Крок 2 · Медицина 2007 · Англійська

A 40 y.o. woman has changes of mammary gland. What are the most often symtomps that precede the malignization?

Heart auscultation of a 16 y.o. boy without clinical symptoms revealed accent of the S II and systolic murmur above the pulmonary artery. Heart sounds are resonant, rhythmic. What is the most probable diagnosis?

A 54 y.o. woman complains of increasing fatigue and easy bruising of 3 weeks duration. Physical findings included pale, scattered ecchymoses and petechiae and mild hepatosplenomegaly. In blood: RBC- 2,5×10¹²/L; Hb- 73 g/L; HCT- 20%; PLT- 23×10⁹/L; and WBC- 162×10⁹/L with 82% blasts, that contained Auric rods; peroxidase stain was positive. What is the most probable diagnosis?

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

A patient was admitted to the hospital with complaints of periodical pain in the lower part of abdomen that gets worse during menses, weakness, malaise, nervousness, dark bloody smears from vagina directly before and after menses. Bimanual examination revealed that uterus body is enlarged, appendages cannot be palpated, posterior fornix has tuberous surface. Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and pararectal fat have "cyanotic eyes". What is the most probable diagnosis?

A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdosE. What is the treatment tactics in this case?

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 28 y.o. patient who has no permanent residence was admitted to the hospital with preliminary diagnosis "influenza", on the 5-th day of disease there are appeared maculopapular and petechial rash on his body and internal surfaces of his extremities. Body temperature is 41°С, euphoria, hyperemic face, scleras reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A 58 y.o. patient complains of weakness, leg edemata, dyspnea, anorexia. He has been suffering from chronic bronchitis for many years. During the last 5 years he has been noting intensified discharge of sputum that is often purulent. Objectively: RR- 80/min, AP- 120/80 mm Hg. Disseminated edemata, skin is dry and pale, low turgor. In urine: intense proteinuria, cylindruria. Specify the most probable pathological process in kidneys:

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 district doctor keeps the record of reconvalescents after infectious diseases, people who are disposed to frequent and long-lasting diseases, patients with chronic pathologies. What category of patients should belong to the III health group?

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

A 50 y.o. woman for 1 year complained of attacks of right subcostal pain after fatty meal. Last week the attacks have repeated every day and become more painful. What diagnostic study would you recommend?

A 10 y.o. child who is at oligoanuretic stage of acute renal insufficiency has got sensations of pricking in the mucous membrane of oral cavity and tongue, extremities numbness, reduced reflexes, respiratory disturbance, arrhythmia. What are these symptoms caused by?

A young man has painful indurations in the peripapillary regions of both mammary glands. The most reasonable action will be:

A 75 y.o. man with IHD (atherosclerotic cardiosclerosis, atrial fibrillation, cardiac insufficiensy stage 2 B; chronic pyelonephritis) was prescribed digoxin. During the first 6 days the digoxin dose amounted 0,25 mg twice per day that let to abatement of dyspnea, edemata and cyanosis. But on the 7-th day the patient developed nausea and bradycardia. What is the most probable cause of digoxin intoxication?

The patient was admitted to the hospital on the 7-th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. The dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient went fishing two weeks ago. What is the diagnosis?

A 19 y.o. girl was admitted to Emergency Department: unconsionsness state, cyanosis, myotic pupil, superficial breathing - 12/min. BP- 90/60 mm Hg, Ps- 78/min. Choose the action corresponding to this clinical situation:

A 3 m.o. child fell seriously ill, body temperature rised up to 37,8°С, there is semicough. On the 3-rd day the cough grew worse, dyspnea appeared. On percussion: tympanic sound above lungs, on auscultation: a lot of fine moist and wheezing rales during expiration. What is the most probable diagnosis?

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?

A child is 2 m.o. Inguinofemoral folds contain acutely inflamed foci with distinct borders in form of spots that are slightly above the surrounding areas due to skin edema. The rash has appeared during the week. Vesiculation and wetting are absent. What is the most probable diagnosis?

A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?

A 30 y.o. patient has got multiple body skin rash consisting of small paired elements that are scattered on the skin diorderly and mostly focally, they are accompanied by itch. The rash appeared a few days after attending sport centre and sauna. What is the most probable diagnosis?

