A patient complains of intense pressing pain in the pharynx, mainly to the right, impossibility to swallow even liquid food. The illness started 5 days ago. The patients condition is grave. Body temperature - 38,9°С, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?
A pediatrician examines a healthy mature breast-fed baby, aged 1 month. Prevention of what condition should be recommended in the first place?
A patient, aged 70, complains of pain, lacrimation, loss of visual acuity on the right eye. Fell ill 3 days ago after eye injury with a tree branch. On examination: palpebral fissure is narrowed, photophobia, mixed injection. On the cornea there is an opacity area with irregular borders, progressive edge and epithelial defect. Cornea sensitivity is normal. Hypopyon. Chronic dacryocystitis. What is the most likely diagnosis?
A 45-year-old man was brought to clinic with complaints of a sudden pain in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after considerable weight lifting. On physical examination: shallow breathing, RR - 38/min, left chest part is getting behind during respiration, by percussion - tympanitic sound, respiration is not auscultated. Ps - 110 bpm, of weak filling. BP - 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient?
A 48-year-old man was taken to the emergency department in a grave condition. Medical history: 3 hrs ago he was treating potato plantations with the pesticides against Colorado beetles. Physical examination: acrocyanosis, bronchorrhea, tachypnea, BP - 100/60 mm Hg, Ps - 44 bpm. What method of efferent therapy is the most expedient on this stage?
A diagnosis of chronic arsenous intoxication was set to patient who is working as a nightman. What form of anaemia is characteristic for this disease?
A 43-year-old male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?
A patient, aged 14, suffering from heart failure, undergoes in-patient treatment. On ECG: changes in the form of a trough-shaped displacement of ST segment below isoline and frequent ventricular extrasystoles. What is the most probable cause of these changes?
Study of pulmonary tuberculosis provided data about social and everyday conditions of life and bad habits of patients. Which of the following methods allows to assess degree of influence of smoking on tuberculosis incidence?
A victim of a road accident suffered multiple fractures of extremities and pelvis bones. In medical history: haemophilia. On examination: hematomes are forming on the injured areas. The patients condition is aggravating. BP - 90/50 mm Hg. What is the most expedient combination of infusion medications for patients treatment after administering polyglukine and saline?
In 10 min after childbirth by a 22-year-old woman, the placenta was spontaneously delivered and 100 ml of blood came out. Woman weight - 80 kg, infant weight - 4100 g, length - 53 cm. The uterus contracted. In 10 minutes the haemorrhage renewed and the amount of blood constituted 300 ml. What amount of blood loss is permissible for this woman?
A 37-year-old patient has sudden acute pain in the right epigastric area after taking fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?
A 20-year-old woman complains of weakness, wet cough, body temperature raise up to 37,5°С in the evenings during one month. In childhood she was under phthisiatric observation due to conversion of tubercular tests (PPD). The condition is good. No rales in lungs. Chest X-ray: a shadow with dim contours 3х4 cm with a clearing and focuses near the shadow in the upper lobe of the right lung. Blood analysis: ESR - 20 mm/hour, WBC - 7,6*10^9/L. What is the most likely diagnosis?
A neonate was born from the 1st gestation on term. The jaundice was discovered on the 2nd day of life, then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275 mmol/L, direct bilirubin level - 5 mmol/L, Hb- 150 g/l. Mother's blood group - 0[I], Rh+, child's blood group- A[II], Rh+. What is the most probable diagnosis?
A girl, aged 14, complains of sleep disorders, weight loss, palpitations, heartaches, fatigue. On examination: thyroid gland hyperplasia ІІ degree, exophthalmus. What disorders of hormones level are the most characteristic for this decease?
A baby, aged 8 months, is examined and a diagnosis of atypical community-acquired pneumonia of chlamidial etiology is made. What is the optimum alternative of antibiotic therapy in this case?
A district physician has diagnosed domestic accident at worker of chemical factory who is at home. The worker is temporarily disable. What document should be given to legalise his disability?
A 40-year-old woman complains of yellow colour discharges from the vagina. Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodine probing. What is your tactics?
A 65 y.o. patient complains of shortness of breath, cough with red foamy sputum, feeling of air deficit, fear of death. On examination: orthopnea, pale skin, acrocyanosis, cold sticky sweat. Rough breathing sounds, in inferior-posterior arias on both sides - small and medium moist rales. BR - 40/min. Heart sounds are distinctly muffled. On the cardiac apex - gallop rhythm. What is the most probable preliminary diagnosis?
A 10-year-old child fell ill acutely a week ago after overcooling when there appeared pain in the stomach and the back, fever up to 38°С. Urine analysis: leukocytes 25-30 per v/f, protein 0,33 g/L. Which of the following is the most appropriate test for prescribing etiotropic treatment?
A 23-year-old man has a gun-wound on the left arm. The arm bones are undamaged. What appropriate surgical help must be provided to such a patient?
A patient complains of an ulceration on the inner surface of the lower third of the right shin. On xamination: the ulcer is round-shaped, up to 5 cm in diameter, with sloping edges. On the inner surface of this shin there are varicose veins. What complication appeared in this patient?
A patient, aged 25, suffering from stomach ulcer. Had a course of treatment in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defence in pyloroduodenal area. Development of which complication aggravated the patients state?
A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case the patients blood from the abdominal cavity can be used for autotransfusion?
A patient, aged 50, during 15 years is ill with essential hypertension, not under treatment. BP - 220/140 mm Hg, Ps - 80bmp, rhythmic. On percussion: the left heart border is 2 cm to the outside from the left midclavicular line. Sound 1 is moderately weakened. Sound 2 is accentuated over the pulmonary artery. What changes will be characteristic on ultrasound heart examination?
