1. After semolina was introduced into the diet, a 1-year-old child for 2 months has been presenting with loss of appetite, irritability, loss of body mass, and loss of previously learned skills. The feces are copious and foul-smelling. The skin is pale and dry, the hair is brittle. The abdomen is distended, while the limbs are thin. Stool test shows high levels of fatty acids. What is the most likely diagnosis?

 

1. Celiac disease

2. Functional diarrhea

3. Lactase deficiency

4. Irritable bowel syndrome

5. Mucoviscidosis (cystic fibrosis)

 

​

1. A 17-year-old girl complains of a pain and swelling of her second finger on the right hand. Three days ago she made a manicure. The pain developed on the second day after that. Objectively, her nail fold is swollen, hyperemic, overhangs the nail plate, and is painful on palpation. What is the most likely diagnosis in this case?

 

1. Cutaneous panaritium

2. Erysipeloid

3. Subcutaneous panaritium

4. Paronychia

5. Subungual panaritium

 

​

1. A quarry produces granite, which is then broken into pieces with explosives and manual pneumatic hammers. When breaking granite rocks and drilling blast holes for the explosives, the workers are exposed to local vibration of medium and high frequency. Vibration measurement revealed that it exceeds the maximum permissible level. What specific changes can develop in the workers as the result of prolonged exposure to such working conditions?

 

1. Sensory polyneuropathy with angiospastic syndrome

2. Somatoform autonomic dysfunction

3. Hand dermatitis

4. Sensorineural hearing loss

5. Psychasthenia

 

​

1. A 65-year-old man complains of cough attacks that occur when he eats liquid foods. Three months ago he was diagnosed with a carcinoma in the upper third of the esophagus. He underwent radiation therapy. What complication developed in this man?

 

1. Tracheoesophageal fistula

 

1. Spontaneous pneumothorax

 

1. Tracheal stenosis

 

1. Perforation of a gastric cardia ulcer

 

1. Lung abscess rupture into the pleural cavity

 

1. A 32-year-old woman complained of sudden piercing headache and fell down unconscious. In an ambulance, an emergency physician noted her severe edition, sopor, and meningeal syndrome. After her hospitalization, the lumbar puncture yielded bloody cerebrospinal fluid. Her cerebrospinal fluid pressure is 260 mm H₂ O. Make the provisional diagnosis:

 

1. Ischemic stroke

2. Traumatic brain injury

3. Aneurysm rupture, subarachnoid hemorrhage

4. Meningoencephalitis

5. Meningioma

 

​

1. On the 10th day after giving birth a woman came to a doctor complaining of high temperature of 38°C and sudden pain, hyperemia, and an indigestion in her left breast. Objectively, the skin of her left mammary gland has local hyperemia in its upper outer quadrant. During its palpation the pain intensifies. What is the most likely diagnosis in this case?

 

1. Breast hemangioma

2. Cyst of the left breast with suppuration

3. Fibroadenoma of the left breast

4. Lactational mastitis

    5. Left breast cancer

 

1. An 8-year-old girl after a case of acute respiratory infection has been complaining for the last 2 weeks of a pain in the area of her heart and palpitations. Objectively, her body temperature is febrile, her skin is pale, the heart borders are extended to the left, heart rate is 142/min. The girl presents with paired atrial extrasystoles, dull heart sounds, and a low intensity systolic murmur that reaches its maximum at point 5. Make the provisional diagnosis:

 

1. Functional changes in the heart

2. Congenital heart disease

3. Somatoform vegetative dysfunction

4. Endocarditis

5. Myocarditis

 

​

1. A 24-year-old man has fallen on his feet from a fourth floor balcony. He felt a sharp pain in his back, because of which he was unable to stand up unassisted. Examination shows smoothed out lumbar lordosis. The spine axial load is positive. Palpation of the spinous processes, especially of Th12, is painful. Sensitivity and mobility of the legs are not disturbed. Make the diagnosis:

 

1. Fracture of the lumbar spine spinous processes

2. Th12 fracture with dysfunction of the spinal cord

3. Lumbar spine contusion

4. Th12 compression fracture without dysfunction of the spinal cord

5. Pelvic fracture with dysfunction of the pelvic organs

 

​

1. During medical examinations of high and middle

school students, the doctors were assessing correlation between biological and calendar age of the school students based on the following criteria: height growth rate per year, ossification of the carpal bones, the number of permanent teeth. What additional development criterion should be assessed at this age?

 

1. Chest circumference

2. Development of secondary sex characteristics

3. Vital capacity of lungs

4. Body mass

5. Hand strength

 

​

1. A man suffers from urolithiasis and periodically develops hyperoxaluria. What products should be reduced in his diet?

 

1. Canned soup

2. Dairy products

3. Meat, fish

4. Fatty foods

5. Sorrel, spinach, tomatoes

​

​

1. A 38-year-old woman complains of weakness, sleepiness, pain in the joints, weight gain despite low appetite, and constipations. She presents with dry and thickened skin, puffy and amimic face, narrowed palpebral fissures, thick tongue, and deep hoarse voice. Her heart sounds are weak, pulse is 56/min. Low levels of free T4 are observed. This patient needs to take the following on a regular basis:

 

1. Lithium carbonate

2. Calcium gluconate

3. Furosemide

4. Mercazolil (Thiamazole)

5. Thyroxine

 

​

1. A 52-year-old man had an acute onset of the disease after an overexposure to cold that occurred 3 weeks ago. He complains of cough, high body temperature of 30.5°C, chest pain on the right, and marked dyspnea. His pulse is 120/min., blood pressure - 90/60 mm Hg, respiration rate - 48/min. Acrocyanosis is observed. Objectively, the right side of his chest lags behind during breathing. Percussion detects a pulmonary dullness on the right. Auscultation detects no breathing over the right lung. X-ray shows on the right a shadow with fuzzy upper margin to the level of rib II. Exudate contains 90% of neutrophils. What is the most likely diagnosis in this case?