A primigravida woman appealed to the antenatal clinic on the 22.03.03 with complaints of boring pain in the lower part of abdomen. Anamnesis registered that her last menstruation was on the 4.01.03. Bimanual examination revealed that uterine servix is intact, external fauces is closed, uterus is enlarged up to the 9-th week of pregnancy, movable, painless. What complication can be suspected?

An 8 y.o. child presents with low-grade fever, arthritis, colicky abdominal pain, and a purpuric rash limited to the lower extremities. laboratory studies reveal a guaiac-positive stool, a urinalysis with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most likely diagnosis is:

A 49 y.o. female patient was admitted to the hospital with acute attacks of headache accompanied by pulsation in temples, AP rised up to 280/140 mm Hg. Pheochromocytoma is suspected. What mechanism of hypertensive atack does this patient have?

A 24 y.o. patient 13 months after the first labour consulted a doctor about amenorrhea. Pregnancy has concluded by a Cesarean section concerning to a premature detachment of normally posed placenta hemorrhage has made low fidelity 2000 ml owing to breakdown of coagulability of blood. Choose the most suitable investigation:

A 52 y.o. patient with previously functional Class II angina complains of 5 days of intensified and prolonged retrosternal pains, decreased exercise tolerance. Angina is less responsive to Nitroglycerinum. Which of the following diagnosis is most likely?

A 42 y.o. patient complains of weakness, heartbeat, nasal hemorrhages, cutaneous hemorrhages. His condition has been worsening progressively for a month. Objectively: grave condition, the extremities and body skin has spotted and petechial hemorrhages, lymph nodes are not palpable, Ps- 116/min, liver is +2 cm enlarged, spleen is not palpable. Blood has evident pancytopenia. What disease should you think about first of all?

A patient who has been contacting with benzol for 6 years has a non evident leukopenia, moderate reticulocytosis, gingival hemorrhage, dizziness, asthenovegetative syndrome. What a severity degree of chronic intoxication with benzol corresponds with described symptoms?

The patients has sustained blunt trauma to the chest. Which of the following would most likely be the cause of acute cardiopulmonary collapse?

Laparotomy was performed to a 54 y.o. woman on account of big formation in pelvis that turned out to be one-sided ovarian tumor along with considerable omental metastases. The most appropriate intraoperative tactics involves:

A 74 y.o. patient has been suffering from hypertension for 20 years. He complains of frequent headache, dizziness, he takes enalapril. Objectively: accent of the SII above aorta, Ps- 84 bpm, rhythmic, AP- 180/120 mm Hg. What group of hypotensive medications could be additionally prescribed under consideration of the patients age?

A woman was hospitalised with full-term pregnancy. In survey: the uterus is morbid, the abdomen is tense, heart sounds of the fetus are not auscultated. What is the most probable complication of pregnancy?

X-ray pattern of thorax organs revealed a large intensive inhomogeneous opacity with indistinct outlines on the right side at the level of the 4-th rib. In the centre of this opacity there is a horizontal level and clearing of lung tissue above it. What disease does this X-ray pattern correspond with?

A 44 y.o. man has acute disarthria, right-sided Horners syndrome, hiccup, right-sided ataxia, loss of pain sensation of his face to the right and of his body to the left. The man is conscious. Computer tomography of brain is normal. The most reasonable measure will be:

A 40 weeks pregnant woman in intrinsic obstetric investigation: the cervix of a uterus is undeveloped. The oxytocin test is negative. Upon inspection at 32 weeks it is revealed: AP- 140/90 mm Hg, proteinuria 1 g/l, peripheric edemata. Reflexes are normal. Choose the most correct tactics of guiding the pregnant:

A patient consulted a doctor about acure respiratory viral infection. The patient was acknowledged to be off work. The doctor issued him a medical certificate for 5 days. The patient is not recovering. What measures should the doctor take in order to legalize the further disability of patient?

A full-term child survived antenatal and intranatal hypoxia, it was born in asphyxia (2-5 points on Apgar score). After birth the child has progressing excitability, there are also vomiting, nystagmus, spasms, strabismus, spontaneous Moros and Babinskys reflexes. What localization of intracranial hemorrhage is the most probable?

A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in the lumbar part of his spine, increase of muscle tonus in the lumbar area and sluch during moving. X-ray pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most necessary for confirming a diagnosis?