A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand. This state lasted for a few secondsAfter that the patient was rather confused, for some moments he couldn't understand what was happening. He totally forgot the state he was in and the events around him, occurring while he was in that state. What disorder is the most probable?
District physician was charged with plan preparation concerning the conducting of medical and preventive measures among the population in the area he is assigned to. What measures must he include in this plan as regards secondary prevention of illness?
A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examination: acuity of vision of the left eye is 0,01, not correctable. The eye is not irritated, the pupil of the eye is greyish, reflex from the fundus is absent. Intraocular pressure is 18 mm Hg. What is the most probable preliminary diagnosis?
A patient, aged 34, has been suffering for 7 years from pulmonary tuberculosis. He complains of muscle weakness, weight loss, diarrhea, frequent urination. On examination: hyperpigmentation of skin, gums, and inner sides of the cheeks. BP - 90/58 mm Hg. In blood: RBC - 3,1×10¹²/L, Hb - 95 g/L, colour index of blood – 0,92; WBC - 9,4×10⁹/L, eosinophils - 7, segmented neutrophils - 45, band neutrophils - 1, lymphocytes - 40, monocytes - 7, Na+ - 115 mmol/L, К+ - 7,3 mmol/L. What is the preliminary diagnosis?
A 30-year-old man has a history of recurrent pneumonias and chronic cough with foul smell, purulent sputum, occasionally blood tinged, which becomes worse in the morning and in reclining position. On physical examination, it is a chronic patient with clubbing of fingers, wet inspiratory rales at the root of lungs from behind. What is the most probable diagnosis?
A patient, aged 64, complains of pain in the knee-joints, appearing 2–3 hours after walking. On examination: knee-joint deformation, restriction of joints movements due to painfulness, crackling on movement, on both hands there are Heberdens nodes. In medical history: stomach ulcer. Which of the mentioned medications is expedient to prescribe to this patient?
A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°С. Sudden onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, peoples faces get cartoon features, loss of time and space judgement. What is the most likely diagnosis?
A child, aged 6, suffers from "bold" patches on the head. On examination: single large focuses, in which the hairs are broken on the same level - 6-8 mm from the skin surface. What is the most probable preliminary diagnosis?
A woman aged 35 has been suffering with pulmonary tuberculosis for 10 years. When in phthisiatric clinic, she started to act strangely: put on a gaudy make-up, gathered the other patients around herself, was singing and dancing with them. Highly excited, passed all the time among males, flirted, started sexually-biased conversations. The whole night absented from the clinic ("was on a date"). What leading syndrome of mental disorders is observed?
A 62-year-old patient with DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation for inguinal hernia. What should be the tactics of hypoglycemic therapy?
A 48-year-old woman complains of fatigue, weight and appetite loss, headache. Suffered from acute glomerulonephritis as adolescent. Suffers from arterial hypertension since age 25. Has not systematically undergone medical treatment, consulted doctor very rarely. On laboratory investigation signs of chronic renal failure first degree were found. (creatinine - 0,23 mmol/L). What nutrition recommendations are the most suitable for this patient?
A youth aged 17 complains of a sudden onset of palpitation 10 minutes ago. On examination: skin has normal colour. Heart borders without changes, HR=Ps=200bmp, regular rhythm, BP - 135/75 mm Hg. Heart sounds are intensified. On ECG: QRS = 0,09 sec. What measure should be done on the first stage of aid?
A woman aged 30 complains of dizziness, weakness, nails fragility, falling-out of hair, taste disorder. On examination: pale skin, Ps - 98bmp, BP - 100/60 mm Hg. In blood: Hb - 80 g/L, RBC - 3,4×10¹²/L, colour index of blood - 0,7, ESR - 20 mm/h. Serum iron - 7,2 mmol/L. What medicine is expedient to prescribe?
A 41-year-old woman complains of weakness, fatigue, fever up to 38°С, rash on the face skin, pain in the wrists and elbows. Physical exam: erythematous rash on the cheeks with "butterfly" appearance. The wrist and elbow joints are affected symmetrically, swollen, tender on motions. Pleural friction rub over the lungs, the heart sounds are weak, regular, HR - 88/min, BP - 160/95 mm Hg. CBA: anaemia, leucopenia, lymphopenia. Urinalysis: proteinuria, leukocyturia, cylinders. What is the main mechanism of disease development?
A 35-year-old woman was admitted to thoracic surgery department with fever up to 40°С, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?
A pupil of the 8th form after trauma has acute atrophy of the left leg muscles, tonus of which is distinctly decreased, active movements are only in the knee joint, his foot is deformed. Support function of the left leg is absent, support function of the right leg is preserved. The boy wears an orthopedic footwear. What group of physical training does the boy belong to?
A patient, aged 40, ailing during approximately 8 years, complains of exertion pain in the lumbar part of the spine, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?
A man, aged 56, complains of shortness of breath with difficult expiration, sputum excretion in the mornings during 22 years. Smokes 1 packet of cigarettes per day starting from the age of 18. On external respiration tests with bronchial spasmolytic: respiratory obstruction reversibility is 10%. What medication should be prescribed in the beginning of the treatment?
A female patient, aged 25, is hospitalised due to exudative pericarditis. Complains of shortness of breath, weakness, compression in the chest. Believes that she got ill 2 weeks ago, after common cold. What peculiarity found during examination will tell about chronic pericardium affection?
