Крок 2 · Медицина 2006 · Англійська

A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localised in frontal region of head, accompanied by nausea and stomach discomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesn’t take any medicines. Inbetween the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index - 29), AP- 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?

A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a crosscountry race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37,50C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb- 123 g/L, leukocytes - 5,6 * 103 * * * * * 9/L, thrombocytes -354 * 109/L, prothrombin time -12 seconds (normally 10-15 seconds), partly activated thromboplastin time - 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?

On the 3rd day after the acute anterior myocardial infarction a 55 y.o. patient complains of dull ache behind his breast bone, that can be reduced by bendi- ng forward, and of dyspnea. Objectively: AP- 140/180 mm Hg, heart sounds are dull. ECG results: atrial fibrillation wi- th frequence of ventricular contractions at the rate of 110/min, pathological Q wave and S-T segment raising in the ri- ght chest leads. The patient refused from thrombolisis. What is the most probable diagnosis?

A 54 y.o. man was admitted to the hospital with complaints of sudden intense headache in occipital region and vomiting. In the medical hystory: moderate arterial hypertension, the patient was taking hydrochlorothiazide. Three days ago he consulted a therapeutist about intense headache that was suppressed by an analgetic. Objectively: consciousness is confused, left pupil is mydriatic. Evident photophobia and tension of neck muscles. Left-side hemiparesis with increased muscle tonus and reflexes. Body temperature is low, rash is absent. AP-230/130 mm Hg, Ps- 50 bpm, BR- 12/min. What is your preliminary diagnosis?

A 76 y.o. woman complains of progressing swallowing disorder, mostly she has had problems with solid food for the last 6 weeks. Sometimes she has regurgitation of solid masses. Swallowing is not painful. She lost 6 kg. 10 years ago she had myocardiac infarction, she takes constantly aspirine and prolonged nitrates. She consumes alcochol in moderate proportions, smokes. Objectively: icteric skin, neck has no pecularities, lymph nodes are not enlarged. Thorax has no changes, cardiovascular system has no evident changes. Liver is +3 cm. What is the preliminary diagnosis?

A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?

A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, consciousness is confused. AP- 80/40 mm Hg. The palpitation of the fetus is not determined. In medical hystory there was a Cesarean section a year ago. Make a diagnosis:

A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?

A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?

Name a statistical observation unit for determination of blood sugar impact on the healing of wound’s surface in a postoperative period:

Choose a method of graphic representation of monthly information about the number of registered cases of acute intestinal infection and their comparison to the average monthly values, obtained for 5 last years:

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 is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?

An employee has been invalid for 6 months as a result of a hip fracture. Who has the right to authorize the issue of the medical sick-list for the last 2 months?

An employee had an abortion by medical indications on the 6.03.2001 and she stayed in a hospital till 1703.2001. What term is the medical sick-list issued for?

A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density -1,04 g/cm3, acidity - 21°T, reductase probe - weak-positive. What way is the product to be used in?

Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature - 20° C, relative humidity -45%, air movement velocity - 0,3 m/s, light coefficient - 1/5, noise level - 30 dB. Do hygienic evaluation of the conditions meet the standards?

A 33 y.o. patient, works as a secretary. Her diet contains 150 g of protein (including 100 g of animal protein), 200 g of fat, 600 g of carbohydrates. What pathology can result from this diet?

A 15 year old adolescent was taken to the hospital with complaints of poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjucti-va. The patient’s skin is dry, scales off, folliculitis signs of the face skin are present. What is the cause of this disease?

What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?

A 23 y.o. patient has a gunshot wound of his left arm.The bones of the arm are not damaged. What appropriate surgical care must be provided to the patient?

A 34 y.o. patient 3 hours ago was bitten by a dog. He has got a non-bleeding wound in his left arm caused by the dog’s bite. What surgical care would you provide to the patient?

A 37 y.o. patient complains of pain in the right arm which increases during motion, raised body temperature up to 39°C. In the right cubital fossa there is a trace of injection, hyperemia and thickening along the vein. Your diagnosis?

A 35 y.o. woman was admitted to thoracic surgery department with fever up to 40° C, 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 laboratory obtained a milk sample sent for analysis. Analysis gave the following data: color whitish, smell - has no pecularities, taste - typical for milk, density - 1,038, acidity - Turner’s 35 °, fat - 3,2%. What is the quality level of this milk?