The 10 y.o. boy has complains on headache, weakness, fever 40°С, vomiting, expressed dyspnea, pale skin with flush on right cheek, lag of right hemithorax respiratory movement, dullness on percussion over low lobe of right lung, weakness of vesicular respiration in this zone. The abdomen is painless and soft at palpation. Which disease lead to these symptoms and signs?

A woman had the rise of temperature up to 39°С on the first day after labour. The rupture of fetal membranes took place 36 hours before labour. The investigation of the bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of groupa. The uterus body is soft, tender. Discharges are bloody, mixed with pus. Specify the most probable postnatal complication:

A 30 y.o. man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°С. There was acute 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 25 y.o. patient 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?

Poorly refined wastes of an industrial plant are usually thrown into the river that supplies drinking water. It causes perishing of some microorganisms, disturbs processes of water self-purification and worsens its quality that can have negative influence upon peoples health. How is this effect of environmental factors called?

A 32 y.o. woman consulted a gynecologist about having abundant long menses within 3 months. Bimanual investigation: the body of the uterus is enlarged according to about 12 weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages are not palpated. Histological test of the uterus body mucosa: adenocystous hyperplasia of endometrium. Optimal medical tactics:

A 70 y.o. man is ill with ischemic heart disease. His mood is evidently depressed, anxious. As a result of continious 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?

A 14 y.o. girl got a bad mark at the lesson of math as well as teachers reprimand that made her cry for a long time. At the end of the lesson she suddenly lost consciousness and fell down. Objectively: skin is of pale pink colour, Ps- 100 bpm, satisfactory, AP- 110/70 mm Hg. Eyelids are closed and dont give away to the tries of their opening. There are no evident injuries. What is the provisional diagnosis?

A 32 y.o. patient has been suffering from systematic scleroderma for 14 years. She was repeatedly exposed to treatment in the in-patient department. Complains of periodical dull cardiac pain, dyspnea, headache, eyelid edemata, weight loss, pain and deformation of extremities joints. What organs lesion deteriorates the prognosis for the disease?

A 7 d.o. boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively. The most likely diagnosis is:

An aircraft factory processes materials with use of lasers. It is determined that the device radiates in the light spectrum and that levels of laser radiation at the workplaces exceed the alarm level. Specify, what organs will be affected in the first place?

A 70 y.o. patient complains of weakness, dizziness, short periods of unconsciousness, pain in the cardiac area. Objectively: HR- 40 bpm, heart sounds are rhythmic, the S1 is dull, periodically amplified. AP is 180/90 mm Hg. What is the most probable cause of hemodynamic disturbances?

A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to the posterior surface of his left leg. The pain increases during changing body position and also in the upright position. Examination revealed positive symptoms of tension. What is the preliminary 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. asthmatic man comes for a check up and complains that he is having some difficulty in "starting to urinate". Physical examination indicates that the man has blood pressure of 160/100 mm Hg, and a slight enlarged prostate. Which of the following medications would be useful in treating both of these conditions:

The 7 m.o. infant is suffering from acute pneumonia which was complicated by cardiovascular insufficiency and respiratory failure of II degree. The accompanied diagnosis is malnutrition of II degree. Choose the best variant of therapy:

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 30 y.o. victim of fire has thermal burns of III-A and III-B degree that amount 20% of total skin coverlet. AP is 110/70 mm Hg, HR- 120/min. What transfusion means shoul be used for blind infusion correction during transportation?

A 42 y.o. patient lifted a heavy object that resulted in acute pain in the right half of his chest, increased dyspnea. The patients condition is grave: cyanosis of lips and mucous membranes, RR is 28 pm, Ps- 122 bpm. On percussion there is tympanitis above the right half of chest, on auscultation - stongly diminished breath sounds; accent of the II heart sound above the pulmonary artery. AP is 80/40 mm Hg. What is the main emergency action at the pre-admission stage?

A 23 y.o. woman who suffers from insulin-dependent diabetes was admitted to the acute care department with mental confusion, inadequate anxious behaviour, hyperhidrosis, excessive salivation, tachycardia. What examination will be a primary task?

