L, AST 1.2 mmol/L, platelets 130 10°/L, prothrombin index 52%. What complication has developed in the patient?
A. Liver cancer
B. Bleeding from esophageal varices
C. Uremic coma
D. Portal vein thrombosis
E. Liver failure
Correct Answer: B. Bleeding from esophageal varices
Explanation: The patient’s history of chronic alcohol abuse and hepatic cirrhosis, combined with symptoms such as nosebleeds, bleeding gums, ascites, jaundice, and laboratory findings including a significantly low prothrombin index (52%) and thrombocytopenia, suggest portal hypertension.
Portal hypertension can lead to the development of esophageal varices, which are prone to bleeding. The presence of an unpleasant sweet smell (fetor hepaticus), ataxia, and hyperreflexia are also consistent with advanced liver disease and portal hypertension.
Why the other options are incorrect:
Liver cancer would not typically present with bleeding from the gums and nose without more specific signs or imaging findings. The patient’s symptoms and lab results are more indicative of portal hypertension rather than a primary liver malignancy.
Uremic coma is associated with renal failure and would present with different symptoms, such as changes in mental status related to renal dysfunction rather than the liver-related symptoms described.
Portal vein thrombosis could contribute to portal hypertension but is less likely to present with the acute bleeding symptoms and coagulopathy seen here. The focus on bleeding from mucosal surfaces points more towards variceal bleeding.
Liver failure is a broad term and while it could encompass the described symptoms, the specific signs and symptoms of portal hypertension and variceal bleeding are more precisely indicative of bleeding from esophageal varices.
38. A 50-year-old patient has been hospitalized with complaints of pain in the heart and shortness of breath that occurred suddenly after significant physical overexertion. ECG shows elevation of the ST segment in leads II, III, and aVE Blood biochemistry test reveals that the levels of creatine phosphokinase-MB are twice higher than the norm. What is the most likely diagnosis in this case?
A. Angina pectoris
B. Dissecting aortic aneurysm
C. Acute anterior wall myocardial infarction
D. Acute pericarditis
E. Acute posterior wall myocardial infarction
Correct Answer: C. Acute anterior wall myocardial infarction
Explanation: The patient’s symptoms of sudden onset of chest pain and shortness of breath following significant physical exertion, combined with the ECG findings of ST-segment elevation in leads II, III, and aVF (which are inferior leads) and elevated creatine phosphokinase-MB levels, suggest an acute myocardial infarction (MI).
However, the ST-segment elevation in these specific leads usually indicates an inferior MI. The fact that the patient’s pain and biochemical markers are indicative of an acute MI makes this the most likely diagnosis.
Why the other options are incorrect:
Angina pectoris generally causes chest pain but is not associated with ST-segment elevation on ECG or significantly elevated cardiac biomarkers.
Dissecting aortic aneurysm would present with severe, tearing chest pain, often radiating to the back, and may show different ECG changes, but not typically ST-segment elevation in inferior leads.
Acute pericarditis usually presents with diffuse ST-segment elevation across multiple leads and often with pericardial friction rub, rather than localized elevation in specific leads.
Acute posterior wall myocardial infarction would show ST-segment elevation in leads V7, V8, and V9, rather than the inferior leads II, III, and aVF.
39. A 42-year-old patient has been hospitalized into the trauma department. X-ray reveals a pelvic fracture. Objectively, unassisted urination is not possible, urethrorrhagia is observed. Palpation detects an enlarged bladder and a painful swelling in the perineum. What is the most likely diagnosis in this case?
A. Prostate cancer
B. Acute kidney failure
C. Urethral trauma
D. Perincal hematoma
E. Bladder trauma
Correct Answer: C. Urethral trauma
Explanation: The patient’s symptoms of inability to urinate, urethrorrhagia (bleeding from the urethra), an enlarged bladder, and a painful perineal swelling in the context of a pelvic fracture suggest urethral trauma.
Pelvic fractures commonly lead to injuries of the urethra, particularly the posterior urethra, causing similar symptoms. The presence of a perineal hematoma and difficulty with urination support this diagnosis.
Why the other options are incorrect:
Prostate cancer would not typically present with acute urinary retention, urethrorrhagia, and perineal swelling in the context of a recent trauma.