For the persons who live in a hot area after an accident at a nuclear object, the greatest risk within the first decade is represented by cancer of:

A 40 y.o. patient was diagnosed: 1. Medular thyroid gland cancer. 2. Feochromocytoma. What operation should be performed at first?

A 28 y.o. woman consulted a doctor with the complaints of enlargening in size of an inborn pigment nevus, it was also wetting and itching. What test should not be used for diagnostics in this case?

A 74 y.o. patient has been ill with benign prostate hyperplasy for the last 5 years. 4 days ago, after alcochol consumption, there was an acute retention of urination. At the pre-admission stage his urinary bladder was catheterized with metallic catheter. Examination revealed: right epididymis is enlarged, thick and painful, there are purulent discharges from urethra. What way of emergency care must be chosen?

A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right elbow. There was fever (38,5°) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?

A baby boy was born in time, it was his mother’s 1st pregnancy. The jaundice was revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level - 5 mcmol/L, Hb-150 g/L. Mother’s blood group - 0(I),Rh+, child’s blood group - A(II),Rh+. Make a diagnosis.

Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?

A 2 y.o. girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?

A 7 y.o. girl has mild form of varicella. Headache, weakness, vertigo, tremor of her limbs, ataxia, then mental confusion appeared on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?

A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3,2 kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?

A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog. In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergens is the reason of the development of bronchial astma attacks?

A 40 y.o. patient with rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathlessness and swelling of feet. The patient had tooth extraction one month ago. On examination: t0- 390C, Ps- 100/min. Auscultation: diastolic murmur in the mitral area. Petechial lesion are round of clavicle; spleen was palpable.

A 62 y.o. patient suffers from DM-2. Diabetes is being compensated by diet and Maninilum. Patient has to undergo an operation on inguinal hernia. What tactics of hypoglycemic therapy should be used?

A 33 y.o. woman has been suffering from DM (diabetes mellitus) for 5 years. For the last 3 years she has been taking more than 100 units of insulin per day. Body weight has increased up to 10 kg. Fasting blood glucose is 13 mmol/L, glucoseuria - 3%. Generalized microangiopathy. By increasing the dose of insulin the parameters of glycemia do not change. The diagnosis is:

A 32 y.o. man is divorced, has an irregular sexual life. He complains of falling out of hair in the region of eyelashes, eyebrows, scalp. Objectively: diffuse alopecia is observed, eyebrow margin is absent, eyelashes are stair-like (Pinkus’ si- gn). What examination should be carried out first of all?

A triad of symptoms (“stearing spot' “terminal film' “blood dew”) have been revealed on examination of a patient. What disease should you think about?

A 4 y.o. child attends the kindergarten. Complains of poor appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st, leucomoide reaction of the eosinophi-le type. What pathology must be excluded first of all?

A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics?

A 32 y.o. woman has got the Laiel’s syndrome after taking the biceptol. What immunotrope medicines are to be prescribed in this situation?

A 28 y.o. man fell seriously ill, he feels chill, has got a fever, body temperature raised up to 38,50C, paroxysmal pain in the left iliac region, frequent defecation in form of fluid bloody and mucous mass. Abdomen palpation reveals painfulness in its left half, sigmoid colon is spasmed. What is the most probable diagnosis?

The disease of a 21 y.o. patient began with raise of temperature up to 39, 00C, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor revealed: cytosis -1237 in 1 ml, including: 84% of neutrophils, 16% of lymphocytes. On bacterioscopy: gram-negative cocci are found in liquor. What is the most probable disease?

The family doctor examined a patient and diagnosed an acute bleeding of an intestine. What is professional tactics of the doctor in this situation?

A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous foramen.Complains of palpitation, fatigability, progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the easy activities. What tactics is the most expedient?

A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of acute hemorrhagic anemia. What minimum percent of the whole blood volume could result in death by acute hemorrhage?