A 67 y.o. patient complains of dyspnea, breast pain, common weakness. He has been ill for 5 months. Objectively: t°- 37,3°С, Ps- 96/min. Vocal tremor over the right lung cannot be determined, percussion sound is dull, breathing cannot be auscultated. In sputum: blood diffusively mixed with mucus. What is the most probable diagnosis?

An anestesiologist gives narcosis to the patient, he uses a non-reversive contour. Anesthetic is halothane. Air temperature in the operation room is 21°С, humidity 50%, level of noise 30 db. What occupational hazard is the principal one under these conditions?

Prevalence of a disease in region N amounted 1156 occurences per 1000 of inhabitants. What of the mentioned indices characterizes the disease prevalence?

A 15 y.o. patient has developmental lag, periodical skin yellowing. Objectively: spleen is 16х12х10 cm large, holecistolithiasis, skin ulcer on the lower third of his left crus. Blood count: erythrocytes - 3,0×10¹²/L, Hb- 90 g/L,c.I.- 1,0, microspherocytosis, reticulocytosis. Blood bilirubin - 56 mmole/L, indirect bilirubin - 38 mmole/L. Choose the way of treatment:

A 75 y.o. woman with coronary heart disease constantly takes warfarin. She was taken to the acute care department with complaints of sudden sensation of weakness in the left half of her body and eyeball deviation to the left. What examination of the patient will be a primary task?

A girl 13 y.o. 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 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 worker at a porcelain factory who has been in service for 10 years complains of cough, dyspnea, ache in his chest. What occupational disease are these complaints most typical for?

Name a statistical observation unit for determination of influence amount of bloodsugar on the healing of wounds surface in a postoperative period:

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

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 7 y.o. boy was admitted to the hospital. He complains of unpleasant sensations in the heart region, pain in the epigastrium, dizziness, vomiting. Objectively: evident paleness of skin, dyspnea, jugular pulse. Heart borders are within the normal range. Heart sounds are clear, HR- 170/min, small pulse. AP- 90/50 mm Hg. EKG showed: paroxysm of ventricular tachycardia. The paroxysm can be suppressed by:

At a machine-building plant the casts are cleaned by means of abrasion machines that are a source of local vibration. What are the most efficient preventive measures for preventing harmful effect of vibration on workers organisms?

A number of viable fetuses per 1000 women at the age between 15 and 44 is determined by:

A 33 y.o. patient was admitted to the hospital with stopped repeated ulcerative bleeding. He was pale and exhausted. Blood count: Нb- 77 g/l, Нt- 0,25. In view of anemia there were made two attempts of blood transfusion of the same group - А(ІІ) Rh+. In both cases the transfusion had to be stopped because of development of anaphylactic reaction. What transfusion medium would be advisable in this case?

Medical examination of a 43 y.o. man revealed objectively pailness of skin and mucous membranes, smoothness of lingual papillas, transverse striation of nails, fissures in the mouth corners, tachycardia. Hemoglobin content amounts 90 g/l; there are anisocytosis, poikilocytosis. The most probable causative agent of this condition is deficiency of the following microelement:

A woman in her 39-th week of pregnancy, the second labor, has regular birth activity. Uterine contractions take place every 3 minutes. What criteria describe the beginning of the II labor stage the most precisely?

A patient complains of nycturia, constant boring pain in perineum and suprapubic region, weak urine jet, frequent, obstructed and painful urination. He has been ill for several months, pain in perineum appeared after getting problems with urination. Rectal examination revealed that prostate is enlarged (mostly owing to the right lobe), dense, asymmetric, its central sulcus is flattened, the right lobe is dense, painless, tuberous. What disease can it be?

A 19 y.o. girl admitted to the hospital complained of pain in the knee and fever of 38,6°С. She is ill for 2 weeks after acute tonsillitis. On exam, hyperemia and swelling of both knees, temperature is 37,4°С, HR- 94/min, BP- 120/80 mm Hg, and heart border is displaced to the left; S1 is weak, systolic murmur is present. Total blood count shows the following: Hb- 120 g/L, WBC- 9,8×10⁹/L, ESR of 30 mm/L. ECG findings: the rhythm is regular, PQ = 0,24 sec. What is a causative agent of the disease?