A patient, aged 28, complains of pain in the legs during walking, chilliness of feet, toes. Has being ill for a year. On examination: pale and cool legs skin, turgor diminished, hypotrichosis. Weakened pulsation on the hip and popliteal arteries, pulsation on the feet arteries is felt after nitroglycerine test. Rheographic index
A baby, aged 2 years, has a syndrome of malabsorbtion. On ECG: S-T segment depression, wave T inversion and high wave U. What is the cause of these changes?
A patient was operated on account of perforated stomach ulcer, terminal stage of diffuse peritonitisAfter endotoxic shock in the post-operative period the artificial pulmonary ventilation is carried out with inhalation of 60% oxygen. Blood gasses: РаО2 = 70-78 mm Hg, hypoxemia is not diminishing, CVP - 150-180 mm H₂O, BP - 90/60 mm Hg (with administering of dopamine in high doses). Radiologically: diffuse pulmonary infiltration. What is the reason of the resistant arterial hypoxemia?
A 49-year-old patient complains of fever of 37,5°С, chest pain, dyspnea. On physical examination: Sound 1 is clapping; Sound 2 is accentuated in the pulmonary artery, opening snap, presystolic murmurs are auscultated. What is the most useful investigation for valvular disorder assessment?
A woman, aged 28, consulted a doctor with the complaints of increasing size of pigment nevus which was present from birth, its maceration, itching. What method of investigation should be used for diagnostic in this case?
A 40-year-old man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP - 170/130 mm Hg. On EchOCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3,5 g/day. What is the probable diagnosis?
To study physical development of children and adolescents, anthropometric investigations are widely used. Choose a physiometric method of investigation from the below given
A 2,5-month-old child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamind. What is the dosage and frequency of vitamin D administration?
Biological development indices for the secondary and high school pupils are the following: height, annual height increase, hand ossification, number of permanent teeth. What other index has a special importance for this age group?
In a college with the majority of 14-year-old students preventive anti-tuberculosis planned examination is taking place. Which method from the following should be used?
A 2–year-old girl has been ill for 3 days. Today she has low–grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?
Woman in childbirth, 25 years old, the second period of labour. During internal obstetric examination, opening of the uterine cervix is full. Fetus membranes are absent. The head of the fetus is represented, the head occupies sacral cavity. Sciatic bones are undeterminable. During contractions perineum is sticking out. Where is the head of the fetus situated?
Left eye vision disorders were registered in a male patient aged 22. A year later there developed a weakness of the right foot. On examination: lateral nystagmus, paling of temporal half of the left disk of optic nerve, absence of abdominal reflexes, hyperreflexia on the extremities, clonus of the left foot, Babinskis signs on both sides. What is the most likely diagnosis?
A 68-year-old patient with long-term hypertension complains of dizziness, difficulties by swallowing, nasal voice, wobbly walking. These symptoms appeared about three years ago and are gradually progressing. What diagnosis is the most probable?
A patient is unconscious, with head injuries in the form of calvarium fracture, BP - 60/40 mm Hg, with pathological neurologic signs. On what basis these injuries can be considered as severe?
A woman, aged 60, complains of unendurable pain in the right hypochondrium. In medical history: acute pancreatitis. The body temperature - 38,2°С. On examination: scleral icteritiousness. No signs of peritoneum irritation. Positive Ortners symptom, Gubergrits-Skulsky symptom. Urine diastasis - 320 g/h. What diagnosis is the most likely?
A man aged 68 complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: WBC - 35×10⁹/L, lymphocytes - 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?
A patient, aged 35, complains of frequent heart-burns, air and acid eructation, burning, constringent pains behind the breast-bone, along esophagus, that appear after meals, during forward inclination of body. The patient was not examined, takes Almagel by self-medication, after the intake of which feels better. What is the most probable diagnosis?
A man with meningococcus meningitis has been taking penicillin for 7 days. During last 4 days a body temperature is normal. Meningitic signs are absent. When is it possible to cancel antibiotic?
A 5-year-old child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left - 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?
A 32-year-old patient complains of severe weakness, tremor of extremities. On physical examination, there is loss of body weight, wet and warm skin. The thyroid gland is enlarged up to the 3rd degree, painless, elastic. Ps: 108 bpm. BP- 160/55 mm Hg. The rest is in norm. What can be diagnosed?
A 27-year-old woman was admitted to clinic with complaints of pain in right ankle joint, impossibility to stand on those extremity. Clinical examination: the patient had a fracture of anterior part of distal metaepiphisis of tibia -Pott-Destos fracture. What is the mechanism of such injury?
In the structure of the population of N-region, person category of age from 0 till 14 years constituted 31%, for people from 50 years and older - 20%. Estimate the population structure that characterises the given demographic situation in a most efficient way.
A baby boy with body weight 3700 g is born in a maternity hospital. The general condition of the baby is satisfactory. In the centre of the abdomen there is a formation circa 12 cm in diameter. The formation is covered with smooth membranes through which the intestinal loops and liver are seen. What is the most likely diagnosis?
A 28-years-old man, without permanent residence, was hospitalised with the preliminary diagnosis of "influenza". On the 5th day of the disease there appeared typhoid maculopapular and petechial skin rash on trunk and inner sides of extremities. t°- 41°С, euphoria, facial hyperaemia, sclera reddening, tongue tremor. Ps - 104 bpm. Splenomegalia. What is the most likely diagnosis?
A 26-year-old woman gave birth to a child 6 months ago. She consulted a gynaecologist complaining of menstruation absence. The child is breast-fed. Vagina exam: uterus is of normal form, dense consistence. What is the most probable diagnosis?