A 50 y.o. male patient was taken to the emergency department with diffuse abdominal pain and signs of cardiovascular collapse. On arrival he had BP-95/60 mm Hg, Ps- 120/min, diuresis - 20 ml/h, HgB- 100 g/L, RBC- 2,1 * 1012/L. The patient needs introduction of :

A 58 y.o. man complained of severe inspiratory dyspnea and expectoration of frothy and bloodtinged sputum. He has been suffering from essential hypertension and ischemic heart disease. On examination: acrocyanosis, 'bubbli-ng'breathing, Ps- 30/min, BP- 230/130 mm Hg, bilateral rales. Choose medicines for treatment.

A patient has got a sudden attack of severe substernal pain at night. On examination: confusion, pallor of the skin, acrocyanosis, cold sweat, BP- 80/50 mm Hg, Ps- 120/min, irregular and weak pulse. What condition are these symptoms typical for?

A 61 y.o. man complained of sneezing and substernal pain on exertion. In the last 2 weeks such pain appeared at rest, with increased frequency, and couldn’t be suppressed by 1 tablet of nitroglycerin. What is the most likely diagnosis?

A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, rash on the face skin, pain in the wrists and the elbows. On physical examination: erythematous rash on the cheeks with 'butterfly'look, the wrists and elbow joints are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR-88/min, BP- 160/95 mm Hg. CBC shows anemia, leucopenia, lymphopenia; on urine analysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

A 56 y.o. woman has an acute onset of fever up to 390C with chills, cough, and pain on respiration in the right side of her chest. On physical examination: HR-90/min, BP- 95/60 mm Hg, Ps- 26/min. There is dullness over the right lung. On X-ray: infiltrate in the right middle lobe of the lung en palpation. What is the diagnosis?

A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, discomfort during urination and frequent voiding. Pasternatsky’s sign is positive in both sides. On lab examination: WBC-20 * 109/L; on urine analysis: protein -0,6g/L, leukocyturia, bacteriuria. Your preliminary diagnosis.

A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier’s sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?

A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.

A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC- 3,5 * 1012/L, C.I.- 0,7; ESR- 20 mm/h. Serum iron level was 8,7 mcmol/L. What treatment would you initiate?

A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?

A 30 y.o. man complains of intense pain, skin reddening in the region of ankle joint, temperature rise up to 390C. He fell ill suddenly. In the past there were such onsets that lasted for 5-6 days and didn’t cause any residual changes of the joint. The skin over the joint is hyperemic, without distinct outlines and infiltrative bank at the periphery. What is the most probable diagnosis?

A 6 y.o. asthmatic child was taken to the emergency hospital because of severe coughing and wheezing for the last 24 hours. Physical examination reveals that the child is excitable, has intercostal and suprasternal retractions, expiratory wheezing throughout all lung fields, RR-60/min. Initial treatment may include the prescription of:

A surgical department admitted a newborn boy with foamy discharges from nose and mouth, cyanosis attacks. X-ray examination: blind end of esophagus is at the level of the II thoracic vertebra, gastric air bubble is under the left cupula of diaphragm. What is the most probable diagnosis?

A 30 y.o. man complains of sharp pain in the right ear, hearing loss, high temperature for three days. Objectively: right ear whispering language - 0,5 m, external ear is intact, otoscopically - eardrum protrusion, hyperemia and swelling, loss of landmarks. What disease is it?

A youth, aged 15, from childhood suffers from atopic dermatitis and allergy to the shellfish. In the last 3 months after acquiring aquarium fish rhinitis, conjunctivitis, itching in the nose developed. Level of what immunologic index should be defined in this case?

A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of bloody discharges. In her medical history there were two artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage and USD showed a placental presentation. The uterus is in normotonus, the fetus position is transversal (Ist position). The heartbeats is clear, rhythmical, 140 bpm. What is the further tactics of the pregnant woman care?

Studying of pulmonary tuberculosis incidence provided data about patients’ socioeconomic living conditions and bad habits. What method allows to estimate the impact of these factors on tuberculosis incidence?

A 15 y.o. girl was examined. Her medi- cal history registers gradual onset of fever, malaise, loss of weight. There was nothing typical about the kind of fever which has been present for more than 7-10 days and changed quickly. Physical examination didn’t give evident results. What is the only most important examination for excluding miliary tuberculosis?

A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white coating. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin is erythematous and glistering over the lymphatic nodes. What is the most probable diagnosis?

A 17 y.o. patient complains of acute pain in the knee joint and t0- 38°C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

A girl is 12 y.o. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37,8°C. Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in f/vis, RBC-1-2 in f/vis. What diagnosis is the most probable?