A 39 y.o. patient complains of having dyspnea during physical activity, crus edemata, palpitation, heart intermissions. Objectively: HR is 150 bpm, atrial fibrillation. Heart is both ways enlarged. Heart sounds are muted. Liver is 6 cm below the costal margin. Echocardiogram reveals dilatation of heart chambers (end diastolic volume of left ventricle is 6,8 cm) is 29% EF, valve apparatus is unchanged. What is the most probable diagnosis?

A 65 y.o. man who has problems with urination as a result of benign prostate gland adenoma dveloped fever and chill, hypotension, sinus tachycardia. Skin is warm and dry. Clinical blood analysis revealed absolute granulocytopenia. These hemodynamic changes are most likely to be caused by:

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

A 41 y.o. woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC- 9,8×10⁹/L, RBC- 3,0×10¹²/L, sedimentation rate - 52 mm/hour. What medication provides pathogenetic treatment of this patient?

A 74 y.o. patient complains of abdomen pain and sweling, nausea. She suffers from ischemic heart disease, postinfarction and atherosclerotic cardiosclerosis. Objectively: the patient is in grave condition, abdomen is swollen, abdominal wall doesnt take active part in respiration. Laparoscopy revealed a small amount of muddy effusion in abdominal cavity, one of the loops of small intestine is dark-cyan. What is the most probable diagnosis?

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. boy has crampy abdominal pain and a rash on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. He is most likely to be affected by:

The patient 25 y.o. was admitted on the 1st day of the disease with complaints of double vision in the eyes, heavy breathing. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?

An 18 y.o. woman consulted a gynecologist about the pain in the lower part of abdomen, fever up to 37,5°С, 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 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: Нb- 70 g/L, RBC- 2,3×10¹²/L, Ht- 20. What is the most probable diagnosis?

A 35 y.o. patient was admitted to the local hospital a week after a road accident with clinical picture of clotted hemothorax. What is the most appropriate treatment tactic for prevention of acute pleural empyema?

An 8 y.o. boy complains of constant cough along with discharge of greenish sputum, dyspnea during physical activities. At the age of 1 year and 8 months he fell ill for the first time with bilateral pneumonia that had protracted course. Later on there were recurrences of the disease 5-6 times a year, during the remission periods there was constant productive cough. What examination results will be the most important for making a final diagnosis?

A 42 y.o. woman works at the factory on the fabrication of mercury thermometers, complains of the headache, swoons, reduction of memory, small and frequent flutter of fingers of drawn hands, the eyelids and the tongue, bleeding gums, gingivitis. What preparation is it nessesary to use for the elimination of mercury from the organism?

A 43 y.o. patient was admitted to the hospital with complaints of high temperature of the body and severe headache. On examination: carbuncle is revealed on the forearm. There are intense edema around it, insignificant pain, regional lymphadenitis. The patient is a worker of cattle-ranch. What disease is it necessary to think about first?

A 34 y.o. woman in the 10-th week of gestation (the second pregnancy) consulted a doctor of antenatal clinic with purpose of statement on the dyspensary record. In the previous pregnancy there took place hydramnion, the childs birth weight was 4086. What method of examination is necessary for carrying out, first of all?

A 60 y.o. patient cpmplains of weakness, dizziness, heaviness in the upper part of abdomen, paresthesia of toes and fingers. Objectively: skin icteritiousness, tongue is crimson, smooth. Hepatomegaly. In blood: Hb- 90 g/l, erythrocytes - 2,3×10¹²/l, reticulocytes - 0,2%; color index - 1,2, macrocytosis; Jollys bodies, Cabots ring bodies. What medication is the most appropriate for treatment?

A doctor of the general practice has registered the following death causes for the previous year: the first place was taken by cardiovascular diseases (60%), the second - by tumors (18%), then - traumas (8,3%) etc. What diagrams will provide the most substantial information about the registered ocurrences?

A 22 y.o. patient complains of having boring pain in the right iliac region for one week, morning sickness, taste change. Delay of menstruation is 3 weeks. Objectively: AP- 110/70 mm Hg, Ps- 78/min, t°- 37,0°С. Bimanual examination revealed that uterus is a little enlarged, soft, movable, painless. Appendages palpation: a painful formation 3х4 cm large on the right, it is dense and elastic, moderately movable. What is the most probable diagnosis?