Acute kidney failure would present with symptoms related to renal impairment and may include changes in urine output, but not with urethrorrhagia and an enlarged bladder due to obstructive urethral injury.
Perineal hematoma might be a result of urethral trauma or other trauma, but the combination of symptoms suggests an underlying urethral injury rather than just the hematoma.
Bladder trauma could be considered, but the symptom profile—particularly urethrorrhagia and difficulty urinating—is more directly indicative of urethral injury, especially with the history of pelvic fracture.
40. A 24-year-old woman has been noting a cold sensation in her fingers for the last three years. During such episodes, her lingers become cyanotic-white and numb. After 5-10 minutes pass, the skin becomes red and the fingers warm up, which is accompanied by in this cain. What is the most likely diagnosis
A. Obliterating atherosclerosis
B. Sjogren’s disease
C. Raynaud’s disease
D. Buerger’s disease
E. Obliterating endarteritis
Correct Answer: C. Raynaud’s disease
Explanation: The symptoms of cold sensation in the fingers, color changes (cyanotic-white to red), and numbness that resolve with warming are classic for Raynaud’s disease.
This condition is characterized by episodic vasospasm of the fingers and toes, which leads to color changes and sensory alterations in response to cold or stress.
Why the other options are incorrect:
Obliterating atherosclerosis usually affects larger arteries and would not typically present with episodic color changes and numbness in the fingers, but rather with more persistent symptoms such as claudication.
Sjogren’s disease primarily presents with dry mouth and eyes due to autoimmune destruction of exocrine glands, rather than episodic finger color changes and numbness.
Buerger’s disease (thromboangiitis obliterans) involves inflammation and thrombosis of small and medium-sized arteries, predominantly affecting the hands and feet, leading to severe ischemic changes, but it is often associated with tobacco use and has different clinical manifestations.
Obliterating endarteritis is a term related to chronic inflammation and narrowing of the arteries but is not typically used to describe episodic vasospastic symptoms with color changes in fingers.
41. A 28-year-old patient with acute gastrointestinal bleeding of the Ill degree was transfused with 1000 mL of preserved packed erythrocytes of the same group. What must be used during the hemotransfusion to prevent citrate intoxication?
A. Sodium chloride
B. Lithium chloride
C. Calcium chloride
D. Magnesium sulfate
E. Potassium gluconate
Correct Answer: C. Calcium chloride
Explanation: Preserved packed erythrocytes are stored with anticoagulants that contain citrate, which binds calcium and can lead to citrate intoxication during massive or rapid transfusions.
To prevent this, calcium chloride or calcium gluconate is administered to counteract the effects of citrate by replenishing calcium levels in the blood.
Why the other options are incorrect:
Sodium chloride is used for general fluid replacement and as a diluent for medications but does not counteract citrate effects.
Lithium chloride is not relevant to blood transfusion or citrate management.
Magnesium sulfate is used in different clinical contexts and does not address citrate toxicity.
Potassium gluconate is used for potassium supplementation and does not address calcium needs or citrate toxicity.
42. A 40-year-old woman complains of headache attacks, throbbing in the temples, dizziness, palpitations, and muscle weakness During the attack, she becomes pale and her blood pressure rises significantly to 270/160 mm Hg. These attacks occur mainly at night. Taking hypotensive agents in tablets does not improve her condition. What drug would be most effective in this case, when taken parenterally?
A. Phentolamine
B. Captopril
C. Dibazol (Bendazol)
D. Magnesium sulfate
E. Clonidine
Correct Answer: A. Phentolamine
Explanation: The patient’s symptoms, including severe headaches, dizziness, palpitations, muscle weakness, and significantly elevated blood pressure, suggest a hypertensive crisis, potentially due to a condition like pheochromocytoma.
Phentolamine is a non-selective alpha-adrenergic antagonist that is effective for rapidly lowering blood pressure in hypertensive emergencies by blocking the effects of excess catecholamines.
Why the other options are incorrect:
Captopril is an oral ACE inhibitor used for long-term management of hypertension, not typically effective in immediate control of severe hypertensive crises.
Dibazol (Bendazol) is a vasodilator with less immediate effect on severe hypertension and is generally not used for hypertensive emergencies.
Magnesium sulfate is primarily used for managing seizures in conditions like eclampsia, not for immediate control of severe hypertension.
Clonidine is an oral alpha-2 agonist that can lower blood pressure, but it is not suitable for immediate parenteral administration in acute hypertensive emergencies.
43. Examination of the children at a boarding school has detected reduced working ability, rapid fatigability, apathy, and drowsiness in the children. Bleeding gums and subcutaneous punctate hemorrhages were observed in 19% of the examined children. What vitamin is lacking in the examined children?
A. C
B. E
C. В
D. B
E. K
Correct Answer: A. C
Explanation: The symptoms described, including reduced working ability, rapid fatigability, apathy, drowsiness, bleeding gums, and subcutaneous punctate hemorrhages, are indicative of vitamin C deficiency, also known as scurvy.
Vitamin C is essential for collagen synthesis and overall vascular integrity, and its deficiency leads to symptoms such as bleeding gums and bruising.
Why the other options are incorrect:
Vitamin E deficiency typically causes neurological symptoms and is less associated with bleeding issues.
Vitamin B and Vitamin B12 deficiencies often lead to anemia, neurological symptoms, and fatigue but do not typically cause bleeding gums or punctate hemorrhages.
Vitamin K deficiency primarily affects blood clotting and can lead to bleeding issues, but it is less associated with the systemic symptoms like apathy and drowsiness described here.
44. A 19-year-old patient complains of loose stools with blood and mucus occurring up to 8-9 times per 24 hours, weight loss of 10 kg over the past 4 months, and pain along the large intestine. Objectively, the abdomen is soft to palpation, painful in the left iliac region and periumbilical region. Blood test results: erythrocytes 2.9-10^12/L, hemoglobin 100 g/L; leukocytes 10.2. 10°/L, eosinophils 3%, band neutrophi-Is 8%, segmented neutrophils 70%, lymphocytes 14%. Colonoscopy detects brightly hyperemic mucosa and no vascular pattern. On the surface, there are multiple erosions and superficial ulcers, covered with fibrin in some places. What is the most likely diagnosis in this case?
A. Nonspecific ulcerative colitis
B. Colorectal cancer
C. Crohn’s disease
D. Typhoid fever
E. Choler
Correct Answer: A. Nonspecific ulcerative colitis
Explanation: The patient’s symptoms of frequent loose stools with blood and mucus, significant weight loss, abdominal pain, and the findings from colonoscopy (hyperemic mucosa, absence of vascular pattern, multiple erosions and superficial ulcers covered with fibrin) are characteristic of nonspecific ulcerative colitis.
This condition involves inflammation and ulceration of the colonic mucosa and is often associated with these specific endoscopic findings.
Why the other options are incorrect:
Colorectal cancer would typically present with a different pattern of lesions, often more irregular, and usually with a different age profile and more localized symptoms.
Crohn’s disease can also cause similar symptoms but often presents with transmural inflammation and may affect any part of the gastrointestinal tract. It is also more likely to present with deeper ulcers and skip lesions, which were not described in this case.
Typhoid fever generally presents with systemic symptoms like fever and is diagnosed with stool cultures or blood tests, rather than primarily by colonoscopy findings.
Cholera typically causes severe watery diarrhea rather than bloody stools and would not be identified primarily through colonoscopy.
45. A patient with a transmural myocardial infarction presented with a blood pressure decrease to 80/60 mm Hg, atrial fibrillation and right bundle branch block during the acute period of the disease. On the tenth day after the onset of the disease, the presence of QS complexes with ST segment elevation was noted in the ECG. At the same time, the patient developed signs of pericarditis, polyarthritis, and pleurisy. What complication of myocardial infarction has occurred in the patient?
A. Dressler syndrome
B. Cardiogenic shock
C. Left ventricular aneurysm
D. Complete atrioventricular block
E. Pulmonary thromboembolism
Correct Answer: A. Dressler syndrome
Explanation: Dressler syndrome is a type of post-myocardial infarction pericarditis that typically develops several weeks to months after the infarction. It is characterized by pericarditis, pleurisy, and sometimes polyarthritis.
The presence of QS complexes with ST segment elevation on the ECG in the context of recent myocardial infarction and the development of these symptoms strongly suggests Dressler syndrome.
Why the other options are incorrect:
Cardiogenic shock would typically present acutely with severe hypotension, signs of inadequate perfusion, and not necessarily the delayed appearance of pericarditis and polyarthritis.
Left ventricular aneurysm usually develops later and may show abnormal ECG findings, but it typically does not present with acute pericarditis or pleurisy.
Complete atrioventricular block is a possible complication of myocardial infarction but would present acutely and would not account for the delayed onset of pericarditis and other systemic symptoms.
Pulmonary thromboembolism would typically present with symptoms related to the lungs, such as sudden onset of dyspnea, and would not typically cause pericarditis and polyarthritis.
46. A woman complains of frequent and copious foamy stools without pathological admixtures, cramping, pain in her periumbilical region, rumbling in the abdomen, and lever. According to the patient’s diet history, she was eating soft-boiled duck eggs. What is the most likely causative agent of her condition?
A. Salmonella typhi
B. V.cholerae
C. Escherichia coli
D. Shigella sonnei
E. Salmonella enteritidis
Correct Answer: E. Salmonella enteritidis
Explanation: The symptoms described—frequent and copious foamy stools, cramping pain in the periumbilical region, and rumbling in the abdomen—along with the history of consuming soft-boiled duck eggs, suggest a foodborne infection.
Salmonella enteritidis is commonly associated with eggs and poultry and is a frequent cause of gastrointestinal symptoms like those described.
Why the other options are incorrect:
Salmonella typhi causes typhoid fever, which typically presents with prolonged fever, abdominal pain, and sometimes a rash, rather than the acute diarrhea and cramping described.
Vibrio cholerae causes cholera, characterized by severe watery diarrhea without blood or mucus and is often associated with poor sanitation and contaminated water.
Escherichia coli can cause gastrointestinal symptoms, but the foamy nature of the stools and association with egg consumption points more specifically to Salmonella enteritidis.
Shigella sonnei causes shigellosis, which typically presents with dysentery (bloody and mucoid stools) and is less commonly associated with eggs.
47. A 6-year-old child complains of a fever of 39.9°C, itching skin, decreased appetite, and a rash all over the body. According to the patient’s medical history, the onset of the disease was 3 days ago. Objectively, the skin is pale, there is a polymorphous rash in the shape of spots, papules, vesicles, and scabs on the scalp, face, torso, and limbs. What is the most likely diagnosis in this case?
A. Measles
B. Infectious mononucleosis
C. Scarlet fever
D. Pseudotuberculosis
E. Chickenpox
Correct Answer: E. Chickenpox
Explanation: The presentation of a fever, itching skin, decreased appetite, and a polymorphous rash consisting of spots, papules, vesicles, and scabs is characteristic of chickenpox (varicella).
The rash typically evolves from red spots to vesicles and then to crusts, and it often appears in various stages of development simultaneously, which aligns with the description provided.
Why the other options are incorrect:
Measles typically presents with a rash that starts on the face and spreads downwards, consisting mainly of maculopapular lesions, and is preceded by a prodrome of cough, coryza, and conjunctivitis.
Infectious mononucleosis usually presents with fever, sore throat, lymphadenopathy, and sometimes a rash, but the rash is not typically polymorphous or vesicular.
Scarlet fever is associated with a sandpaper-like rash, often starting in the groin and axillae, and is accompanied by a high fever and sore throat but lacks the vesicular stage of the rash.
Pseudotuberculosis often presents with symptoms similar to typhoid fever, such as fever and abdominal pain, but the rash is not typically vesicular.
48. Examination of a 5-year-old child detected round red inflammatory spots with peeling surface on the skin of the thigh. The spots have clear borders and are prone to peripheral growth. On their periphery, there are nodules and vesicles. There are small, mildly inflamed spots with peeling surface on the child’s scalp. Within the foci, the hair is broken off at the height of 6-8 mm. During examination, a green glow can be observed in the light of a fluorescent lamp. What is the most likely diagnosis in this case?
A. Inguinal epidermophytosis
B. Tinea Versicolor
C. Rubromycosis
D. Microsporia
E. Trichophytia
Correct Answer: D. Microsporia
Explanation: The presence of round, red inflammatory spots with peeling surfaces, clear borders, peripheral growth, nodules and vesicles, and hair broken off at the height of 6-8 mm, along with the green glow under a fluorescent lamp, strongly suggests tinea capitis caused by Microsporum species.
Microsporum infections often present with these clinical features and the green fluorescence under Wood’s lamp is a classic diagnostic indicator for Microsporum species.
Why the other options are incorrect:
Inguinal epidermophytosis typically refers to fungal infection in the groin area (tinea cruris) and would not usually show the green fluorescence under a Wood’s lamp.
Tinea Versicolor (also known as pityriasis versicolor) presents with hypopigmented or hyperpigmented patches rather than the inflammatory red spots and does not show the green glow under Wood’s lamp.
Rubromycosis (also known as tinea rubrum) generally affects the skin of the feet and hands (tinea pedis and tinea manuum) and does not typically cause the green fluorescence seen with Microsporum .
Trichophytia (or tinea corporis caused by Trichophyton species) usually does not present with the same characteristic green fluorescence under Wood’s lamp and often has different clinical features compared to Microsporum .
49. A 26-year-old man complains of a rash on his face, itching, feeling of heat, and pain. According to the patient’s medical history, this condition has been lasting for over two years. Objectively, the skin of the face in the area of the chin has infiltrated bright red areas, covered in pustules and scabs, with numerous erosions. Papulo-pustular elements are located on the periphery. What is the most likely diagnosis in this case?
A. Contact dermatitis
B. Scabies
C. Sycosis
D. Eczema
E. Acne vulgaris
Correct Answer: C. Sycosis
Explanation:
Sycosis is a chronic bacterial infection of the beard and mustache areas, often caused by Staphylococcus aureus.
The symptoms and findings presented, including a rash, itching, heat, pain, pustules, scabs, erosions, and papulo-pustular elements on the periphery, are consistent with sycosis.
The other options are less likely because:
Contact dermatitis and eczema are typically associated with a more widespread rash and less severe symptoms.
Scabies is a parasitic infestation that would likely present with intense itching, especially at night, and would be more likely to affect the entire body.
Acne vulgaris is generally a more widespread condition affecting the face, chest, and back, and often presents with comedones (blackheads and whiteheads) in addition to pustules.
50. A 25-year-old woman complains of shortness of breath during physical exertion, a fever of 37.8°C, dull pain in the area of her heart, and palpitations. According to the patient’s medical history, 2 weeks ago she had a case of acute viral infection. Objectively, she has pale skin, pulse 95/min., blood pressure 100/60 mm Hg. Auscultation detects vesicular respiration, respiratory rate 22/min. The heart sounds are rhythmic, the first heart sound is weakened at the apex, a systolic murmur can be heard. ECG shows reduced voltage and negative I wave, Laboratory tests detect elevated levels of AST, LDH, and CPK. What is the most likely diagnosis in this case?
A. Acute myocardial infarction
B. Exudative pleurisy
C. Viral myocarditis
D. Infective endocarditis
E. Acute pericarditis
Correct Answer: C. Viral myocarditis
Explanation: Viral myocarditis is consistent with a recent viral infection followed by symptoms such as shortness of breath, dull chest pain, palpitations, and fever.
The weakened first heart sound and systolic murmur are indicative of myocardial inflammation affecting heart function. Elevated levels of AST, LDH, and CPK suggest myocardial damage, supporting the diagnosis of myocarditis.
Why Other Options are Incorrect:
Acute myocardial infarction typically presents with severe chest pain, often radiating to the left arm or jaw, and significant changes in the ECG such as ST elevation or depression. This patient’s ECG shows reduced voltage and negative I waves, not characteristic of an acute myocardial infarction.
Exudative pleurisy usually presents with pleuritic chest pain, reduced breath sounds, and sometimes a pleural friction rub. The patient’s symptoms and lab findings are more aligned with myocarditis rather than pleurisy.
Infective endocarditis often presents with symptoms like fever, heart murmurs, and signs of systemic infection or embolic phenomena. The patient does not show typical signs of endocarditis such as petechiae or osler nodes.
Acute pericarditis would typically present with a sharp, pleuritic chest pain relieved by sitting forward and may show characteristic ST elevation in multiple ECG leads. The systolic murmur and lab results are more indicative of myocarditis.