A 56 y.o. patient has worked at the aluminium plant over 20 years. Within 3 last years he has got loosening of teeth, bone and joint pains, piercing pains in heart area, vomiting. The preliminary diagnosis is:

A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37,50C. The patient has been ill for a week and associates her illness with common cold. There are a pain and tenderness on palpation of her left cheek. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudate is seen in the middle meatus in maxillary. What is the most probable diagnosis?

Condition of a parturient woman has been good for 2 hours after live birth: uterus is thick, globe-shaped, its bottom is at the level of umbilicus, bleeding is absent. The clamp put on the umbilical cord remains at the same level, when the woman takes a deep breath or she is being pressed over the symphysis with the verge of hand, the umbilical cord drows into the vagina. Bloody discharges from the sexual tracts are absent. What is the doctor’s further tactics?

A 34 y.o. patient has been suffering from pulmonary tuberculosis for 7 years; he complains of muscle weakness, weight loss, diarrhea, frequent urination. Objectively: hyperpigmentation of skin, gums, internal surface of cheeks. AP- 90/58 mm Hg. Blood count: RBC- 3,1 * 1012/L, Hb95 g/L, C.I.- 0,92; leukocytes - 9,4 * 109/L, eosinophils - 7, segmentonuclear leukocytes - 45, stab neutrophils - 1, lymphocytes - 40, monocytes - 7, Na+-115 mmol/L, K+- 7,3 mmol/L. What is the preliminary diagnosis?

A 52 y.o. hard smoker complains of persistent cough with purulent sputum discharge especially in the mornings, dyspnea provoked even by slight physical exercises, wheezing chest, tachypnoe, general weakness. He considers himself to be ill for 12 years. The foresaid presentations appear 3-4 times per year usually after a common cold and have tendency to progress. What disease do you think about first of all?

3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid with acute edge. The blood analysis revealed total bilirubin -160 mkmol/L, direct -110 mkmol/L, AST- 2.1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol9.2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?

In the gynecologic office a 28 y.o. woman complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingooophoritis in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. What diagnostic method will you start from the workup in this case of sterility?

A patient has undergone an operation on account of perforated ulcer of stomach, terminal phase of diffuse peritonitis and endotoxic shock. In the postoperative period he is prescribed artificial pulmonary ventilation with 60% oxygen inhalation. Blood gases: Pa02- 7078 mm Hg, hypoxemy doesn’t ecrease, CVP (central venous pressure) - 150180 mm of water column, AP90 /60 mm Hg (against the backgound of taking big doses of dopamine). Radiogram shows diffuse pulmonary infiltration. What cause the refractory arterial hypoxemia?

According to results of medical and pedagogical observation during the gymnastics lesson in the 9th grade there was plotted a phisiological curve characterized by gradual increasing of pulse rate during the opening part of lesson, 80% increase during the main part; the curve has 4 waves. How can the lesson’s structure be assessed?

A patient is 16 y.o. In the last year his behaviour has gradually changed: he secluded himself, was not interested in communication with friends, in learning. He became indifferent towards relatives, motivelessly rude, was speaking or laughing to himself. He answers the questions formally correctly, laconically. Considers himself to be absolutely healthy but a little tired, says, he’s thinking about writing a book 'Projection of humanity on the plane of Universe'. He always has a copybook with which is full of a great many of the same daggers. What is the most

A worker was temporarily off work because of illness for l6 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list of this patient?

The results of a separate diagnostic curettage of the mucous of the uterus’ cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium - the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?

A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary - a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?

A 40 y.o. patient complains of yellowi- sh discharges from the vagina. Bimanual examination: no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum test. Your tactics:

A full-term new-born suffered from ante- and intranatal hypoxia, was born in asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most probable location of the intracranial hemorrhage in this case?

A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?

A patient at a doctor complains of temperature rise up to 38, 20C, edema in the region of his upper lip. Objectively: upper lip is evidently edematic, in the middle of edema there is a coneshaped swelling. Skin and mucous membrane over it are dark-red. Diagnosis: labial furuncle. A surgeon cut the furuncle, treated the wound with hydrogen peroxide solution and applied a bandage with hypertensive solution. What therapeutic regimen should be recommended?

A 15 y.o. boy was twice attacked by bees, as a result he had severe anaphylactic shock. What is the most effective prophylaxis method?

A healthy 75 y.o. woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 mmol/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?

In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of patients should be observed. Which of these rights are the most significant?

A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around eyes and over knee joints. HR- 120/min, heart sounds are weak. Blood count: leukocytes - 12 * 109/L, ESR- 40 mm/h. What is the

A military unit stopped for 3-day’s rest in inhabited locality after a long march. The sanitaryepidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for drinking water in the field

A district doctor was commisioned with a task to work out a plan of treatment-and-prophylaxis actions for the population of his district. What actions of secendary prophylaxis must he include into this plan?

A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37, 2°C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A 20 y.o. patient was admitted to the hospital with complaints of having skin and sclera icteritiousness, dark urine, single vomiting, appetite loss, body temperature rise up to 380C for 2 days. Three weeks ago he went in for fishing and shared his dishes with friends. Objectively: the patient is flabby, t0- 36,80C, skin and scleras are icteritious, liver sticks from under the costal margin by 3 cm, it is sensi- tive; spleen isn’t palpable. Urine is dark, stool is partly acholic. What is the most probable diagnosis?

A full-term newborn child has a diagnosis Rh-factor hemolytic disease of newborn. Bilirubin rate is critical. The child’s blood group is B(III), his mother’s blood group - A(II). The child has indication for hemotransfusion. What donor blood must be chosen?

At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patient’s treatment. What index of hospital work can be calculated based upon this data?

A 52 y.o. patient fell from 3 m height on the flat ground with the right lumbar area. He complains of pain in this area. There is microhematuria in the urea. Excretory urography revealed that kidney’s functioning is satisfactory. What is the most probable diagnosis?

A 3 y.o. child with weight deficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 mmol/L. What is the most probable diagnosis?

A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Hb- 70 g/L, RBC- 2, 3 * 1012/L, Ht-20. What is the most probable diagnosis?

A 33 y.o. patient with first time detected diabetes mellitus keeps the diet and maintains glycemia at the level of 10,0 mmol/L after meal. He keeps himself from insulinotherapy. What examination is the most important for differentiation of the 1st (insulin-dependent) and the 2 nd (insulin-independent) types of diabetes?

A 43 y.o. patient had cholecystectomy 6 years ago because of chronic calculous cholecystitis. Lately he has been suffering from pain in the right subcostal area and recurrent jaundice. Jaundice hasn’t gone for the last 2 weeks. Stenoutic papillitis 0,5 cm long has been revealed. What is the best way of treatment?

A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had evident edemata, proteinuria - 7,1 g/L, protein content in the daily urine - 4,2 g. Biochemical blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9,2 mmol/L). What variant of glomerulonephritis is the most probable?

A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: 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?

Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?

Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic is the most reasonable?

A 3 y.o. girl has had a temperature rise up to 380C, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn’t reveal any changes over her lungs. Percussion sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?

A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to 39 — 40 oC. She complains of general indisposition, dizziness, sudden rash in form of red spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and there with erosive surface or epidermis peeling. Nikolsky’s symptom is positive. What is the most probable diagnosis?

A patient complains of pathological lump, appearing in the right inguinal region on exercise. The lump is round-shaped, 4 cm in diameter, on palpation: soft elastic consistency, is positioned near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A 54 y.o. patient has been sufferi- ng from osteomyelitis of femoral bone for over 20 years. In the last month there appeared and gradually progressed edemata of lower extremities. Urine analysis: proteinuria - 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia, increase of a2- and q-globulins, ESR- 50 mm/h. What is the most probable diagnosis?

A mineshaft is situated on the territory of homestead land, it is 20 m away from the house, 10 m- from the toilet and 15 m - from the neighbour’s house. What is the smallest distance that, according to the sanitary code, should be established between the well and the source of

A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. 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 boy, aged 9, was 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 complex assessment of the child’s physical development?

A 14 y.o. child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for atack reduction?

A 16 y.o. teenager complains of weakness, dizziness, sense of heaviness in the left hypochondrium. Objectively: skin and visible mucous membranes are icteric. Steeple skull. Liver +2 cm, the lower pole of spleen is at the level of navel. Blood test: RBC- 2, 7 * 1012/L, Hb- 88 g/L, WBC-5,6 * 109/L, ESR- 15 mm/h. What is the most probable reason of bilirubin level change?

A 28 y.o. woman consulted a doctor about edematic face, moderate legs edemata; occasionally her urine has colour of 'meat slops'. When she was a teenager she often fell ill with angina. Objectively: skin is pallor, body temperature is 36,80C, Ps- 68/min, rhythmic. AP- 170/110 mm Hg. What urine changes are the most probable?

A 58 y.o. woman had voluminous bleeding from the ruptured varicous node on the left crus. What first aid should be provided?

It is determined that 30 of a 100 women with risk factor had preterm labor, and of a 100 women without risk factor 5 women had preterm labor. What method of statistic data processing should the doctor use in order to estimate reliability of differences between the compared groups?

A patient was admitted to the hospital with complaints of occasional pains at the bottom of abdomen that get worse during menses, weakness, indisposition, nervousness, some dark bloody discharges from vagina on the day before and the day after menses. Bimanual examination results: body of womb is enlarged, appendages cannot be determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries, peritoneum of rectouterine pouches and pararectal fat are covered with 'cyanotic spots'. What is the most probable diagnosis?

A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal of uterus by means of Hegar’s dilator N° 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

A 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He suffers from hemophilia B-type. What antihemophilic medicine should be included in pre- and postoperative treatment plan?

A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fith day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 410C, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37,5°C, considerable mucopurulent discharges from the genital tracts, painful urination. Vaginal examination with mirrors: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened; fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most probable?

A 28 y.o. patient complains of pain in legs during walking, chill of feet and toes. He has been ill for a year. Objectively: leg skin is pale, cool; turgor is decreased, hypotrichosis. Femoral and popliteal artery pulsation is weak, it is palpable on the foot arteries only after nitroglycerine test. Rheographic index is <1. What is the most probable diagnosis?

A 2 m.o. child was delivered in time with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:

A woman consulted a doctor on the 14th day after labor about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 390C, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the medical hystory: acute pancreatitis. Body temperature is 38, 20C. Objectively: sclera icteritiousness. No symptoms of peritonium irritation are present. There are positive Ortner’s and HubergritsSkulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most probable?

A 48 y.o. patient has been staying in the emergency department for 2 days on account of acute anteroseptal myocardial infarction. In the course of examination he suddenly 'snored'. There was a tonic contraction of skeletal muscles; eye pupils dilatated. Pulse on a.carotis is absent. What is the immediate tactics?

A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37,50C. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the most probable?

8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region - 3,0x1,0 cm, neck muscles rigidity, Ps- 58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?

A girl, aged 13, consulted 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 pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?

In course of observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?

A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of conti-nious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?

200 patients suffering from essential hypertension were examined in order to obtain data about patients’ arterial pressure and age. What statistic value should be applied in order to measure relation between these characteristics?

A 24 y.o. woman consulted a doctor about continued fever, night sweating. She lost 7 kg within the last 3 months. She had casual sexual contacts. Objectively: enlargement of all lymph nodes, hepatolienal syndrome. Blood count: leukocytes - 2, 2 * 109/L. What disease can be suspected?

A 31 y.o. patient has been suffering from systemic scleroderma for 14 years. She has been treated in hospital many times. She complains of occasional dull pain in the heart region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of extremities joints. What organ affection worsens the disease prognosis?

A 2 month old child who was born with body weight 5100 g has jaundice, hoarse cry, umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are of normal color. In anamnesis: delayed falling-away of umbilical rest. Blood count: Hb- 120 g/L, RBC- 4,5 * 1012/L, ESR- 3 mm/h. General level of serum bilirubin - 28 mcmol/L, unconjugated bilirubin - 20 mcmol/L, conjugated bilirubin - 8 mcmol/L. What disease would you think about first of all?

The doctors in maternity hospital made a newborn boy the following diagnosis: congenital heart disease (interventricular septal defect). At the age of 2 months the boy has got a dyspnea. Objectively: BR- up to 60/min, tachycardia up to 170/min, liver is 3 cm below the costal margin. What medicines must be immediately prescribed?

A 50 y.o. woman who suffers from chronic pyelonephritis was prescribed a combination of antibiotics for the period of exacerbation - gentamicin (80 mg 3 times a day) and biseptol (960 mg twice a day). What consequences may be caused by such a combination of antibiotics?

A 60 y.o. patient complains of having passing reduction of strength in his left extremities for a month. Some time later he has got persistent weakness of extremities in the mornings. Objectively: AP-140/90 mm Hg, conscious, central paresis of the VII and XII pair of left-side cranial nerves, central hemiparesis and hemi-hyperesthesia also on the left side. What medicines should be chosen for the differentiated treatment of the patient?

A 52 y.o. male patient suffers from squeezing pain attacks in substernal area which irradiates to the left hand and occurs occasionally and on physical exercises. He has had it for 1 year. On examination: heart borders are enlargement to the left side, sounds are muffled, Ps- 76 bpm, rhythmic, AP-155/80 mm Hg, ECG: the left type, the rest signs are normal. What additional examination is necessary to confirm the diagnosis?

A 70 y.o. patient complains of weakness, dizziness, short periods of loss of consciousness, pain in the region of heart. Objectively: HR- 40/min, sounds are rhytmic, the 1st sound is dull, occasionally very intensive. AP- 180/90 mm Hg. What is the most probable reason of hemodynamic disorders?

A 32 y.o. patient who has been staying in a hospital on account of acute abscess of his right lung suddenly felt pain after coughing in the right half of thorax, he got heavy breathing, cyanosis. What complication is the most probable?

Fluorography of a 45 y.o. man revealed some foci of small intensity with nondistinct outlines on the top of his right lung. The patient doesn’t feel worse. He has been smoking for many years. Objectively: vesicular resonance over lungs, respiration is vesicular, rales are absent. Blood count is not changed. What is the most probable diagnosis?

An 18 y.o. patient was admitted to the hematologic department with complaints of headache, general weakness, poor appetite, body temperature rise up to 390C, neck swelling. Objectively: skin and mucous membranes are extremely pale, lymph nodes on the both sides of neck are up to 1 cm large, painless. Liver is enlarged +1 cm, painless, spleen +0,5 cm, t0380C. Blood count: Hb- 98g/L, RBC-2,9 * 1012/L, leukocytes - 32 * 109/L, stab neutrophils 0 %, segmental leukocytes - 28%, monocytes - 2%, lymphocytes -39%, blasts - 31%, reticulocytes - 31%, thrombocytes - 120* 109/L, ESR- 36 mm/h. What form of leukosis does the patient have?

A mother of a 5 y.o. girl consulted a doctor about doughter’s involuntary urination at night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition, intellectual development is good, the girl can read and explains common situations quite adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithi-asis. What type of diathesis is the most probable in the child’s case?

After manual reposition and application of plaster splint a patient with fractures of forearm bones had an edema of hand and fingers, he felt pain and lack of sensitivity. What tactics should the doctor choose?

A 35 y.o. male patient suffers from chronic glomerulonephritis and has been treated with hemodialysis for the last 3 years. He has got irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventricular block, high sharpened T-waves. Some time before he had seriously broken the water consumption and dietary pattern. What is the most likely cause of these changes?

A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable diagnosis?

A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss. Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly is soft, there are no symptoms of peritenium irritation, 'splashing sounds'in epigastrium. Defecation once in 3 days. What complication corresponds with the patient’s state and described clinical presentations?

An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/l; RBC- 3, 2 * 1012/L; C.I.-0,95; thromb.- 20 * 109/L. The sedimentation time according to Lee White is 5'; hemorrhagia duration according to Duke is 8', 'pinch and tourniquet' test is positive. What is the most probable diagnosis?

A 46 y.o. patient complains of skin itch, sweating, especially at night, body temperature rise up to 38, 6°C. Objectively: chest skin has marks of scratching, supraclavicular lymph nodes are as big as a pigeon egg, they are not matted together with skin. What test is the most reasonable?

A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. An echinococcus liver affection is suspected. What type of examination will be the most informative in this case?

A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?

A 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?

A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38,50C, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?

A 1,5 y.o. child fell seriously ill: chill, body temperature rise up to 40,10C, then rapid dropping to 36, 20C, skin is covered with voluminous hemorrhagic rash and purple cyanotic spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis, fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission stage?