A 43 y.o. patient complains of periodical pain attacks in the right half of her face. The attack is characterized by spasm of mimetic muscles of the right faces half, reddening of skin on this side. Blood has no pathologies. She was diagnosed with right-sided trifacial neuralgia. What medication should be prescribed?

A 41 y.o. patient was admitted to the intensive care unit with hemorrhagic shock due to gastric bleeding. He has a history of hepatitis B during the last 5 years. The source of bleeding are esophageal veins. What is the most effective method for control of the bleeding?

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 post-operative treatment plan?

A patient with a history of coronary artery disease and atrial fibrillation has the onset of sudden pain and weakness of the left leg. Examination reveals a cool, pale extremity with absent pulses below the groin and normal contralateral leg. The most likely diagnosis is:

A 25 y.o. man who has been suffering from disseminated sclerosis for 4 years complains of increasing unsteadyness, weakness of his lower extremities, urinary retention. Objectively: central tetraparesis. Cerebellar ataxia. Disturbed function of pelvic organs. What is the most appropriate therapy in this case?

A 75 y.o. man has acute pain in the paraumbilical region accompanied by vomiting and feeling of abdominal swelling in approximately 30 minutes after meals. He lost 10 kg during the last months because he doesn't eat in order to avoid pain. Abdomen examination reveals no changes in the periods between pain attacks. Above the right femoral artery a murmur can be auscultated, peripheral pulsation in the lower extrimities is weak. X-ray examination of stomach and colonoscopy reealed no changes. What is the leading factor of this pathogenesis?

The parameter of infantile mortality for the last year was - 16,3, in present year - 15,7. Name a kind of the diagram that can be used for a graphic representation of it:

Elderly people develop tumors more frequently. One of the main causes is:

A patient is staying in the hospital with the diagnosis of abdominal typhus. During the 3-d week from the beginning of the disease the patient stopped keeping diet and confinement to bed. As a result the body temperature and rapid pulse decreased and melena appeared. What kind of complications should we think about first of all?

A 40 y.o. patient complains of yellowish 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:

Atmospheric air of an industrial centre is polluted with the following wastes of metallurgical plants: sulphuric, nitric, metal, carbon oxides that have negative influence upon the inhabitants health. The effct of these hazards can be characterized as:

A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%, specific density - 1,04 g/cm3, acidity - 210Т, reductase probe - weak-positive. What way is the product to be used in?

The disease began acutely. The frequent watery stool developed 6 hours ago. The bodys temperature is normal. Then the vomiting was joined. On examination: his voice is hoarse, eyes are deeply sunken in the orbits. The pulse is frequent. Blood pressure is low. There is no urine. What is the preliminary diagnosis?

A 35 y.o. patient experienced a strong nervous stress that resulted in formation of reddened and edematic areas on the back surface of her hands with further formation of small inflammated nodules, vesicles and then erosions accompanied by profuse discharge of serous liquid. The process is also accompanied by intense itching. What is the most probable diagnosis?

6 m.o. infant was born with bodys mass 3 kg and length 50 cm. He is given natural feeding. How many times per day the infant should be fed?

The child has complains of the "night" and "hungry" abdominal pains. At fibroscopy in area a bulbus ofa duodenum the ulcerrative defect of 4 mms diameter is found, the floor is obtected with a fibrin, (H.p+). Administer the optimum schemes of treatment:

A 38 y.o. patient has been treated in a hospital. A fever of 39°С, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7-th day of the treatment. Chest X- ray shows left lower lobe infiltrate. Which of the following is the treatment of choice for this patient?

A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. AP is falling rapidly, it is necessary to perform hemotransfusion. Who can determine the patients blood group and rhesus compatibility?

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

Medical examination of a man revealed "geographic tongue". This microsymptom is the evidence of the following vitamin deficiency:

A 20 y.o. man has a stab knife wound in the left half of thorax close to nipple. AP is 90/60 mm Hg, Ps- 130/min, BR- 32/min. During inspiration there is increase of pulse wave in the region of jugular vein, decrease of peripheral arterial pulse and reduction of AP. Respiratory murmurs are unchanged. X-ray pattern of thorax organs has no pecularities. After introduction of 2 l of isotonic solution the AP stayed low, CVP raised up to 32 cm of water column. The first step in further treatment of the patient will be:

A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours. Hearbeat of fetus is muffled, arrhythmic, 100/min. Vaginal examination: cervix of uterus is completely opened, fetus head is level with outlet from small pelvis. Saggital suture is in the straight diameter, small crown is near symphysis. What is the further tactics of handling the delivery?