 

1. Lung cancer

2. Exudative tuberculous pleurisy

3. Pleural empyema

4. Infiltrative tuberculosis of the right lung

5. Croupous pneumonia

 

1. A 25-year-old woman has been suffering from diabetes mellitus since she was 9. She was admitted into the nephrology unit with significant edemas of the face, arms, and legs. Blood pressure - 200/110 mm Hg, Hb - 90 g/L, blood creatinine - 850 mcmol/L, the daily amount of urine is decreased - 200 ml, urine proteins -1.0 g/L, leukocytes - 10-15 in the vision field. Glomerular filtration rate - 10 mL/min. What tactics should the doctor choose?

 

1. Transfer into the hemodialysis unit

2. Active conservative therapy for diabetic nephropathy

3. Dietotherapy

4. Kidney transplantation

5. Transfer into the endocrinology clinic

 

1. It is the 11th day after a woman has given birth and for the last 5 days she has been ill. She complains of chills. Her body temperature fluctuates between 35.8°C and 39.9°C. She cannot pump milk from her left breast. Objectively, her skin and mucosa are pale, her left mammary gland is significantly larger than the right one,the skin there is hyperemic, the upper and lower quadrants are dense, palpation detects a fluctuation and provokes sharp pain. The nipple is edematous and has a fissure with a purulent crust. The right mammary gland is normal. Make the provisional diagnosis:

 

1. Postpartum period. Physiological course

2. Postpartum period. Sepsis

3. Postpartum period. Right breast cancer

4. Postpartum period. Serous mastitis of the right breast

5. Postpartum period. Right breast abscess

 

1. A 20-year-old student after failing an exam developed complaints of a sensation of a round foreign body in her throat, difficult swallowing. She fixates on her condition, limits her diet, often cries, seeks attention, exhibits demonstrative attitude. She is highly susceptible to psychotherapeutic suggestions. What psychiatric diagnosis can be made in this case?

 

1. Hysterical neurosis

2. Paranoid personality disorder

3. Obsessive neurosis

4. Hypochondriacal neurosis

5. Depressive neurosis

 

​

1. A 29-year-old woman complains of a general weakness, increased fatigability. weight loss, and infrequent scanty periods. One year ago she had a childbirth. complicated with a massive bleeding. Objectively, the woman is asthenic, her skin is pale and dry, the hair cover is thin on her scalp and absent in her armpits. Her mammary glands and genitals are hypertrophic. Make the provisional diagnosis:

 

1. Pituitary tumor

2. Anorexia nervosa

3. Asthenoneurotic syndrome

4. Sheehan's syndrome

5. Hypoplastic anemia

 

1. A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No signs of gynecological pathology were detected. In the family history there was a case of cervical cancer that occurred to the patient's grandmother. The patient was consulted about the maintenance of her reproductive health. What recommendation will be the most helpful for prevention of invasive cervical cancer?

 

1. Antiviral and antibacterial drug

2. Vaccination against human papillomavirus (HPV)

3. Vitamins, calcium, omega-3

4. Timely treatment of sexually transmitted diseases

5. Immunomodulators

 

1. A 7-year-old boy after playing with a cat suddenly developed problems with breathing. Objectively, the boyis pale, frightened, and sits, leaning onto his arms. His body temperature is 36.6°C, heart rate - 120/min., respiration rate 42/min., speaks in syllables. The exhale is long and accompanied by wheezing. Percussion detects a bandbox resonance over the lungs. An inhalation of ventolin (salbutamol) solution was started via a nebulizer. What can help assess the child's need for oxygen therapy in this case?

 

1. Chest X-ray

2. Assessment of accessory muscles involvement

3. Spirometry

4. Pneumotachometry

5. Pulse oximetry

 

1. A 7-day-old girl is markedly inert and suffers from recurrent (sometimes projectile) vomiting, liquid stools, exicosis, and marked progressing hypotension. She gains no weight. Her skin is earthy gray and her nipples are pigmented. She presents with enlarged clitoris, incomplete union of the vulvar lips, and incomplete separation of the urethra and vagina. She has marked hyperkalemia and hyponatremia, metabolic acidosis, and hypoglycemia. Her blood aldosterone levels are low, while her plasma renin activity is high. Make the provisional diagnosis:

 

1. Turner syndrome

2. Adrenogenital syndrome, simple-virilizing form

3. Adrenogenital syndrome, hypertensive form

4. Hermaphroditism

5. Adrenogenital syndrome, salt-wasting form

 

1. A pregnant woman at 32 weeks of gestation with the risk of preterm labor undergoes a treatment to prevent fetal respiratory distress syndrome. What medicine was she prescribed?

 

1. Gynipral (hexoprenaline)

2. Misoprostol

3. Oxytocin

4. Dexamethasone

5. Progesterone

 

1. A 25-year-old parturient woman is hospitalized with contractions that have been occurring for 12 hours already. The contractions last 25 seconds, while the intervals between them last 3-4-7 minutes. The contractions are irregular and sharply painful, with pain spreading upwards from the lower uterine segment. The baby is in the cephalic presentation, the head is pressed to the entrance into the lesser pelvis. Uterine hypertonus is observed. Internal obstetric examination shows that the cervix is smoothed and the opening of the external orifice uterus is 3 cm. The amniotic sac is intact. Make the provisional diagnosis:

 

1. Discoordinated labor activity

2. Physiological course of the labor

3. Cervical dystocia

4. Primary weakness of the labor activity

5. Secondary weakness of the labor activity

 

1. A 65-year-old man has an over 17-year-long history of chronic obstructive bronchitis. He complains of dyspnea with difficult inspiration, heaviness in his right subcostal region, and edema of feet and shins. Auscultation detects rough respiration and dry crackles over the lungs and an accentuated split second heart sound in the second intercostal region. What changes can be expected on the ECG?

 

1. Extrasystole

2. Left atrial hypertrophy

3. Deviation of the electrical axis of the heart to the left

4. Right ventricular myocardial hypertrophy

5. Ciliary arrhythmia

 

1. For the last 2 years, a 32-year-old woman has been observing periodical pain attacks in her right subcostal area that could be removed with no-spa (drotaverine). The pain is not always associated with meals, sometimes it is caused by anxiety and accompanied by cardiac pain and palpitations. Objectively, the woman is emotionally labile. Abdominal palpation detects a slight pain in the area of the gallbladder. What pathology is the most likely to cause such clinical presentation?

 

1. Chronic cholangitis

2. Duodenitis

3. Chronic cholecystitis

4. Chronic pancreatitis

5. Biliary dyskinesia

 

1. A 36-year-old woman complains of nausea, belching, liquid stool, and a pain in the epigastrium after meals. For the last 2 years the disease has been slowly progressing. Objectively, her skin is pale and dry, her tongue is coated, moist, and has imprints of the teeth on its edges. Abdominal palpation detects a diffuse pain in the epigastrium. What test will be the most informative in this case and should be conducted next?

 

1. Comprehensive complete blood count

2. Gastrointestinal X-ray

3. Fractional analysis of gastric secretion

4. Fibrogastroscopy with biopsy of the gastric mucosa

5. Abdominal CT scan

 

1. A 62-year-old woman was brought into the dmission room with complaints of severe burning retrosternal pain and asphyxia. She has a 10-year-long history of essential hypertension. Objectively her condition is moderately severe. She presents with skin pallor, cyanotic lips, and vesicular respiration over herlungs. The II heart sound is accentuated over the aorta. Blood pressure - 210/120 mm Hg. heart rate (pulse) - 76/min. ECG shows elevation of ST segment in the leads 1, AVL, and VS-V6. What is the most likely diagnosis?

 

1. Pulmonary embolism

2. Hypertensive crisis complicated with acute left ventricular failure

3. Uncomplicated hypertensive crisis

4. Hypertensive crisis complicated with acute myocardial infarction

5. Hypertensive crisis complicated with instable angina pectoris

 

1. A 40-year-old woman after an unsuccessful treatment by a neurologist was referred to a gynecologist. She complains of swollen breasts, depression intermittent with aggression, weakness, tearfulness, numb arms, and meteorism that appear 2-3 days before a menstruation and disappear after the menstruation is over. She considers herself ill for the last 1 years. Gynecological examination detects no pathologic changes in her genitals. She was diagnosed with premenstrual syndrome. What clinical form of premenstrual syndrome is the most likely in this case?

2.  

3. Crisis

 

1. Mixed

 

1. Cephalgic

 

1. Edematous

 

1. Neuropsychic

 

1. During examination a 4-month-old child with

 

meningococcemia presents with acrocyanosis, cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor. What clinical syndrome is it?

 

1. Exicosis

 

1. Encephalic syndrome

 

1. Acute renal failure

 

1. Neurotoxicosis

 

1. Toxic shock syndrome

 

1. A 39-year-old woman complains of high body temperature of 37.8°C that persists for two days already, frequent urination, and a dull lumbar pain. These sighs appeared for the first time, after an overexposure to cold. During physical examination, palpation of the renal region is painful. Urinalysis shows the following: pH alkaline, protein - 0.099 g/L, leukocytes cover the whole vision field, erythrocytes - 0 in the vision field, cylinders -

 

1. in the vision field. Complete blood count shows the following: hemoglobin - 140 g/L, leukocytes - 9.2-109/L, ESR - 30 mm/hour. What medicine should be chosen for empiric antibiotic therapy in this case?

 

 

1. Amikacin

 

1. Fosfomycin

 

1. Trimethoprim/sulfamethoxazole

 

1. Amoxicillin

 

1. Ciprofloxacin

 

1. A 60-year-old man came to a hospital complaining of a bursting sensation behind his sternum that develops during fast walking and physical exertion. The pain lasts for approximately 5 minutes and passes on its own in a resting state. Objectively, his pulse is 75/min., blood pressure - 140/80 mm Hg. The heart borders are normal. Heart sounds are slightly weakened, rhythmic, and clear. ECG shows no changes. Make the provisional diagnosis:

 

1. Exertional angina pectoris

 

1. Somatoform autonomic dysfunction

 

1. Variant angina pectoris

 

1. Myositis

 

1. Intercostal neuralgia

 

1. A baby is 4 days old. The baby's condition after birth is severe (tonic-clonic seizures, no newborn reflexes). The muscle tone is asymmetrical. The large fontanelle exhibits increased pulsation and is 3x3 cm in size. The baby's respiration rate is 32/min., with apnea episodes. The heart sounds are clear and rhytmical, the heart rate is 122/min. Neurosonogram shows enlarged lateral ventricles with echo- positive inclusions in the ependyma. What is the most likely cause of the child's condition in this case?

 

1. Spinal cord birth injury

 

1. Respiratory distress syndrome

 

1. Meningitis

 

1. Intraventricular hemorrhage

 

1. Hydrocephalus

 

1. A 39-year-old man came to a doctor complaining of a pain in his left leg. The disease onset was 2 days ago. Objectively. His body temperature is 37.8°C and he has subcutaneous varicose veins on the inner surface of his left thigh and shin. The skin over the varicose veins is hot and red. The Moses and Homans signs are negative. What is the most likely diagnosis in this case?

 

1. Acute ascending thrombophlebitis of the saphenous veins in the left leg

 

1. Acute deep vein thrombosis in the left leg

 

1. Thrombosis of the tibial arteries on the left

 

1. Varicose saphenous veins in the left leg

 

1. Postthrombotic syndrome of the left leg

 

1. A 48-year-old woman complains of disturbed menstrual cycle: her periods last for 7-9 days and are excessively profuse throughout the last half-year. She

 

 

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notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure - 150/90 mm Hg. pulse - 90/min., rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornices are free. What is the most likely diagnosis?

 

1. Uterine myoma

 

1. Stein-Leventhal syndrome (polycystic ovary syndrome)

 

1. Adrenogenital syndrome

 

1. Climacteric syndrome

 

1. Premenstrual syndrome

 

1. A 12-year-old boy with hypertrophic cardiomyopathy complains of dyspnea caused by the slightest physical exertion. Echocardiography detected asymmetrical left ventricular hypertrophy, signs of pulmonary hypertension, and left ventricular dilatation, its ejection fraction is 59%. These developments are indicative of:

1. Heart failure with preserved ejection fraction

 

1. Primary pulmonary hypertension

 

1. Primary arterial hypertension

 

1. Symptomatic arterial hypertension

 

1. Heart failure with reduced ejection fraction

 

1. During a regular examination, an 8-year-old girl with type 1 diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?

 

1. Allergic response

 

1. Development of atrophic lipodystrophy

 

1. Development of hypertrophic lipodystrophy

 

1. Formation of a post-injection abscess

 

1. Formation of a post-injection infiltration

 

1. Anthropometric measurements are widely used to study the physical development of children and teenagers. What measurement is the functional one?

 

1. Determining the shape of the backbone

 

1. Measuring the vital capacity of the lungs

 

1. Weight measurement

 

1. Determining the shape of the chest

 

1. Height measurement

 

1. A 27-year-old man complains of dry cough, dyspnea during the slightest exertion, chest pain, and high temperature of 37.3°C that persists for the last 3 weeks. He has a past history of drug abuse. His respiration is rough, without crackles. He has tachycardia of 120/min.

 

 

X-ray shows interstitial changes on the both sides of his lungs. Bronchoscopy detects Pneumocista carinii in the lavage fluid. What medicine will be the most effective for the treatment of this patient?

 

1. Erythromycin, rifampicin

 

1. Cefamezin (cefazolin), nitroxoline

 

1. Ampicillin, nizoral (ketoconazole)

 

1. Biseptol (co-trimoxazole), clindamycin

 

1. Interferon, rimantadine

 

1. During regular examination of a 2 year-old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cystoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?

 

1. Hypoplasia of the right kidney

 

1. Dystopia of the right kidney

 

1. Agenesis of the right ureter

 

1. Ectopic right ureteral orifice

 

1. Agenesis of the right kidney

 

1. A 20-year-old man was hospitalized on the 9th day of the disease. He attributes his disease to eating of insufficiently thermally processed pork. At its onset this condition manifested in periorbital edemas and fever. Objectively, his body temperature is 38.5°C. The face is puffy and the eyelids are markedly swollen. Palpation of gastrocnemius muscles is sharply painful. Blood test shows hypereosinophilia. What is the etiology of this disease?

 

1. Echinococci

 

1. Trichuris

 

1. Ascarididae

 

1. Trichinella

 

1. Leptospira

 

1. A 55-year-old woman complains. of a recurrent diarrhea, peeling and pigmentation of the exposed areas of her skin (neck, hands, and feet), irritability, and anxiety. What vitamin deficiency is it?

 

1. Pantothenic acid

 

1. Riboflavin

 

1. Nicotinic acid

 

1. Thiamine

 

1. Retinol

 

1. A 35-year-old pregnant woman with hypertension, developed edemas and headache at the 33 week of her pregnancy. Objectively her general condition is satisfactory, blood pressure - 160/100 mm Hg, normal uterine tone. Fetal heart rate is 140/min., rhythmic. She was diagnosed with daily proteinuria - 4 g/L, daily

 

 

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diuresis - 1100 mL. Creatinine - 80 mcmol/L, urca - 7 mmol/L, platelets - 100 * 109/L. What complication of pregnancy occurred?

 

1. Hypertensive crisis

 

1. Severe preeclampsia

 

1. Renal failure

 

1. Mild preeclampsia

 

1. Moderate preeclampsia

 

1. A 30-year-old man has received second-degree burns that cover 40% of his body. On the fourth day after the injury, his general condition acutely deteriorated. E developed inspiratory dyspnea, frequent cough with frothy sputum, and cyane skin. Auscultation detects numerous crackles in the lungs. His blood press is 110/60 mm Hg, heart rate - 100/m respiration rate 32/ min, Central ves pressure 100 mm H₂ O, total protein 50 g/L, Ht 30%, Hb - 90 g/L. shows sinus tachycardia. What mechanism of pulmonary edema pathogenesis is the

 

1. Decreased contractility of the myocardium

 

1. Hypervolemia of the pulmonary

 

1. Surfactant dysfunction

 

1. Pulmonary hypoventilation

 

1. Decreased plasma osmotic pressure

 

1. A 28-Year-Old man after lifting weight felt an intense lumbar pain that irradiated to the right leg. He made an appointment with a doctor. After examination, the doctor diagnosed him with acute discogenic lumbosacral radiculitis. What additional examination is necessary to confirm this diagnosis?

 

1. Lumbar puncture

 

1. Lumbar MRI

 

1. Urinalysis

 

1. Kidney X-ray

 

1. Electromyography of the leg muscles

 

1. A man complains of a heaviness behind his sternum, periodical sensation of food retention, and dysphagia. During X-ray the barium contrast reveals a single pouch-like protrusion in the right anterior wall of the esophagus. The protrusion has clear margins and a clearly defined neck. What is the most likely diagnosis in this case?

 

1. Esophageal carcinoma

 

1. Esophageal diverticulum

 

1. Hiatal hernia

 

1. Varicose veins of the esophagus

 

1. Esophageal polyp

 

1. Analysis of the population morbidity in a village, located near a chemical factory, shows that within the last several years the number of gout and esophageal

 

 

cancer cases has significantly increased. What pollutant of the environment is the likely cause of such dynamics?

 

1. Nickel

 

1. Molybdenum

 

1. Mercury

 

1. Strontium

 

1. Manganese

 

1. A 56-year-old woman was diagnosed with stage 2 hypertension of the 2nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is contraindicated to this patient?

 

1. Angiotensin-converting enzyme inhibitors

 

1. Imidazoline receptor antagonists

 

1. β-blockers

 

1. Diuretics

 

1. Calcium antagonists

 

1. A 47-year-old man has been ill for 3 days already. Palpation detects a painful inflamed infiltration in his right subcostal region. His body temperature is 38.9°C. Sonography allowed diagnosing him with calculous destructive cholecystitis. Clinical and laboratory data are not indicative of choledocholithiasis. What tactics should be chosen for the treatment of this man?

 

1. Monitoring, cholecystectomy if peritonitis starts developing

 

1. Choleretics, hepatoprotectors, Corticosteroids

 

1. Complex anti-inflammatory therapy

 

1. Surgical treatment - cholecystectomy

 

1. Laparocentesis, abdominal drainage

 

1. A 37-year-old man complains of a pain in his lumbar and thoracic spine and limited spinal mobility for the last 5 years. After examination he was diagnosed with central ankylosing spondylitis. This man is likley to be a carrier of the following HLA antigen:

1. HLA-B27

 

1. HLA-B5

 

1. HLA-DR20

 

1. HLA-DR8

 

1. HLA-DR4

 

1. A 7-year-old child complains of stomachache episodes that occur after mental stress, cold drinks, or ice cream. After clinical and instrumental examination the boy was diagnosed with hypertensive biliary dyskinesia. What medicines should be prescribed first for the treatment in this case?

1. Antibiotics

 

1. Antioxidants

 

1. Sedatives and cholekinetics

 

1. Antispasmodics and choleretics

 

1. Choleretics and cholekinetics

 

 

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1. A 32-year-old woman presents with obesity (mostly her shoulders and torso are affected), hirsutism, and menstrual irregularities. She has purple-cyanotic striae and stretch marks on her shoulders, chest, abdomen, and thighs. What is the cause of striae development in this case?

 

1. Hypoestrogenemia

 

1. Catabolic effect of corticosteroid excess

 

1. Insulin resistance

 

1. Overproduction of androgens

 

1. Hypergonadotropinemia

 

1. A 3-year-old child, while playing. suddenly developed cough attacks and problems with breathing. Objectively, the child has a dry cough and mixed type dyspnea. Auscultation detects a small amount of dry crackles in the lungs. Respiration is weakened on the right. The child does not attend kindergarden and has all necessary immunizations for that age. What pathology can be suspected?

 

1. Airway foreign body

 

1. Pertussis

 

1. Acute respiratory viral infection

 

1. Bronchial asthma

 

1. Pneumonia

 

1. A man, who one day ago returned from a trip to Africa, presents with a sharply painful cluster of lymph nodes in his armpit. The skin over the lymph node cluster is hyperemic. Bubonic plague is suspected. What must the contact persons use for urgent prevention of this disease?

 

1. Homologous immunoglobulin

 

1. Heterologous serum

 

1. Praziquantel

 

1. Fluconazole

 

1. Doxycycline

 

1. You witnessed a car accident. When examining the place of the accident you noticed a man of about 30 years, who was hit by the car. He is unconscious. On his neck on the left there is a profuse hemorrhage with bright-red blood. How to stop this hemorrhage?

 

1. Put him in a stable position

 

1. Apply a neck brace

 

1. Maximal hyperextension of the neck

 

1. Apply a plaster cast

 

1. Digital occlusion, Mikulich method

 

1. A 21-year-old woman came to a surgeon 5 hours after she had scalded her left forearm with boiling water. Objectively, a skin patch 17x10 cm in size had flaccid vesicles; epidermis there was torn and displaced in some areas. The wound bottom was whitish-gray, dry,

 

 

and its pain sensitivity was reduced. After a treatment with bandages soaked with a solution of furacilin (nitrofural), levosin, and hiposol, on the 29th day after the burn, the necrotic scab came off, leaving a pink superficial scar in its place. What was the degree of the burn in this case?

 

1. IIIA degree burns

 

1. IIIB degree burns

 

1. IV degree burns

 

1. Il degree burns

 

1. I degree burns

 

1. A man suddenly developed a sharp pain in the right side of his chest. Dyspnea has rapidly progressed. Objectively, the patient has marked acrocyanosis and is in a severe condition. Subcutaneous emphysema is observed in the area of the patient's neck and upper chest. Over the right lung a bandbox resonance can be heard, respiration is absent there. The heart borders are displaced to the left. The patient's heart rate is 110/min., blood pressure -100/60 mm Hg. What is the most likely disease in this case?

 

1. Community-acquired pneumonia

 

1. Exudative pleurisy

 

1. Lung infarction

 

1. Spontaneous pneumothorax

 

1. Myocardial infarction

 

1. A 48-year-old woman was arrived to the surgical unit with wounds in her thigh. On examination the wound surface has dirty-gray coating with unpleasant sweet smell. Wound content resembles raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What microflora is the most likely to cause such inflammation?

 

1. Blue pus bacillus

 

1. Anaerobic clostridial

 

1. Staphylococci

 

1. Streptococci

 

1. Anaerobic non-clostridial

 

1. When helping a man with a bleeding, the emergency physician has pricked his own finger. The patient is an injecting drug user, who underwent a test for HIV, but the results of the test are unknown. What measures must the doctor take in this case?

 

1. Nothing needs to be done

 

1. Process the contaminated skin area, test the patient for HIV, start chemoprophylaxis

 

1. Process the contaminated skin area, start antiviral and antibiotic treatment

 

1. Process the contaminated skin area, administer donor immunoglobulin

 

 

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1. Process the contaminated skin area. examine the patient for TORCH infections, start antibiotic treatment

 

1. A 2-year-old boy against the background of lacunar tonsillitis developed problematic breathing through the nose and mouth. Mesopharyngoscopy shows hyperemic palatine tonsils and posterior pharyngeal wall, yellow films in the openings of the tonsillar crypts, and a protrusion on the posterior wall of the oropharynx that fluctuates during palpation. What complication must be avoided during the surgical treatment of this condition?

1. Mediastinitis

 

1. Esophagitis

 

1. Major vessel injury

 

1. Disturbed lymphatic efflux

 

1. Pus aspiration

 

1. Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust- induced diseases. What is the main physical property of dust aerosols?

1. Magnetization

 

1. Dispersion

 

1. Ionization

 

1. Electric charge

 

1. Solubility

 

1. A 46-year-old woman has diarrhea with abdominal distension, loss of body mass, and large amounts of porridge-like foul-smelling stool without blood streaks or tenesmus. Objective examination detects moderate tenderness in the mesogastrium and left abdominal flank. Stool analysis detects steatorrhea with neutral fat and creatorrhea. What prescription would be the most advisable in this case?

 

1. Antacids and antispasmodics

 

1. Anticholinergic drugs and antibacterial agents

 

1. Metronidazole and loperamide

 

1. Anticholinergic drugs

 

1. Multi-enzyme preparations

 

1. An 18-year-old girl complains of sneezing attacks that occur mostly in the morning 15-20 times in a row, an itch in her nose and throat, profuse watery discharge from her nose, rhinitis, and pain in her eyes. What test will be the most informative for diagnosis-making in this case?

 

1. Droplet test

 

1. Skin prick test

 

1. Intradermal test

 

1. Provocation test

 

1. Total IgE levels

 

 

1. A 56-year-old woman has been working as a disinfector for 19 years. She complains of general weakness, nausea, bitter taste in her mouth, heavy sensation in her right subcostal area, and rapid fatigability. Objectively, her body temperature is 37.1°C, the sclerae are icteric, and the liver is enlarged. Total bilirubin is 40 mcmol/L. What is the likely diagnosis?

1. Acute cholecystitis

 

1. Biliary dyskinesia

 

1. Chronic pancreatitis

 

1. Chronic cholecystitis

 

1. Occupational toxic hepatitis

 

1. A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset. What is the most likely diagnosis?

 

1. Acute bronchiolitis

 

1. Acute pulmonary inflammation

 

1. Stenosing laryngotracheobronchitis

 

1. Acute bronchitis

 

1. Bronchial asthma

 

1. A patient was brought into the pulmonology department with complaints of inspiratory dyspnea and dry cough at the highest point of inhalation. On examination the following is observed: pale skin, cyanotic lips, «Hippocratic fingers». Auscultation detects Velcro-type crackles (like opening a Velcro fastener). X-ray shows a «ground glass opacity» pattern. What is the most likely diagnosis

 

1. Exogenous allergic alveolitis

 

1. Pulmonary histiocytosis X

 

1. Idiopathic pulmonary hemosiderosis

 

1. Hand-Schuller-Christian disease

 

1. Idiopathic pulmonary fibrosis

 

1. A 62-year-old woman has an acute onset of the disease: high temperature of 39.8°C, chills, intense headache, and aching body. She complains of nausea and one episode of vomiting. 18 hours later, her right inguinal lymph nodes became enlarged and sharply painful. After another 6 hours, she developed edema of the right shin and skin hyperemia with irregular-shaped clear margins. What is the most likely diagnosis in this case?

 

1. Phlegmon of the right shin

 

1. Anthrax, edematous form

 

1. Bubonic tularemia

 

1. Bubonic plague

 

1. Erysipelas, erythematous form

 

 

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1. A 17-year-old young man demands a plastic surgery. He thinks that it's impossible to live with such an ugly nose as his. He claims that wherever he is, everyone is laughing at him and mocking him behind his back. He walks with a cap pulled low over his face, turns his face downwards, and pulls up his scarf up to his eyes. Objectively, there are no indications for rhinoplasty - the young man has a nearly classical shape of the nose. What psychopathological condition is it?

 

1. Intrusive thoughts

 

1. Dysmorphomania

 

1. Capgras syndrome

 

1. Body schema disorder

 

1. Hypochondriacal neurosis

 

1. A 36-year-old woman complains of a headache, paresthesia, muscle weakness, spasms, thirst, and polyuria. Objectively, her temperature is 36.6°C, respiration rate - 18/min., pulse - 92/min., blood pressure - 180/110 mm Hg. Her ECG shows ST depression. Her potassium levels in blood plasma are low, sodium levels are high, plasma renin activity is significantly decreased, aldosterone concentration is high. 24-hour urine specific gravity does not exceed 1.008-1.011, alkaline reaction is observed. Spironolactone test is positive. CT scan shows enlarged right adrenal gland. What is the most likely diagnosis in this case?

1. Cushing's syndrome

 

1. Androsteroma

 

1. Diabetes insipidus

 

1. Conn's syndrome

 

1. Pheochromocytoma

 

1. A 23-year-old woman, para 2, full term, is in labor. Her waters were clear and broke three hours ago. The labor activity is regular. The contractions last 25-30 seconds, with intervals of 4-5 minutes. The baby is in the longitudinal lie, cephalic presentation. The head is pressed to the entrance into the lesser pelvis, Fetal heart rate is 136/min. Internal examination shows that the cervix is smoothed out, the opening of the external orifice of uterus is 3 cm, no amniotic sac, the lower pole of the fetal head is at the level of l. terminalis. What stage of labor is it?

 

1. Stage II of labor

 

1. Labor precursors

 

1. Stage III of labor

 

1. Preliminary stage

 

1. Stage I of labor

 

1. One year ago a 46-year-old woman underwent a partial thyroidectomy duc so multinodular goiter. Now she complains of general weakness, drowsiness, constant fatigue, low working ability, constipations

 

 

edema of her face and limbs. Objectively her body temperature is 36°C. Her skin is dry and wrinkled. She started losing her hair and developed amenorrhea. What condition is it?

 

1. Primary hypothyroidism

 

1. Thyrotoxicosis

 

1. Chronic thyroiditis

 

1. Hypoparathyroidism

 

1. Subclinical hypothyroidism

 

1. A 19-year-old young man after a treatment for bilateral pneumonia developed thirst, high appetite, weight loss, and dry mouth. The signs continue to intensify. Examination shows fasting glycemia of 19.7 mmol/L, glucosuria of 2.8 g/L, and signs of acetonuria. What treatment should he be prescribed?

 

1. Glucose solution

 

1. Physiological saline

 

1. Biguanides

 

1. Insulin

 

1. Metformin

 

1. A man complains of a headache, problematic breathing through the nose, and purulent discharge from the nose that are observed for the last 3 months. Four months ago he underwent a treatment of his upper right premolar. X-ray shows a shadow over the right maxillary sinus. Its diagnostic puncture yielded a large amount of thick foul-smelling granulated pus. What is the most likely diagnosis in this case?

 

1. Maxillary sinus tumor

 

1. Chronic purulent odontogenic maxillary sinusitis

 

1. Chronic purulent maxillary sinusitis

 

1. Chronic atrophic maxillary sinusitis

 

1. Acute purulent maxillary sinusitis

 

1. A 9-year-old boy is in a severe condition. His body temperature is - 38-39°C, he has nosebleeds and complains of pain in his bones. Objectively, the boy presents with acute pallor, hemorrhagic rash, and ulcerative necrotizing stomatitis. All the groups of lymph nodes are enlarged. The liver is +5 cm. The spleen is +4 cm. What test will be decisive for diagnosis-making in this case?

 

1. Immune complex testing

 

1. Abdominal ultrasound

 

1. Complete blood count

 

1. X-ray of the mediastinum

 

1. Myelogram

 

1. A 38-year-old man has been for many years suffering from epilepsy. Three days ago he had an episode of clouded consciousness that started suddenly and was accompanied by anger. In this state he was

 

 

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speaking nonsense, breaking furniture, and hit his wife. He remained in this state for about an hour, after which he fell asleep. Later he was claiming that he didn't remember any of the events that had happened during the episode. What is the most likely definition of this condition?

 

1. Ambulatory automatism

 

1. Twilight state

 

1. Trance

 

1. Fugue state

 

1. Amentive state

 

1. Two weeks after an antibacterial therapy for a febrile illness, a 25-year-old woman developed severe watery diarrhea, colicky abdominal pain, and elevated body temperature. Proctosigmoidoscopy detects focal mucosal lesions with a pale yellow coating. What is the most likely diagnosis in this case?

 

1. Pseudomembranous colitis

 

1. Ulcerative colitis

 

1. Crohn's disease

 

1. Gastroenteritis

 

1. Ischemic colitis

 

1. Daily diet of a 10-year-old girl contains the following: vitamin B₁ - 1.2 mg, vitamin B2 - 0.6 mg, vitamin B6- 1.4 mg, vitamin PP - 15 mg, vitamin C - 65 mg. Assessment of the girl's nutrition status reveals that she has cheilosis, glossitis, angular cheilitis, and conjunctivitis. The girl is likely to have:

 

1. Vitamin C hypovitaminosis

 

1. Vitamin B2 hypovitaminosis

 

1. Vitamin PP hypovitaminosis

 

1. Vitamin B6 hypovitaminosis

2. Vitamin B₁ hypovitaminosis

 

1. A 38-year-old woman complains of a tensive pain in her lower abdomen and the small of her back that is observed within the last month and intensifies on the day before menstruation. Premenstrual dark bloody discharge was observed. She has a history of four medical abortions and one birth. Ultrasound shows isolated foci of increased echogenicity in the myometrium, increased anteroposterior size of the uterus, and round hypoechogenic inclusions 2 mm in diameter. What is the most likely diagnosis in this case?

 

1. Hormone-producing ovarian tumor

 

1. Chorionepithelioma

 

1. Ovarian endometriosis

 

1. Retrocervical endometriosis

 

1. Adenomyosis

 

1. During analysis of morbidity in the city, it was determined that age structure of population is different in

 

 

each district. What statistical method allows to exclude this factor, so that it would not skew the morbidity data?

1. Correlation-regression analysis

 

1. Analysis of average values

 

1. Standardization

 

1. Dynamic time series analysis

 

1. Wilcoxon signed-rank test

 

1. A regional cardiologist is given a task to develop a plan for preventive measures aimed at decreasing cardiovascular mortality rates. What measures should be planned for secondary prevention?

 

1. Prevention of recurrences and complications

 

1. Referring patients for inpatient treatment

 

1. Optimization of lifestyle and living conditions

 

1. Prevention of diseases

 

1. Referring patients for sanatorium-and spa treatment

 

1. A 73-year-old man against the background of acute transmural anterior myocardial infarction has developed a decrease in systolic pressure (70 mm Hg) and diuresis (100 mL per 24 hours) and an increase in blood creatinine (480 mcmol/L). Proteinuria is observed in the urine (0.066 g per 24 hours). What is the cause of decreased diuresis?

 

1. Congested kidney

 

1. Acute tubulointerstitial nephritis

 

1. Acute renal failure

 

1. Prerenal acute kidney injury

 

1. Rapidly progressive glomerulonephritis

 

1. A 74-year-old woman came to a doctor complaining of a pain in her right inguinal region. The signs appeared suddenly, approximately 2 hours ago. The woman notes that she already had these signs 3 weeks ago, but back then they disappeared on their own after she lay down. Objectively, palpatio detects below the Poupart's ligament a sharply painful, dense, and tense formation 3.5 cm in diameter. The Dejerine sign (aggravation on coughing) is negative. What is the most likely diagnosis in this case?

 

1. Acquired strangulated femoral hernia

 

1. Acquired incarcerated inguinal hernia

 

1. Inguinal lymphadenitis

 

1. Acquired incarcerated femoral hernia

 

1. Acquired strangulated inguinal hernia

 

1. When investigating a case of mass poisoning, it was determined that the car mechanics, who tested diesel engines in a repair bay with a broken exhaust ventilation, at the end of their working day developed the following signs: headache, nausea, vomiting, tinnitus, labile pulse. Objectively, their skin and mucosa are cherry-red. What toxic factor has caused mass poisoning of the car mechanics?

 

 

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1. Carbon dioxide

 

1. Sulfur dioxide

 

1. Carbon disulfide

 

1. Nitrogen oxide

 

1. Carbon monoxide

 

1. A 68-year-old man diagnosed with acute myocardial infarction is in an intensive care unit. Suddenly he fell unconscious. Objectively, his pulse and blood pressure cannot be detected. ECG shows frequent irregular waves of varying shape and amplitude. What complication occurred in this patient?

 

1. Acute heart failure

 

1. Pulmonary embolism

 

1. Asystole

 

1. Paroxysmal ventricular tachycardia

 

1. Ventricular fibrillation

 

1. A pregnant woman at the term of 11-12 weeks was hospitalized into the gynecological department with uterine bleeding and cramping pain in her lower abdomen. Vaginal examination shows that her vagina is filled with blood clots and her cervical opening is 2 cm. A tense amniotic sac can be detected in the birth canal. The uterus is tense and enlarged to the size that corresponds to the period of 11-12 weeks of pregnancy. The discharge is profuse and bloody. What must the doctor do in this case?

 

1. Prescribe progesterone

 

1. Perform uterine curettage

 

1. Perform conservative monitoring

 

1. Conduct blood transfusion

 

1. Conduct tocolytic therapy

 

1. A 72-year-old man on the 7th day after a surgical reposition of an intertrochanteric hip fracture has suddenly developed dyspnea and an intense pain in the left side of his chest. Examination reveals distended cervical veins and cyanosis. His respiration rate is 26/min. Auscultation detects weakened breathing over the left lung Heart rate - 98/min. Blood pressure - 120/70 mm Hg. CT scan shows significant disappearance of the lung pattern on the left. Echocardiography shows no signs of right ventricle overload. What next step will be the most advisable in this case?

1. Installing a vena cava filter

 

1. Prescribing aspirin (acetylsalicylic acid)

 

1. Surgical embolectomy

 

1. Thrombolytic injection into the left pulmonary artery

 

1. Prescribing low molecular weight heparin

 

1. A 25-year-old woman was hospitalized into the gynecological department with complaints of pain in her lower abdomen and high temperature of 39.7°C.

 

 

Objectively, her blood pressure is 120/80 mm Hg, pulse-108/min., of satisfactory strength and volume. The abdomen is moderately distended and sharply painful in its lower segments. The Bloomberg's sign is positive in the hypogastrium. During vaginal examination, the uterus and its appendages cannot be palpated because of anterior abdominal wall rigidity. The posterior vaginal fornix is overhanging and sharply painful. What is the most likely diagnosis in this case?

 

1. Acute adnexitis

 

1. Acute endometritis

 

1. Ectopic pregnancy

 

1. Ovarian apoplexy

 

1. Pelvioperitonitis

 

1. A 72-year-old man has been brought into a vascular surgery department with complaints of pain and chills in his legs. Ultrasound of his leg arteries shows atherosclerotic lesions of the vascular wall. What diagnostic method is necessary to determine the localization and the extent of the pathologic process in this case?

 

1. Angiography

 

1. Thermometry

 

1. X-ray of the extremities

 

1. Chest X-ray

 

1. ECG

 

1. Having examined a 52-year-old patient, the doctor diagnosed him with obesity (body mass index - 34 kg/m², waist circumference - 112 cm) and arterial hypertension (170/105 mm Hg). 2-hour postprandial blood sugar is

 

10.8 mmol/L. What biochemical blood analysis needs to be conducted to diagnose the patient with metabolic syndrome X?

 

1. Bilirubin

 

1. Calcium and phosphorus

 

1. Creatinine and urea

 

1. Lipid profile

 

1. Electrolytes

 

1. A 75-year-old man in a severe condition suffers from dyspnea at rest, marked weakness, and arrhythmia. Abdominal aortic pulsation is observed, further on there is a systolic murmur detected. Palpation reveals a volumetric formation in the mesogastrium. Blood pressure is 70/40 mm Hg. There is no pulsation over the femoral arteries. Oliguria is detected. Which diagnosis is the correct one?

 

1. Dissecting aortic aneurysm

 

1. Pancreatic cyst

 

1. Cardiosclerotic aneurysm

 

1. Acute cardiac aneurysm

 

1. Acute pericarditis

 

 

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1. A child is 4 months old. The disease onset was acute and manifested as a temperature of 37.8°C and a slight cough. On the third day after the onset, the cough intensified and became accompanied by dyspnea. Percussion detects a tympanic sound over the lungs, while auscultation reveals numerous wet fine bubbling and sibilant wheezes during the exhalation. Make the provisional diagnosis:

 

1. Focal pneumonia

 

1. Bronchopneumonia

 

1. Acute bronchiolitis

 

1. Acute bronchitis

 

1. Obstructive bronchitis

 

1. A 35-year-old man complains of rapidly increasing fatigue, palpitations, «visual snow», dizziness. He has a history of peptic ulcer of the stomach. Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic murmur is detected over the cardiac apex, heart rate is 100/min., blood pressure is 100/70

 

mm Hg. The epigastrium is slightly tender on palpation. Blood test: erythrocytes - 3.2 * 1012/L, Hb - 100 g/L, color index - 0.95. What type of anemia is the most likely present in this case?

 

1. Posthemorrhagic anemia

 

1. Hemolytic anemia

 

1. Sideroblastic anemia

 

1. Hypoplastic anemia

 

1. Chronic iron-deficiency anemia

 

1. A 42-year-old man has received a polytrauma in a car accident: closed displaced fractures of his right humerus and the bones of his left forearm and a closed blunt abdominal trauma. He was brought into the admission room 30 minutes after the trauma. His skin is pale. His blood pressure is 90/20 mm Hg. The fracture sites are deformed and painful. The abdomen is rigid and its palpation causes sharp pain. The Bloomberg's sign is positive. What medical procedures must be performed first in this case?

 

1. Additional examination to determine the exact diagnosis

 

1. Urgent laparotomy

 

1. Infusion therapy to stabilize the blood pressure

 

1. Immobilization of the fractures, pain relief

 

1. Fracture blockade with a topical anesthetic