You suspect that a 34-year-old patient has got an abscess of Douglas spaces. What method of investigation is preferable to diagnostics?
A woman, aged 30, in the second childbirth there is a baby born with anaemic-icteric form of the hemolytic disease. Blood group of the mother is А(ІІ) Rh-, blood group of the new-born is В(ІІІ) Rh+, blood group of the father is В(ІІІ) Rh+. What is the most probable cause of immune conflict?
A man, aged 28, suddenly fell ill. There appeared chills, sensation of heat, fever up to 38,5°С, intermitting pain in the left iliac area, frequent liquid stool in the form of sanguinomucoid mass. On palpation: the left part of the abdomen is painful, spastic sigmoid colon. What is the most likely diagnosis?
A 60-year-old boiler-house worker presents to factorys sectorial doctor with headache and tiredness. Lab tests: carboxyhemoglobin in blood. Poisoning with which substance is the most likely to cause formation of carboxyhemoglobin in blood?
A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain gets worseAcute pain appears on touching with the probe in ligament projection. What decease is the most likely?
A 52-year-old man has recurrent transient ischemic attacksAuscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply first?
A 20-year-old man complains of pain and edema in the right buttock. Physical examination: limited tenderness, painful swelling with skin hyperaemia and local hyperthermia. Positive fluctuation symptomAbscess is diagnosed. What are the tactics for the therapy?
In laboratory a sample of milk is analysed. There determined the following: colour – whitish, smell – without peculiarities, taste – specific for milk, density – 1,038, acidity – 350 Turner, fats – 3,2%. What is the degree of milk quality?
A 47-year-old man with gastric cancer, complicated by profuse haemorrhage was successfully treated by surgical intervention. After the operation the native blood plasma transfusion was performed. During transfusion developed acrocyanosis, hypersalivation, hyperpnea, BP - 80/40 mm Hg, Ps- 120 bpm. With injection of which substance the initial medication has to begin?
Mother with an infant visited the pediatrician. Her baby was born with body mass of 3,2 kg and 50 cm length. He is 1 year old now. How many teeth the baby should have?
A 42-year-old man has died in a road accident after the haemorrhage on the site, due to acute hemorrhagic anaemia. Loss of what minimum percentage of the total blood volume would result in death at acute haemorrhage?
A man, aged 30, intravenous drug addict complains of weakness, moderate jaundice, sensation of heaviness in the right hypochondrium. The patients condition aggravated gradually. Biochemical tests: Total bilirubin - 48,2 mmol/L; ALT - 3,0 mmol/hL. What examination will verify the diagnosis?
A 8-year-old boy has suffered from tonsillitis. In 2 weeks he started complaining of migratory joint pain, edema of joints, restriction of movements, fever. On examination, an acute rheumatic heart disease, activity of the III-rd degree, primary rheumocarditis, polyarthritis; acute course of disease, cardiovascular failure IIA. What medication is to be prescribed?
A 52-year-old woman suffering from obesity, complains of bloody discharges from genital tracts during 4 days. Last normal menses were 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. What reason from the mentioned below caused the development of disease?
A woman was hospitalised with full-term pregnancy. Examination: the uterus is tender, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the most probable complication of pregnancy?
A baby, aged 1,5 months, in the right parietotemporal area has from the birth a tumour-like formation of purple colour, rising over the skin surface, not disappearing on pressure, dimensions 2–3 cm. What is the most likely diagnosis?
A 72-year-old patient after operation of holecystectomia was prescribed gentamicyn (80 mg every 8 hours) and cephalothin (2 g every 6 hours) because of fever. In 10 days there was an increase of creatinine up to 310 mu mol/L. BP - 130/80 mm Hg, daily quantity of the urine is 1200 ml. Urine tests are without pathology. Ultrasound: the size of kidneys is normal. What is the most probable reason for renal failure?
89A 29-year-old woman is critically ill. The illness was manifested by high fever, chills, sweating, aching pain in lumbar area, a discomfort during urination, and frequent bowel voiding. Pasternatsky's sign is positive in both sides. On lab exam, WBC - 20×10⁹/L; Urinalysis: protein - 0,6 g/L, leukocyturia, bacteriuria. What is the preliminary diagnosis?
A patient, aged 49, was operated on account of acute catarrhal appendicitis. 8 days later there appeared vomiting, no passage of gasses or defecation. On examination: the abdomen is inflated, positive Sklyarovs and Wahls symptoms. Leucocytosis. Acute intestinal obstruction is suspected. What supplementary examination methods are the most informative to diagnose the complication?
A patient was operated 2 years ago on account of perforated duodenal ulcer, suture plication was performed. In the last 2 months lost 12 kg, which explains by dread of solid food intake because of pain and exhausting nausea appearing after meals. Self-induced vomiting brings relief. What is the most probable preliminary diagnosis?
A man fell abruptly ill. Frequent watery stool developed 6 hours ago. The body temperature is normal. Then vomiting took place. On physical examination: mans voice is hoarse, eyes are deeply set in the orbits. The pulse is frequent. Blood pressure is low. There is no urine. What is the preliminary diagnosis?
A patient with nosocomial pneumonia has signs of collapse. Which of the following pneumonia complication is the most likely to be accompanied with collapse?
A patient is suffering from a severe attack of bronchial asthma lasting for over 1 hour in spite of administration of beta -adrenoceptor agonists by inhalation and I.V., aminophilline and anticholinergics. What medication should be added to the urgent treatment?
A 10-year-old child is sick with chronic viral hepatitis B with marked activity of the process. Total bilirubin - 70 mmol/L, direct - 26 mmol/L, indirect - 44 mmol/L. АSТ - 6,2 mmol/L, АLТ - 4,8 mmol/L. What mechanism underlies the transaminase level increase of this patient?
District physician was charged with plan drafting concerning medical and preventive measures among the population in the area he is assigned to. What measures must he include in this plan as regarding primary prevention of illness?
During intramuscular DTP vaccination in clinic, a 3-month-old child developed signs of laryngospasm, paleness of skin, cyanosis of lips, "cock cry", stop of respiration, tension of the whole body with overturned backward headAllergological history of the child is not complicated. What is the most probable diagnosis?
A patient, aged 25, is brought to the infection diseases unit with suspected rabies, excitement stage. Four weeks ago on the hunting was bitten in a hand by a fox. What leading symptom will verify the diagnosis
A 43-year-old woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?
A 6-year-old asthmatic child is brought to the emergency room with severe coughing and wheezing during the prior 24 h. The child has been taking theophylline without relief. Physical examination reveals a child who is anxious, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, and RR - 60/min. Initial treatment may include the administration of which of the following?
A 52-year-old patient has hypervolemic type of essential hypertension. What medication is necessary to prescribe either as monotherapy or in complex with other antihypertensive remedies?
Water that is used for supply of the city, contains fluoride - 2,0 mg/L, nitrates - 43 mg/L, chlorides - 250 mg/L, ferrum - 0,2 mg/L, residual nitrogen - 0,5 mg/L. What medical condition is the most likely to occur among the inhabitants of this city?
Public health is characterised by a group of indices. Which of the following indices are demographic?
A woman complains of fever up to 39°С the next day after the child-birth. Fetal membranes rupture took place 36 hours before delivery. Pelvic examination: the uterus is soft, tender. Discharges are bloody, mixed with pus. Uterine culture: haemolytic streptococcus, groupa. What is the most probable postnatal complication?
A boy, aged 10, is under treatment in cardiological unit on account of rheumatic fever. The first onset of the decease. Discharged in the satisfactory condition. What medication is the most expedient for secondary rheumatism prevention?
During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?
A primipara is in labour for 19 hours, amniotic fluid has discharged 7 hours ago. Pelvic sizes are: 24-25-29-18 cm. Fetal position is longitudinal, head presents and is engaged to pelvic inlet. Fetus heart rate is 160 bpm. No autonomous urination. Vaginal inspection: cervix is smoothed and 8 cm dilated. Head is presented, sagittal suture occupies the transverse diameter of pelvic inlet; small fontanel is on the left. Lower uterine segment is tender on pressing. What medical tactics should be chosen?
After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?
A 37-year-old patient has come to clinic being wounded in the area of umbilicus an hour ago. On physical exam, there is a prick and cut painful wound of about 0,5x1 cm around umbilicus on the abdominal skin with slight bleeding. How would you help this patient?
A patient was admitted to the hospital on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?
A woman, aged 64, is hospitalised on account of metrorrhagia and anaemia. After 12 years of menstruation absence, 7-8 months ago there appeared at first sero-watery discharge from vagina, then - sero-bloody, with "meat slops" colour, pain in the lower abdomen. What pathology is the most probable?
A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, circa 4 cm in diameter, on palpation: soft elastic consistency, positions near the medial part of Pouparts ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?
A 30-year-old man who suffered from headaches, felt an intense headache in the form of the blow on his head while lifting up a heavy object with the following onset of nausea, vomiting, light dizziness. In a day there was an objectively presented meningeal syndrome, t°- 37,6°С. The doctor have suspected subarachnoidal haemorrhage. What additional examination is necessary to confirm the diagnosis?
A 14-year-old boy periodically complains of pain in the epigastrium on an empty stomach, nausea and heartburn during 3 years. Gastroduodenoscopy: signs of gastroduodenitis and ulcer defect of the mucous membrane of the duodenum. What is the most effective medication to treat this child?
In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anaemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?
In order to differentiate diagnosis of anuria and ishuria what supplementary examination should be carried out?
A patient complains of fever up to 38,2 degree С, an edema of the upper lip. On examination: the upper lip is distinctly hydropic, in the centre of the edema there is a cone-shaped swelling. The skin and the mucosa over it are deep-red. A furuncle of the upper lip is diagnosed. Surgeon executed a lancing of furuncle, cleansed the wound with peroxide solution and dressed it with hypertonic solution. What therapeutic regimen should be recommended to the patient?
A 3-day-old new-born who has suffered from asphyxia in birth, presents with bleeding from umbilical sore. Lab tests: hypocoagulation, thrombocytopenia, hypothrombinemia. What is the most likely cause of clinical and laboratory changes?
Parents of 5-year-old boy complain of ventral curvature of boys penis. Physical examination: external urethral meatus is on the apex of penis, prepuce is hood-like. What is the most likely diagnosis?
A 75-year-old patient can not tell the month, date and season of the yearAfter long deliberations she manages to tell her name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as "invaluable books". What is the most probable diagnosis?
A woman, aged 40, primigravida, with infertility in the medical history, on the 42–43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are diminished. What should be tactics of delivery?
When examining a patient with supposed pelvis fracture, the doctor exerts pressure with both hands on the wings of ileum in opposite direction. What is the cause of pain syndrome appearing in this case?
A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her reddened skin 3 hours later. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemic. On tonsils there are greyish patches. Submaxillary glands are enlarged and painful. What is the most likely diagnosis?
A man, aged 64, complains of cough with sputum discharge, sometimes with blood spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic examination in the middle lobe of the right lung there is a cavernous formation, the inner outline is irregular, contains a small quantity of fluid, on the right the central lymph nodes are enlarged. What examination is the most informative to define the diagnosis?
A 16-year-old woman complains of the abdominal pain and purpuric spots on the skin. Laboratory investigations discovered normal platelet count with hematuria and proteinuria. What is the most probable diagnosis?
A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t°- 38,2°С, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?
A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joints pain. On examination: excited, t°- 39°С, Ps - 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?
A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed chest injury, closed right hip fracture. BP - 100/60 mm Hg, Рs - 124/min, RR - 28/min. 2 hours after skeletal extension under local anaesthesia with lidocaine, there appeared abrupt aggravation of the patients condition: developed face and neck cyanosis, BP - 60/40 mm Hg, HR - 160/min, RR - 44/min. What complication most probably aggravated the severity of multiple injuries?
A 5-year-old child had an attack of palpitation with nausea, dizziness, generalised fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication should be given for emergent care?
A man, aged 52, fell down from the height of 3 m on the level surface of the earth hurting his right lumbar region. Complains of the pain in the right lumbar region. Urinalysis: microhematuria. Excretory urography: kidneys function is satisfactory. What is the most likely diagnosis?
A man, aged 54, complains of constant dull ache in mesogastric area, weight loss, dark blood admixtures in feces, constipations. In the course of the year the weight loss is up to 10 kg. In blood: RBC - 3,5*10^12/L, Hb - 87 g/L, WBC – 12,6*10^9/L, stab shift, ESR – 43 mm/h. What is the most probable preliminary diagnosis?
A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density- 1,04 g/cm3, acidity 21°С, reductase probe – weak positive. What way the product is to be used in? What would you advise?
A 30-year-old man complains of a sharp pain in the right ear, hearing loss, high temperature during three days. Objectively – right ear whispering language – 0,5 m, external ear is intact, otoscopically - eardrum protrusion, hyperaemia and swelling, loss of landmarks. What is the most likely diagnosis?
A woman, aged 30, in labour, is brought to the maternity in term of 35–36 weeks with weakened labour activity. Fetal movements are not felt. On echography: fetuss heartbeat not determined. Vaginal inspection: cervix is 6 cm dilated, green amniotic fluid has discharged, the head of the fetus is engaged to pelvic inlet. What is the further tactic of delivery?
A 27-year-old man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Неlісоbасtеr Pylori. What can be diagnosed in this case?
A patient complains of periodic rash eruptions in the course of the year on the elbow and knee joints. The first eruption occurred after stress. Now it consists of multiple plates, the central part of which is covered with silvery scales. What is the most likely diagnosis?
A girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?
A 3-year-old boy fell suddenly ill: fever up to 39°С, weakness, vomiting. Haemorrhagic rash of various size appears on his lower limbs in 5 hours. Meningococcemia with infective - toxic shock of 1 degree was diagnosed. What medications should be administered?
A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toesAll types of sensitivity are preserved. No blisters. What degree of frostbite is observed?
A baby, aged 2 months, is hospitalised to the surgery unit with fever up to 38,5 degree С, edema, hyperaemia and absence of movements in the left shoulder joint. In medical history – omphalitis, pseudofurunculosis. What is the most likely diagnosis?
A male patient, aged 38, accountant. During acute allergic infectious myocarditis developed the full left bundle-branch block. After treatment and 2 months of observation patients condition is satisfactory, absence of complains or objective and clinical manifestations of decease, but there are still changes on the ECG. What should be the doctors tactics in this case?
A worker (battery attendant) at the end of the working day complains of intensive pains in the epigastric area, diarrhea, subfebrility, BP - 170/110 mm Hg, skin and scleras are yellow. At the lunch he has drunk 250 ml of vodka. What diagnosis is the most likely?
A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge of the case issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?
In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of the patients should be observed. Which of these rights is the most significant?
A woman, aged 23, complains of periodical febrile chills with fever up to 40°С, sensation of heat alternating with profuse sweat. During last three months has lived in a tropical African country. The patient has already suffered 3 such attacks, which appeared every other day, lasted 12 hours, were accompanied by the headache, lumbar and muscular pain. The face is pale with yellowish tinge. Cyanotic lips. Liver, spleen are enlarged. In blood: RBC - 2,5×10¹²/L. What is the most likely diagnosis?
Body temperature of a 12-year-old girl increased up to 39-40°С in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Nikolsky syndrome is positive. What is the most probable diagnosis?
A 10-year-old boy complains of a headache, weakness, fever (temperature - 40°С), vomiting. On physical examination: there is an expressed dyspnea, pale skin with a flush on a right cheek, right hemithorax respiratory movement delays, dullness on percussion of the lower lobe of the right lung, weakness of vesicular respiration in this region. The abdomen is painless and soft by palpation. What disease causes these symptoms and signs?
On examination of a patient, aged 49, cancer of the right lung, ІІА stage, is diagnosed. What TNM combination corresponds to this stage?
The occipital part of new-born head of dolichocephalic form shows with labour edema with centre in the area of small fontanel. In which presentation of fetal head did child-birth occur?
A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?
A female patient, aged 45. Two weeks after pneumonia developed shortness of breath during walking, constant ache in precardiac area, shin edema. On examination: t°= 37,2°С, Heart borders without changes, Sound 1 on the apex is weakened. ECG: atrioventricular heart block І degree, lowering of the amplitude of Т wave in V2-V6. In blood: Hb - 124 g/L, WBC - 5,68*10^9/L, ESR - 18 mm/h. What is the most likely diagnosis?
A patient is hospitalised with the complaints of acute fatigue, fever up to 39,2°С, pain in the throat during swallowing, hemorrhagic rash on the skin of the trunk. On examination the blood analysis shows anaemia, thrombocytopenia, blastocytes – 14%, ESR - 40 mm/h. What examination is necessary to define the diagnosis?
The diagnosis of a right-sided pneumothorax is set to a 36-year-old patient. What method of treatment is indicated to the patient?
A woman in labour, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labour stage is this?
A boy, aged 7, is under treatment during 1 month. On hospitalisation: significant edema, proteinuria - 7,1 g/L, protein in daily urine - 4,2 g. Blood biochemical profile: stable hypoproteinaemia (43,2 g/L), hypercholesterinaemia (9,2 mmol/L). Which variant of glomerulonephritis is the most probable in this case?
In medical history of a 2-years-old girl: recurring pneumonias with obstructive courseAuscultation: heterogeneous moist and dry rales in lungs, weakened breathing. Difficult excretion of thick, viscous sputum. Observed "drumstick" fingers, mental deficiency. What is the preliminary diagnosis?
A woman, primipara, consults a gynecologist on 05.03.2002A week ago felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When she should be given maternity leave?
An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?
A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic episodes of loss of consciousness. Physical examination: Ps - 42 bpm, cardiac rhythm is regular. What can cause the development of such condition?
A military unit after long march stopped for 3-days rest in the vicinity of a inhabited locality. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field conditions
A 18-year-old woman consulted a gynaecologist with complaints of the pain in the lower part of the abdomen, fever up to 37,5°С, considerable mucopurulent discharges from the genital tract, colic during urinatingAfter mirror and vagina exam the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?
A full-term new-born suffered ante- and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points)After birth babys excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moros reflexes. What is the most probable location of the intracranial haemorrhage in this case?
In the development of the inflammation processes glucocorticoids reduce the level of a certain most important active enzyme. It results also in the reducing of the synthesis of prostaglandins and leucotrienes which have a key role in the development of inflammation processes. What is the exact name of this enzyme?
A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog - in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?
In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?
A patient, aged 36, is diagnosed with ascites, splenomegaly, liver dimensions by Kurlov 11х9х8 cm, varicose esophagus veins. In medical history: abdominal injury, stomach bleeding.AST – 0,46 mmol/gL; ALT – 0,68 mmol/gL; total bilirubin – 21 mu mol/L, unconjugated bilirubin – 17,1 mu mol/L. What is the preliminary diagnosis?
A woman, aged 26, is brought to emergency department with complaints of sudden pain in the lower abdomen, weakness, loss of consciousness at home. The previous menstruation absented. Hb - 106 g/L, Ps - 120/min, BP - 80/50 mm Hg. Painfulness and peritoneum irritation symptoms in the lower right flank. What is the most likely diagnosis?
The district doctor is charged with the analysis of the morbidity rate in the area he is assigned to. Which type of morbidity characterises the group of protractedly and frequently ill?
A woman, aged 37, primigravida, is in labour during 10 hours. The contractions last 20-25 sec every 6-7 min. Fetal position is longitudinal, head presents and is engaged to pelvic inlet. Vaginal inspection: cervix is 1 cm long, lets in 2 horizontal fingers. Fetal bladder is absent. What is the most likely diagnosis?
A 43-year-old woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There was multiple vomiting without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?
A 2-months baby, after preventive vaccination, suffered from protracted haemorrhage from the point of injection, later there developed an intramuscular hematoma. On examination: a significant growth of prothrombine consumption and distinct prolongation of activated partial thromboplastin time. What is the most likely diagnosis?
A 2,5-year-old child fell ill 10 hours ago, became anxious, held on the stomach, had fever up to 38 degree С. In 7 hours condition has worsened with vomiting and diarrhea. Physical examination: tongue is dry, coated. Abdomen barely participates in breathing. Palpation is impossible due to childs anxiety. Digital rectal investigation reveals overhang of front rectum wall. What is the most likely diagnosis?
A man, aged 28, power-supply system operator, was at his working place during the breakdown on the nuclear power plant. In the result of the steam-air explosion there was an emission of circa 30 kg radioactive iodine (І131). Which radioprotector is expedient in this case?
A worker of the chemical plant complains of fatigue, insomnia, headache. Works at the amalgam production. On examination: tremor, asymmetry of reflexes, labile pulse, stable red dermographism. Excretory gingivitis. What is the cause of the illness?
A patient, aged 24, is suffering from an asthmatic fit with non-productive cough and skin itch after diclofenac intake. In medical history: urticaria. On examination: edematous face, swelling of the cervical veins, the patient is supporting himself in a seated position, audible stridor breathing. What is the most likely diagnosis?
A patient, aged 38, had acute glomerulonephritis 10 years ago, complains of face and legs swelling, headache, dull pain in loins. BP - 220/130 mm Hg. Urinalysis: protein - 9,9 g/L, WBC - 3-4 in the field of vision, RBC - 10-12 in the field of vision, hyaline cylinders - 3-4 in the field of vision, ceraceous - 2-3 in the field of vision. Creatinine - 102 mu mol/L. Which of the mentioned antihypertensive agents are expedient to prescribe in this case?
A boy, aged 9, is examined: height – 127 cm (-0,36), weight – 28,2 kg (+0,96), chest circumference - 64,9 cm (+0,66), lung vital capacity – 1520 ml (-0,16). What is the integrated assessment of the childs physical development?
A boy, aged 13, suffers from an abrupt aggravation of condition, there appeared shortness of breath, skin paleness with cyanosis. BP - 80/55 mm Hg, Ps- 128/min, heart sounds weakened. On ECG: diffuse muscular changes, polytopic extrasystole. Radiologically: acute enlargement of the heart borders in all directions. Two weeks ago there occurred a reaction on analgin administration. What is the most likely diagnosis?
In 2 weeks after pharyngitis a 25-year-old patient started complaining of rise in temperature to 38°С, fatigue, shortness of breath during walking, migrating joint intumescence and pain. On physical exam: cyanosis of lips, pulse is weak, rhythmical, 100 bpm. The left heart border is moved outwards from mediaclavicular line for 1 cm. Sound І on the apex is weakened, soft systolic murmur is auscultated. What etiologic factor caused this pathological process in the most probable way?
A man consults a physician with complaints of cramping pain in left side of the chest, general weakness, fever and headache that have appeared 2 days ago. This morning the patient noticed a skin rash on the chest. Physical examination: multiple aggregated vesicles with edematous covers filled with transparent liquid, 2-4 mm in diameter. Vesicles are situated on the erythematous and edematous background along 4-5 intercostals. What is the most likely diagnosis?
A breakdown on a nuclear power-plant caused the radioactive fuel material release in the atmosphere, which resulted in the radionuclid pollution of a large territory and increasing of the background ionising radiation. The incidence of what deceases will be increased among the population of this territory in the future?
A 27-year-old patient was admitted to the psychiatric hospital for the 4-th time during 2 years. He heard voices commenting on his actions, had delusions of persecution (was sure that mafia wanted to kill him). He was discharged from the hospital with the diagnosis of schizophrenia, state of remission after a course of treatment with neuroleptics. What is necessary to do to prevent relapses of schizophrenia?
A 14-year-old victim was drawn out of the water in winter after 15 minutes after drowning. The victim shows no vital signs. What measures are to be taken?
A 36-year-old male, at 4:00 a.m. had an intensive attack of lacerating chest pain, which was accompanied by weakness, cold perspiration, fear of death. ECG: dome-shaped ST segment elevation in leads ІІ, ІІІ, aVF, V5, V6. After pain relieving the ECG has normalised. What is the preliminary diagnosis?
A woman, aged 64, suffering from unstable angina, suddenly collapsed during walking. On examination: unconscious, absence of pulsation on a. carotis and heart sounds, miotic pupils and infrequent shallow respiration. What is the first measure to start resuscitation?
A child, aged 5, is ill with fever, vesicular rash mainly on the trunk and head skin. On the 8th day there appeared severe headache, ataxia, lethargy, movement discoordination, tremor of the extremities. On the second wave of the fever encephalitis is diagnosed. Complication of what decease can be encephalitis in this case?
A pregnant woman, aged 35, is in grave condition, complains of headache, vision disorders, "midges" before the eyes. On examination: anasarca, BP - 180/120 mm Hg. Suddenly there appeared fibrillar twitching of the facial muscles, tonic spasms. Breathing stopped. 1 minute later breathing restartedA profuse foam discharge from the mouthAmnesia. In clinical urine analysis: protein - 7 g/L. What is the most likely diagnosis?
A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin. He had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?
A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers skin – greyish warts. Factorys sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?
At the radiological unit of the hospital, gamma-devices of radiotherapy of "Agat" type and other closed sources of ionising radiation are used for treatment of malignant neoplasms. What are the measures to be taken to protect personnel at the time of work with radioactive sources of such type?
A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months, after acquiring aquarium fish, developed rhinitis, conjunctivitis, itching in the nose. The level of what immunologic index should be defined in this case?
A 29-year-old patient complains of sterility. Sexual life is during 4 years of marriage, does not use contraception. There was no pregnancy before. On physical examination, genitals are developed normally. Uterine tubes are passable. Rectal temperature during three menstrual cycles is monophase. What is the most probable reason for sterility?
During 3 years a patient with diagnosis of chronic bronchitis has been under regular observation in the clinic. This year he applied 3 times for medical aid on account of exacerbation of this decease. What should be the statistical record of this decease?
The mental status of a 22-year-old man is characterised by a stable pathological depressed mood. The patient is sociable, replies briefly but to the point. The speech is laconic, in slowed tempo, movements are constrained and inhibited. Speaks on the ideas of self-accusation and self-humiliation. Medications of what group are to be prescribed to this patient?
During 2 hours after delivery the condition of the woman is good: the uterus is firm, spherical, the fundus of uterus is on level of the navel, no haemorrhage. The clamp, placed on the umbilical cord segment, remains on the same level. On deep inhalation and on pressing with edge of the hand above symphysis the umbilical cord retraction into the vagina. There is no bloody discharge from the genital tracts. What should be the further tactics of the doctor?
In a new-born baby-girl on the 4 day of life there determined the swelling of the mammary glands with secretions, swelling of the vulva, bloody discharge from the genital tracts. What is the most probable cause of this condition?
A woman complains of unpleasant feelings in different body parts and organs, and sometimes very burdensome feelings of compression, torsion, turning-over. Repeated consultations with specialists, clinical examinations, after that - referral for psychiatric advice. What psychopathological disorder is most likely?
A mother who is on partially paid maternity leave got sick and was hospitalised. What document is to be issued to a working father who will be taking care of a child during his mothers illness?
The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?
A 34-year-old patient is hospitalised with complaints of cervical and axillary lymph nodes enlargement, subfebrile temperature during the last 2 months, increased sweating. There are Reed- Sternberg (Berezovsky) cells in the puncture of lymph nodes. What method of investigation is expedient to study the extent of tumour process?