On the 4-th day of injections a 60 y.o. patient felt pain and tissue induration in the left buttock. Objectively: the skin in the superexternal quadrant of the left buttock is red and hot, palpation reveals a painful infiltrate 6х6 cm large with softening in the centre. Body temperature is 37,9°С. What action is necessary to diagnose an abscess?

A patient has been suffering from morning cough accompanied by discharge of small amount of sputum, dyspnea for 8 years. He has been smoking for 10 years. Objectively: cyanosis, prolonged expiration, dry rales. What is the most probable diagnosis?

A 56 y.o. patient ill with cholecystectomy suddenly had an intense hemorrhage. She needs blood transfusion. Her blood group is АВ(ІV) Rh-. Hemotransfusion station doesnt dispose of this group. What group of donors can be involved?

A 35 y.o. patient who suffers from chronic glomerulonephritis and has been hemodialysis-dependent for the last three years developed intermissions of heart activity, hypotension, increasing weakness, dyspnea. ECG showed bradycardia, atrioventricular block type I, high pointed wavest. The day before the flagrant violation of diet took place. What is the most probable cause of these changes?

A 42 y.o. woman complains of dyspnea, edema of the legs, and tachycardia during small physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?

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

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?

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 woman consulted a doctor on the 14-th day after labor about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39°С, 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 7 y.o. girl fell ill abruptly: fever, headache, severe sore throat, vomiting. Minute bright red rash appear in her reddened skin in 3 hours. It is more intensive in axillae and groin. Mucous membrane of oropharynx is hyperemic. Greyish patches is on the tonsills. Submaxillary lymph nodes are enlarged and painful. What is your diagnosis?

A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2 hours later after food intake. He has been suffering from ulcer for 11 years. Objectively: t°- 36,5°С, RR- 16/min, Ps- 70 bpm, AP- 120/80 mm Hg. On palpation: local painfulness in the right epigastric region. What parameters of intragastric Ph-meter in the region of stomach body are the most typical for this patients disease?

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?

Fluorography of a 45 y.o. man revealed some little intensive foci with indistinct outlines on the top of his right lung for the first time. The patient doesnt feel worse. He has been smoking for many years. Objectively: pulmonary sound above lungs on percussion, respiration is vesicular, no rales. Blood count is unchanged. What is the most probable diagnosis?

A 28 y.o. woman comes to the Emergency Room with a slightly reddened, painful "knot", 8 cm above the medial malleolus. Examination in the standing position demonstrates a distended vein above and below the mass. There are no other abnormalities on physical examination. The most likely diagnosis is:

A 58 y.o. patient developed acute myocardium infarction 4 hours ago, now he is in the acute care department. ECG registers short paroxysms of ventricular tachycardia. The most appropriate measure will be to introduct:

The total area of ground intended for building of a regional hospital is 2,0 hectare. What is the highest possible capacity of the in-patient hospital that can be built upon this ground?

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 kidneys functioning is satisfactory. What is the most probable diagnosis?

A 46 y.o. patient complains of colicky pain in the right lumbar region that is irradiating to the lower part of abdomen, nausea. She didnt have such pains before. Survey radiograph of abdominal cavity organs didnt reveal any pathological stains. Ultrasonic sonogram revealed in the enlarged right renal pelvis a hyperechoic mass approximately 1,5 cm large that gives rise to an "ultrasonic track". What is the most probable diagnosis?

A patient of 32 y.o. complains of severe weakness, tremor of extremities. Objective examination: body weight loss, wet and warm skin. The thyroid gland is enlarged up to the 3-rd degree, painless, elastic. Ps- 108/min. BP- 160/55 mm Hg. There are no other abnormalties. The diagnosis is:

A 9 y.o. child with diagnosis "chronic tonsillitis" stands dispanserization control. Within 1 year of observation there was one exacerbation of disease. Physical condition is satisfactory. The general state is not infringed. Define group of health:

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

A 10 y.o. child has average indices of body length and her chest circumference exceeds average indices, body weight index is heightened due to lipopexia. Functional characteristics of physical development are below average. Physical development of this child can be estimated as:

Patient 27 y.o. was hospitalized to the psychiatric hospital for the 4-th time during 2 years. Heard voices commenting on his actions, had delusions of persecution (was sure that the Mafia wanted to kill him). After a course of treatment with neuroleptics was discharged from hospital with the diagnosis of schizophrenia, state of remission. The secondary prevention of the relapses of schizophrenia requires:

An engineer-chemist at the age of 47 often fells ill with an occupational skin disease. Who makes a decision to transfer him to other job accepts?

A 2 m.o. child with birth weight 5100 g has jaundice, hoarse cry, umbilical hernia, physical development lag. Liver is +2 cm enlarged, spleen is not enlarged. In anamnesis: delayed falling-away of umbilical cord rest. In blood: Hb- 120 g/L, erythrocytes - 4,5×10¹²/L, ESR- 3 mm/h. Whole serum bilirubin is 28 mcmole/L, indirect - 20 mcmole/L, direct - 8 mcmole/L. What is the most probable diagnosis?

A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin - striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?

A 54 y.o. woman has been ill with osteomyelitis of femoral bone for over 20 years. During the last month there appeared and have been steadily increasing edemata of lower extremities. Urine analysis revealed: proteinuria - 6,6 g/l. Blood analysis: disproteinemia in form of hypoalbuminemia, raise of ?2- and ?-globulines, ESR- 50 mm/h. What is the most probable diagnosis?

An infant is 2 d.o. It was full-term born with signs of intrauterine infection, thats why it was prescribed antibiotics. Specify, why the gap between antibiotic introductions to the new-born children is longer and dosage is smaller compared to the older children and adults?

A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability. His anamnesis registers frequent respiratory diseases. On percussion: heart borders are dilatated to the left and upwards. On auscultation: amplification of the SII above pulmonary artery, a harsh systolodyastolic "machine" murmur is auscultated between the II and the III rib to the left of breast bone, this murmur is conducted to all other points including back. AP is 100/20 mm Hg. What is the most probable diagnosis?

A 27 y.o. patient has been having for almost a year fatigue, hyperhidrosis, heaviness in the left hypochondrium, especially after meals. Objectively: spleen and liver enlargement. In blood: erythrocytes - 3,2*10^12/l, Hb- 100 g/l, colour index - 0,87, leukocutes - 100*10^9/l, basophils - 7%, eosinophils - 5%, myelocytes - 15%, juveniles - 16%, stab neutrophils - 10%, segmentonuclear leukocytes - 45%, lymphocytes - 2%, monocytes - 0%, reticulocytes - 0,3%, thrombocytes - 400*10^9/l, ESR- 25 mm/h. What is the most probable diagnosis?

A worker diagnosed with "acute dysentery" was sent to the infectious department by a doctor of aid post. What document should be used for registration of this disease?

The major repair of a hospital included renewal of colour design of hospital premises because it is of great psychological and aesthetical importance; and so the walls of patient wards will be painted under consideration of:

A patient complains of feeling heaviness behind his breast bone, periodical sensation of food stoppage, dysphagy. During the X-ray examination barium contrast revealed a single saccular outpouching of anterodextral esophagus wall with regular contours and rigidly outlined neck. What is the most probable diagnosis?

A 51 y.o. women was taken to the emergency department in convulsive status epilepticus. The first means of medical management should be:

A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was admitted to the obstetric department with complaints of sudden and painful bloody discharges from vagina that appeared 2 hours ago. The discharges are profuse and contain grumes. Cardiac funnction of the fetus is rhytmic, 150 strokes in the minute, uterus tone is normal. The most probable provisional diagnosis will be:

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 41 y.o. woman complains of weakness, fatigue, fever up to 38°С, 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. Hematology shows anemia, leucopenia, lymphopenia; on urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism of disease development?

The highest risk of congenital anomalies probably occurs when human embryos or fetuses are exposed to ionizing radiation. During which part of gestational period does it occur?

A 16 y.o. female presents with abdominal pain and purpuric spots on the skin. Laboratory investigations reveals a normal platelet count, with haematuria and proteinuria.The most likely diagnosis: