Банк тестових завдань Крок 2 Лікувальна справа на англійській мові 22.03.2002 рік № ItemText 1. The 52-years woman suffering from obesity, complaints to bloody discharges from sexual paths during 4 days. Last normal menses was 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. Which reasons from listed below promoted the development of disease? 2. The data of a separate diagnostic curettage of the mucous of the uterus’s cervix and body made up in connection with bleeding in a postmenopausal period: in the scraping of the mucous of the cervical canal no pathology is revealed, at endometrium - the highly differentiated adenocarcinoma is found. Metastasises are not found. Which method of treatment is the most correct? 3. The woman of 27 years complaints of the disoders of menstrual function for 3 months, irregular pains in the abdomen. In bimanual investigation: in the dextral appendages range of a uterus there is an elastic spherical formation, painless, DistrA DistrB *Excessive Hypersecretion of transformation of estrogens by tissues preandrogens from of the organism. fatty tissues. DistrC DistrD Poor aromatization The increased of preandrogens contents of FSH owing to hypothyroidism DistrE Supersecretion of androgens by the cortex of paranephroses. *Surgical treatments and hormonetherapy Surgical treatment + Surgical treatments Radial therapy chemotherapy and radial therapy Surgical treatments and hormonetherapy *Administration of Operative treatment Dispensary Anti-inflammatory Chemotherapeutic an estrogen– observation of the therapy treatment. gestogen patient complexes within 3 months with repeated survey diameter of 7 sm. USI: in a right ovary –a fluid formation, diameter of 4 sm, unicameral, smooth. What method of guiding is the most preferable? 4. The patient of 40 years complaints of colic pains in the lower abdomen and abundant bloody discharge from sexual paths. Last 2 years she had menses for 1516 days, abundant, with clots, painful. In anamnesis – 2 medical abortions. In bimanual investigation: from the canal of the cervix of uterus - a fibromatous nodes, 3 sm in diameter, on the thin crus. Discharges are bloody, moderate.Choose correct tactics: 5. The patient of 40 years complains of discharges from the vagina of yellow colour. Bimanual investigation: without pathological variations. In smear – Trichomonas vagynalis and blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing.Your tactics: 6. The 32 year old woman consulted a gynecologist concerning 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 *Operation: untwisting of the borning nodes Hormonal hemostasis Fase by fase vitamin therapy Supravaginal ablation of the uterus without appendages. Hysterectomy without appendages. *Treatment of Diathermocoagulati Specific treatment Cervixectomy specific colpitis on of the cervix of of Trichomonas and with the the uterus colpitis subsequent biopsy Cryolysis of cervix of the uterus. *Surgical treatment Hormonetherapy Phytotherapy Radial therapy Fase by fase vitamin therapy consistence. Appendages are not palpated. Histological investigation of mucosa of the body of the uterus: adenocystous hyperplasia of endometrium.Optimum medical tactics: 7. The woman complaints of slight dark bloody discharges and weak pains in the bottom of abdomen within several days. Last menses were 7 weeks ago. The test for pregnancy is positive. Bimanual investigation: the body of the uterus is about 5-6 weeks of pregnancy, of softish consistence, painless. In the left appendages - a retortlike formation, 7х5sm, mobile, painless. What it is necessary to do to determinate the fetal eggs localization . 8. The woman was hospitalised with fullterm pregnancy. In survey: the uterus is morbid, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the most probable complication of pregnancy? 9. By the end of the 1st period of physiological labor the clear amniotic waters were given vent. Contractions lasted 35-40 sec every 4-5min. Palpitation of the fetus 100 beats per minute. The AP is 140/90 mm Hg. Diagnosis. *USI. Hysteroscopy. Hromogidrotubatio Colposcopy n Cystoskopy. *Premature detachment of the normally posed placenta. Labor before term. Back occipital presentation. Acute hypoxia of a Hydramnion. fetus. *Acute hypoxia of Labors before term. Premature the fetus. detachment of normally posed placenta. Back occipital presentation Hydramnion 10. In the 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 edemas. Reflexes are normal. Choose the most correct tactics of guiding the pregnant. 11. The 26-year old woman had the second for the last 2 years labor with Oxytocin application.The the child’s weight - 4080 gr. After the placent birth there was a massive bleeding, signs of hemorrhagic shock.Despite the introduction of contractive agents,good contraction of the uterus and absence of any uterus cervix and the vagina failures, the bleeding proceeds.Choose the most probable cause of bleeding. 12. The woman is admitted to the maternity home with discontinued patrimonial activity and slight 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 anamnesis there was a Cesarian section a year ago. Establish the diagnosis: 13. In the woman of the first day after labor *Laborstimulation Strict bed regimen Complex therapy after preparation for 1 month. of gestosis for 2 days Cesarian section immediately. Complex therapy of gestosis for 7 days *Atony of the uterus. Failure of cervix of Hysterorrhesis. the uterus Delay of the part of Hypotonia of the placenta. uterus *Hysterorrhesis. Presentation of the cord. Placental presentation Abjointing the Premature mucous fuse from expultion of the cervix of the uterus amniotic waters. *Metroendometritis Thrombophlebitis of Infected hematoma Infective Apostatis of the rise of temperature up to 39?С was registered. The breakage of the fetal membranes has taken place 36 hours prior to labors. The investigation of the bacterial flora of cervix of the uterus revealed – hemocatheretic streptococcus of a group A. The uterus body is soft, tender. Discharges are bloody, with a mixing of pus. Establish the most probable postnatal complication. 14. The woman from a groop of risk (chronic pyelonephritis in anamnesis) had labor through natural patrimonial pathes. In day after labors she complains of fever and loin pains, often urodynia. Establish the most probable complication. 15. The 24-years patient in 13 months after the first labors has addressed with the complaint on amenorrhea. Pregnancy has concluded by a Cesarian 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: 16. In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics- anovulatory. The contents of veins of the pelvis contamination of the urinary system junctures after the episiotomy. *Infection Thrombophlebitis of Infected contamination of veins of the pelvis. hematoma. the urinary system. Endometritis. Apostatis of junctures after episiotomy *Determination of USI of organs of a the level of small pelvis Gonadotropins Progesteron assay Computer tomography of the head Determination of the contents of TestosteronDepotum in Serum of blood. *Computer Determination of tomography of the the level of head. Gonadotropins. USI of organs of a Progesteron assay. small pelvis Determination of the contents of TestosteronDepotum in Serum Prolactinum in blood is boosted. Choose the most suitable investigation. 17. The primapara M., 20 years, is in in time -labors proceeding for 4 hours. Light amniotic waters were given vent. The fetus’ head is pressed to the orifice in the small pelvis. Prospective mass of the fetus 4000,0 ± 200,0. Palpitation of the fetus is in norm. Intrinsic investigation: cervix is absent, disclosure – 2 cm, the fetal bladder is not present. The head is in 1-st plane of the pelvis, a sagittal juncture is in the left slanting dimension. A glucose-calcium-hormone - vitaminized background was conducted with the purpose: 18. The Primapara of 22 years, was hospitalised for ante partum preparation concerning the pelvic presentation. The position of the fetus is longitudinal, breeches are pressed to the orifice of a small pelvis. Palpitation of the fetus is clear, rhythmical, 140 impacts per minute. Patrimonial activity is not present. What it is necessary to include into antenatal preparation 19. The 24 years old primapara, was hospitalised with complains on expultion of the amniotic waters. The uterus during of blood. *Prophylaxes of delicacy of patrimonial activity. Laborinducing Prophylaxes of hypoxia of the fetus Antenatal preparation Treatments of delicacy of patrimonial activity *Folliculinum Oxytocinum Partusistenum Prednisolonum. Zinci sulfas of magnesium *Antenatal expultion of the amniotic waters. Early expultion of The beginning of The end of the 1-st The pathological the amniotic waters. the 1-st term of the term of the labor preliminary term. labor palpation is tonic. The position of the fetus is longitudinal, is pressed with the head to an orifice in a small pelvis. Palpitation of the fetus is rhythmical, 140 beats/min, auscultated at the left below a belly-button. Intrinsic investigation: cervix of the uterus is 2,5 cm long, dense, the externum os is closed, leak light amniotic waters. Point a correct component of the diagnosis: 20. The 29 year old patient has had a surgical treatment concerning the benign serous epithelial tumour of the ovary. The postoperative term has passed without complications.What is it necessary to prescribe in the rehabilitational term: 21. The 34-years old woman on the 10-th week of gestation /the second pregnancy / has consulted the doctor of female consultation with the purpose of statement on the dyspensary record. In the previous pregnancy there took place hydramnion, the child was born with mass of yhe body of 4086. What method of investigation is necessary for carrying out, first of all?: 22. The puerpera is on the 4-th day after the normal labor. The common state is satisfactory, there are no complaints. The body temperature 36,5 °С; sphygmus is of *Hormonetherapy and proteolytic enzymes. Antibacterial therapy and adaptogens Lasertherapy and Magnitotherapy and Does not demand enzymetherapy vitamin therapy the further observation *The test for tolerance to glucose Determination of the contents of ?? fetoproteinum Bacteriological A USI of the fetus. investigation of cardiophonography discharge from the of fetus vagina *To appoint the agents stimulating reductions of the uterus Endometrial instillation of antiseptics solutions. Supravaginal ablation of the uterus Tool revision of the HBO. cavity of the uterus 80 beats / minutes, satisfactory properties, rhythmical; AP of 120/80 mm.Hg on both humeral arterias. Mammas are mild, painless, papillas are safe. The uterus is dense, painless, its bottom is 6-8 cm higher than the bosom. The lochia is serously-bloody. The diagnosis " a subinvolution of the uterus " is made.It is necessary to manufacture the following: 23. The 26 years old woman complaints of the subitaneously arisen pains in the bottom of the abdomen, irradiating to the anus, a nausea, giddiness, bloody dark discharge from sexual tract within one week, the delay of menses for 4 weeks. Signs of boring of the peritoneum are positive. Bimanual investigation: borders of the body of the uterus and its appendages are not determined because of sharp morbidness. The diverticulum and morbidness of the back and dextral vaults of the vagina are marked.What is the most probable diagnosis?: 24. At the gynecology department there is a patient of 32years with the diagnosis: "the acute bartholinitis".The body temperature is 38,2 degrees, leucocytes = 10,4 Т/l, the ESR = 24 mm / hour. In the area of big gland of the vestibulum - a dermahemia, *Broken tubal pregnancy Apoplexy of the ovary Acute right-hand adnexitis Torsion of the leg Acute appendicitis of the tumour of the ovary * Surgical dissecting, a drainage of an abscess of the gland, antibiotics Antibiotics, Sulfanilamidums Surgical dissection, drainage of the abscess of the gland Antibiotic therapy Antibiotics, detoxication and biostimulants. the sign of the fluctuation, sharp morbidness.What is the most correct tactics of the doctor?: 25. At the woman of 33 years during carrying out tool revision of the uterus cavity concerning incomplete infected abortion perforation of a wall of the uterus at a bottom is made. What is the tactics of guiding?: 26. The primagravida with pregnancy of 3738 weeks complaints of headache, nausea, pain in epigastriums. Objective: the skin is acyanotic. Face is hydropic, there are short fibrillar bounces of blepharons, muscles of the face and the inferior extremities.The look is fixed. AP 200/110 mm.Hg; sphygmus of 92 beats / minutes, intense.Respiration frequency 32/min.Activity of the heart isrhythmical Appreciable edemas of the inferior extremities. Urine is cloudy. 27. In the primapara, 30 years, intensive attempts with an interval of 1-2 min, duration 50 sec have begun. In time of inclination of the head of the fetus in the parturient woman complaints on the severe pain in the perineum have developed. The perineum, height= 4 sm, has turned pale. What is it necessary to * Suturing of a Suturing of a punched foramen punched foramen after cutting of the edges of the wound Hysterectomy Antibiotics reducing agents, observation Strict confinement to bed, observation. * Droperidolum of Dibazolum of 1 \% - A papaverine a 0,25 \% - 2,0 ml 6,0 ml hydrochloride of 2 \% - 4,0 ml Hexenalum of 1 \% Pentaminum of 5 \ - 2,0 ml % - 4,0 ml. *Perineotomy Epiziotomija. Protection of the perineum. Vacuum extraction of the fetus. Waiting tactics. perform: 28. The pregnant woman of 29 years old has been suffering from urolithiasis, secondary-chronic pyelonephritis during 8 years. What group of risk the occured complication of pregnancy should be related to? 29. The patient of 23 years old has been registered in female consultation with 4 years ago undergone contagious hepatitis, chronic cholecystopancreatitis. Point one of the most probable complication of pregnancy in the first trimester. 30. The primagravida of 20 years old which has diabetis for 8 years is hospitalised into the gynaecology department with early gestosis of average gravity. Point the most probable complication. 31. Name a statistical observation unit for determination of influence amount of bloodsugar on the healing of wound's surface in a postoperative period: 32. What methods of the collecting of the information is preferable for study of housing conditions of students of medical HIGH SCHOOL for a training period? 33. Define the observation unit, at study the average duration of hospitalization of *Threat of development of a gestosis Threat of patrimonial traumatism Threat of bleeding Threat of delicacy of patrimonial activity Threat of isosensibilisation *Hepatosis pregnant Early gestosis Spontaneous abortion Anemia pregnant Dermatosis of pregnant *Hyperglycemic coma Spontaneous abortion Hypoglycemic coma Bronchial asthma of Anemia of the the pregnant pregnant woman woman The patient who has The patient who a wound surface. was discharge on an after-care. A method of the directed selection. Delivery times of the patient. Statistical. * The patient in a postoperative period. *Questioning. An amount of blood-sugar. Interviewing. The analysis of a blood. Selecting of materials. Average duration of patient's stay *The patient with appendectomy. The patient who is entered in the The clinical form of appendicitis. 34. 35. 36. 37. 38. patients with appendectomy, depending on delivery times in a hospital and the clinical form of appendicitis. Choose a method of a graphic representation of monthly information about number of the registered cases of acute intestinal infection and their comparisons to the average monthly values, obtained for 5 previous years: 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. The average body lenth of neonatal boys is 50,9 cm at a sigma 1,66; and average mass - 3432 at a sigma 5,00. What criteria is correct to compare degree of variability these signs? What kind a method is correct to establish force of correlation connection between age of men and their mortality from a myocardial infarction? Indicate the registration medical document for the patient Н., that 21.02. was addressed to the doctor with diagnosis ARVD the first time in this year: hospital. *The linear diagram. in a hospital. The figured diagram. Curvilinear. The radial diagram. The sector diagram. *Stylar. Linear. Intrastylar. Sector. Radial. *A coefficient of variation. A sigma. A limit. An amplitude. A coefficient of association. *A method of grade correlation (Spirman). 39. Define the basic registration document at The Indirect A method of method (Stjudent). graduated correlation (Armler). *The statistical The statistical The statistical It is necessary to fill The necessary coupon is coupon for coupon to fill in it in the emergency registration form is necessary to fill in registration of final is necessary, but a notice on a case of a not indicated. it and it is diagnoses is not sign + is not contagion. necessary to deliver necessary. necessary to put in. on a sign +. *A card of the "The Report on The leaf of A ambulatory The inpatient A correlation ratio. The quadrate method (Pirson). the profound study of a case rate with temporary lost labor ability at the industrial enterprise: 40. Head of department and a trade-union group have addressed to the head of hospital about dismissal of the senior nurse that works during 17 years. The facts of charge were confirmed and recognized as the main nurse. This nurse lives with a daughter (which does not work, she is divorced) and 9 month grandson. Make a solution from items of management. 41. On the basis of the application form of parents and explanatory note from the senior nurse of reception department the chief of medical service sent the official report to the head of hospital about granting for a money by the senior nurse of hospital the medicines from humanitarian fundfor treatment the child . What should make the head of hospital in this situation from items of management? personal account of reasons of a disability. a case rate. temporary lost labor ability". *To keep the To discharge from The leaf of worker on a post office the worker disability. with the prevention with, i.e. to satisfy of dismissal in case demands of of repeated collective. violation of a labor discipline. medical card. A ambulatory medical card . medical. To shift a solution of this problem on other officials or public organizations. *To conduct To not accept any service activity. investigation by results of which to realize the administrative order according to the revealed circumstances. He should to inform the chief of medical service , and in case of acknowledgement of the facts inform the collective. To discharge from To notify the chief office the senior of medical service sister. about excess by him the official duties . To transmit the official report og chief of medical service to the chief of a reception department for acceptance of effective measures for elimination henceforth similar practice. 42. 25 unorganized children in the age 2 -3 year will be observed on a pediatric district it in the current year . What scheduled number of initial visitations will make to this group of children? 43. The child is 6 years old. For one year of observation he has URI duration 8 days. Physical worked out satisfactory. Define group of health: 44. The 9 years child with diagnosis “chronic tonsillitis” stands dispanserization control. For 1 year of observation there was one exacerbation of disease. Physical condition is satisfactory. The general state is not infringed. Define group of health: 45. The employee was invalid during 6 months in connection with fracture of a hip. Who has the right to authorize for issue a leaf of disability for the last 2 months? 46. The employee 6.03.2001 made abortion under medical signs and she was in a hospital till 17.03.2001. On what term the leaf of disability is issued to her? 47. The man of 38 years was admitted in the hospital from a place of job in July 19, concerning fracture of a hip. He was invalid till November 19. Requires prolongation of treatment. Who solves the *50. 20. 40. 100. 200. *I-st. II-d. III (a). III (b). III (c). *III (a). II-d. I-st. III (b). III (c). *MSEC. Head physician of the polyclinic. DCC. DCC together with Deputy a head the head physician physician on a of a polyclinic. working capacity. For 10 days. For 11 days. *For 12 days. For 3 days. For 4 days. *Specialized (trоumatologic) MSEC. DCC. The head physician of a polyclinic. Interdistrict general Regional MSEC. MSEC. problem on the further temporary invalidity? 48. What is the maximum duration the leaf of disability during tuberculosis? 49. The engineer - chemist in age of 47 years often and duratingly is sick of occupational disease of a skin. Who makes a decision to transfer him to other job accepts? 50. The patient with high temperature was addressed on a medical assistant's health center in the evening . The fact of temporary lost labour ability was fixed. Indicate the order of examination in this case? *2 months. *DCC. Week. A head physician. 2 weeks. The attending physician. Month. The chief of shop. 10 months MSEC. 51. They took the sample from 5 tons milk batch. In the lab analysis it was defined: fat content 2\%, specific density 1,04 g/cm3, acidity 21оТ, reductase probe – weak positive. What way is the product to be used in? Please advise. 52. The adolescent of 15 years old was *retinole deficit brought to the hospital with complaints on poor night vision. Objectively: increased darkness adaptation time, Bitot’s spots on conjuctiva. The patient skin is dry, scales *The reference on remission of job is issued in a night duty, which in the subsequent is used for issue of a medical sertificate by date of the previous day. *sell but inform customers about milk quality The leaf of The leaf of disability for 1 day disability about 3 is issued. days is issued. The leaf of What document is disability for 3 days not issued. is issued. write off for animal technical feeding utilization sell without limitations do product away Thiamine deficit Biotin deficit Folic acid deficit Napthtochynones deficit 53. 54. 55. 56. 57. off, folliculitis signs of the face skin are present. What is a cause of thedisease? The student has devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution The student has devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess meat quality The student has devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air radioactivity Patient with thyreotoxicisis 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 20оС, relative humidity 45\%, air movement velocity 0,3 m/s, light coefficient 1/5, noise level 30 dB. Do hygienic assessment of the conditions Mrs. Т., 33 years old works as the secretary. Her diet contains 150 g of protein (including 100 g of animal), 200 g of fat, 600 g of carbohydrates. What pathology can effect this diet? *Krotov’s apparatus Ebert’s counter Geiger’s counter Mischuk’s device Ebert’s device *Ebert’s device Ebert’s counter Geiger’s counter Mischuk’s device Krotov’s apparatus *Geiger’s counter Ebert’s counter Krotov’s apparatus Mischuk’s device Ebert’s device *discomfortable microclimate non-effective ventilation poor lighting high level of noise all conditions are OK *obesity schizophrenia paradontosis common cold uterine fibromyoma 58. A girl 9 years old, has an average height and harmonic growth development. She was ill with acute respiratory infection for five times. Define the group of her health. 59. 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 hazards is the principal one in these conditions? 60. Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got? А: 10-15 l В: 50-100 l +С: 160-200 l D: 300-400 l Е: 500 l 61. What guarantees from the preconceived attitude to the physician in cases of professional law violations do you know? *2nd group 1st group 3rd group 4th group 5th group *air pollution with improper anesthetic occupational microclimate high level of noise mental overfatigue compelled working pose *160-200 l 10-15 l 50-100 l 300-400 l 500 l 62. All enumerated included all kinds of forensic medical documents with the exemption of: * Sanction of public prosecutor, conduct an inquiry by preliminary investigator of prosecutor’s office, committee of experts * Structure Draw up a statement about forensic medical examination Conduct an inquiry Utilisation copy of by preliminary medical documents investigator of police department Conduct forensic medical examination by district forensic medicine expert Primary Addition, repeated Committee Complex 63. Patient M., 37 years old. He came to the clinic wounded after an hour.On the abdominal skin there is pain around umbilicus due to prick and cut wound of about 0,5 x 1 sm with slight bleeding. What help would you provide to the patient? 64. The patient K. is 23 years old. He has wounded left arm due to the gunfire. The bones of the arm are undamaged. What appropriate surgical help must be provided to such a patient? 65. If a chield has attached fingers in his right hand, then what will be your diagnosis? 66. Patient K., 34 years old. A dog bit him 3 hours before. In the left arm there is wound by the tooth of dog`s bitc without bleeding . What surgical help would you provide to such a patient? 67. Patient K., 37 years old complains of pain in the right arm, which increases during motion, increase body temperature upto 39° C. In the right cubital fossa there is a frace of injection, hyperemia and thickening along the vein. Your diagnosis? 68. What developes most often after accidental intake of Hydrochloric acid: 69. Purulent medisatinitis is diagnosed on a 63 year old patient. What of the below Laparotomy, suevey organs of abdominal cavity. Primary surgical processing of the wound. Primary surgical Processing with a flowing suction. Synductylia Drainage of the Survey the wound Aseptic bandage. wound with rubber with canal probe. strip. Suture the wound Suture wound. Suture wound and Dry wound with dry it. towel gauzes. Aseptic dressing of the wound. Polyductilia Macroductilia Cream bandage. Ectroductylia Ectromelia Wash wound with Aseptic bandage. detergent water and apply anti-septic. Phlebit Phlegmon Complete suture of Incomplete suture the wound. of the wound. Abscess Inflammation of lymph Arizipeloid * Cardiac insufficiency. * Cervical lymfadinitis. Cushing’s syndrome. Deep nech phlegmon. Kutling’s syndrome. Perforation of the cervical part of the Deylads's syndrome. Perforation of the thoracic the Acute pancreatitis. Iatrogenic injury of the trachea. listed diseases are not the cause of purulent mediasdtinitis? 70. The diagnosis of Right sided pnuemothorax is made to a 36 year old patient. What method of treatment is indicated to the patient? 71. The diagnosis – melanoma was made to a 16 year old patient after examination with complaints of frequent pain in the abdomen, pigmentation of the mucosa and skin, polyp in the stomach and large intestine was found. It is know that the mother of the patient analogous pigmentation and was treated often for anemia What disease is suspected? 72. What developes in cases with decompensated pyloric stenosis: 73. A 35 year old woman was admitted to thoracic surgery department with elevation of body temperature upto 40 0 C, onset of pain with deep breath in the side, cough with big quantity of purulent sputum and blood with bad smell. What disease causes these symptoms? 74. A 38 year old woman was hospitalized to the surgical unit with acute abdominal pain irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is easophagus. *Surgical treatment: Drainage of the pleural cavity. * Peytz – Egers’s polyposis. Antiinflammation therapy. Chron’s disease. Symptomatic therapy. easophagus. Pleural puncture. Thoracotomy. Tuberculosis of the Adolescent intestine. polyposis. Hirschprung’s disease. * Isotonic dehydration. * Abcsess of the lungs Hypertonic dehydration [eksikosis]. Complication of liver echinococcosis Hypotonic dehydration. Bronchectatic disease Intoxication. Actinomycosis of lungs Renal insufficiency. Tuberculosis of lungs * Acute pancreatitis Renal colic Acute enterocolitis Perforative gastric Acute appendicitis ulcer obtained. What disease is suspected? 75. Which of the listed below opertion are not done in cases of perforative duodenal ulcers ? 76. Classical X-ray image of intestinal obstrustion is: 77. Contraindications for operation in acute pancreatitis are: 78. A 41 year old 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? 79. At the patient of 34 years of age you suspect an abscess of Douglas spaces. What method of research is preferable to diagnostics: 80. What from the listed operations in treatment of ulcer of stomach and duodenum is carried out only under emergency indications? 81. With the restrained umbilateral hernia which has become complicated by phlegmon hernial, it is necessary to make *Gastrostomy *Gas and horizontal levels * Hemodynamic unstability and pancreatogenic shock * Introduction of obturator nasogastric tube. Resection of 2/3 3/4 of the stomach Vagotomy + Pyloroantrumecto my Filling defect High positioned diaphragm Functional Purulent and septic insufficiency of the complications parenchymatous organs Intravenous Hemostatic administration of therapy pituitrin Vagotomy + resection of the ulcer Reactive pleuritis Peritonitis Suturing of the ulcer Pneumatosis Erosive bleeding Operation Administration of plasma * Digital research of rectum * Sewing up perforative ulcer * Herniotomy by Meio-Sapegko Rectoromanoscopy Laparoscopy Percusion and auscultation of a stomach R-scopy of abdominal cavity Resection of Resection of Selective proximal Truncal vagotomy stomach by Bilrot I stomach by Bilrot vagotomy with pyloroplastic II Herniotomy by Meio Herniotomy by Sapegko Herniotomy by Lekser Herniotomy by Grenov for patient: 82. What treatment is shown for the patient of 63 years of age with an attack of bilious colic, caused by gall-bladder stones? 83. Choose correct tactics at the patient of 53 years of age at the initial stage of obturative intestinal obstruction 84. 52-year-old man have recurrent transient ischemic attacks. Auscultation of the carotid arteries detected murmur. What diagnostic method is necessary to apply the first? 85. On dispensary supervision at theraputist are the patients with diabetes mellitus, hypertonic disease, obesity. The cancer with what localizations in this group is necessary to expect with a high degree of risk? 86. For the persons who are taking place in a zone of failure on nuclear object, the greatest risk of development within the first decade is represented by cancer: 87. 40 year old a patient is diagnosed: 1. Medular thyroid gland cancer. 2. Feochromatcitoma. What operation should be made at first? 88. To the doctor 28 years old a woman has * Conservative treatment * Operative treatment at an inefficiency of conservative actions * Ultrasound dopplerography Emergency operation Only conservative treatment Urgent operation after cupping an attack Emergency operation Antifermental therapy Scheduled operation Laparoscopic cholecystotomy Nasogastral intubation CT of the brain MRI of the brain. Cerebral angiography Electroencephalogr aphy *Uterus body Gulet Liver External sexual organs Uterus neck * Thyroid gland Skin. Reproduction system organs Krail’s operation Breast Lungs * Operation concerning feochromatcitoma * Incision biopsy Operation on thyroid gland Yaks’s reaction Radioisotope Subtotal resection Vanach’s operation of thyroid gland and fascicular resection of limphatic nodes Termography Glass-print addressed with the complaints to increase of the size of pigment nevus which was available from birth, get wetting, itch. What method of research should not be applied to diagnostics in this case? 89. A boy 10 years old complains on pain of left eye and strong photophobia after trauma his left eye by a pencil at the school. Left eye examination : blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball – without changes. Visus 0,9. Right eye is health, Visus 1,0. What additional method do you choose first of all? 90. 27 years old woman complains on photophobia, watering and dimness of vision on right eye. During examination of this eye ciliary congestion and branch-like infiltration of the cornea, which stains with fluorescein, were observed. What eye-drops are contra-indicated ? 91. Within three weeks a patient had violation of nasal respiration, mucopurulent discharges from a nose, headache. At anterior rhinoscopy in middle nasal meathus the stria of pus, edema, hyperemia of the mucosa of the nose have been determined. What diagnostic method diagnostics *Staining test with X-rey examination 1\% fluorescein of orbit Tonometria Gonioscopia Cornea sensationtest * Dexamethazon 0,1\% Tropicamid 1\% Laevomicetin 0,25\% Glucosa 40 \% Acyclovir 3\% *X-ray of paranasal Computer sinuses tomography of a skull Bacteriology analysis of the nasal mucous Punction of the maxillar sinus General blood analises is necessary for assigning first of all? 92. The patient with an acute middle purulent otitis complicated by mastoiditis has been admitted to hospital. On roentgenogram of mastoid processes the shading of the cellular system on the lesion, absence of bone septs have been marked. What are medical actions in the second stage of mastoiditis? 93. A woman, 35 years old, admitted to reanimation department in asthmatic state. What is most trustworthy criterion of breath effectively? 94. Increasing of central venous pressure is marked on the base of decreasing arterial pressure during the dynamic investigation of it at victim with plural combined injuries. What is this combination evidence of? 95. What kind of injures is offen happened while carthquakes? 96. What kind of injures is often happened while explosions at mines [pits]? 97. The most available and informative diagnostic methods for closed trauma of the urinary bladder: 98. In order to differentiate diagnosis of anuria and ishuria you should accomplish: 99. All undermentioned is correct with respect *Mastoidotomy Paracentesis of the drum Radical operation on the middle ear Tympanoplasty Cateterization of the Eustachian tube * РаСО2 and РаО2 Respiratory volume Respiratory volume * Addition of cardiac insufficiency Blood deposition in Shunting venous channel Minute respiratory volume Hypervolemia Determination of “dead” space Growth of bleeding speed * Crash syndrome. C.F.T. [cranio-facial Fracture of upper trauma]. extremities. * Poisonind of CO Burns Fractures *Retrograde cystography Pelvic artheriography Cystography Fracture of lower extremities. C.F.T. [craniofacial trauma] Sonography of the urinary bladder Abdominal traumas Crash - sundrome Palpation and percussion of abdomen None of the above] *Catheterisation of Analysis of urine Analysis of the the urinary bladder blood *Postoperative Hematuria and colic Tumor is often Excretory urography Men are ailing more Treatment – to the tumors of renal pelvis and ureter besides: 100. Female-patient Z.,of 27 years old, was admitted to the clinic with complaints of pain in right ankle joint, non-bearable extremity. On the clinical examination: the patient had a fracture of anterior part of distal metaepiphisis of tibia [PottDesto`s fracture]. What is the mechanism of such an injury? 101. Patient K.,of 22 years old, was admitted to trauma center with complaints of pain in left ankle joint, which increased while movements and weight bearing. On the clinical examination it was found, that the patient had the closed fracture of medial malleolus without displacement. In which position the foot has to be fixed in plaster cast? 102. Female-patient K, of 45 years old, was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. In which position the foot has to be fixed with a plaster cast? 103. What wall of the inguinal canal is strngthenel in case of indirect inguinal hernia? radiation and take place multiple one chemotherapy improve survival * Supination of the Load along the axis Direct blow. foot. with planter flexion of foot. frequently Pronation of the foot. nephrurenerectomy [ with resection of the urinary bladder] Load along the axis with dorsal flexion of foot. * At right angle with varus positioning of the foot. In position of planter flexion of foot. In position of pronation In position of supination. In position of dorsal flexion of foot. * At right angle with varus positioning of the foot. *Anterior In position of planter flexion of foot. In position of pronation. In position of supination. In position of dorsal flexion of foot. Posterior Inferior Superior Posterior-inferior 104. Triangl Callot is orientation for exposure of: 105. The 10 years old child has complaints on fever [39?], frequent painful urination [pollakiuria]. Urinalysis: proteinuria [0,066 g/l], leukocytouria [entirely within eyeshot], bacteriuria [105 colony forming units/ml]. Which diagnosis is the most probable? 106. The 8 years old boy has suffered from angina. In 2 weeks he has complaints on migratory joint pain, joint oedema and restriction of movement, fever. After examination there was diagnosed acute rheumatic heart disease, activity of III-rd degree, primary rheumo-carditis, polyarthritis; acute course, cardio-vascular insufficiency IIA. Which of medicines should be prescribed? 107. The 10 years old boy suffered from angina 2 weeks ago has complaints on joint pain and impossibility of movement in left knee and right elbow. There was fever [38,50] and ankle dysfunction, enlargement of cardiac dullness on 2 cm, tachycardia, weakness of 1st sound, gallop rhythm, weak systolic murmur near apex. Which diagnosis corresponds to such symptoms? *Cystic artery *Acute pyelonephritis. Cystic duct Common bill duct Common hepatic duct Acute Dysmetabolic Acute cystitis glomerulonephritis nephropathy Hepatic artery Urolithiasis *Prednisone Cefazolin Delagil Diprazinum Erythromycin *Acute rheumatic heart disease Systemic lupus erythematosus Juvenile rheumatoid arthritis Reiter’s disease Reactive arthritis 108. The child is 1,5 years old. Symptoms: chronic cough with purulent sputum, dyspnea, retardation of physical development, large amount of stool. Sweat chloride 150 mEq/l. The child has been ill since 2nd month of age. Diagnosis: cystic fibrosis. Choose the best therapy. 109. The 10 years old boy has complaints on headache, weakness, fever [400С], 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 under palpation. Which disease lead to these symptoms and signs? 110. The patient with acute respiratory viral infection [3rd day of disease] has complaints on pain in lumbar region, nausea, dysuria, oliguria. Urinalysis – hematuria [100-200 RBC in eyeshot spot], specific gravity – 1002. The blood creatinin level is 0,18 mmol/l, potassium level - 6,4 mmol/l. Make the diagnosis. 111. The baby boy was born at term from 1st pregnancy. The jaundice was revealed at 2nd day of life, then it increased. The adynamia, vomiting and hepatomegaly *Enzymes + antibiotics Cholepoietic+adapt Н2-blockaders + ogenetic medicines hepatoprotectors Vitamins+antibiotic Vitamins + s mucolytics *Pneumonia croupousa Intestinal infection Acute appendicitis Acute cholecystitis Flu *Acute interstitial nephritis Acute renal failure Acute Acute cystitis glomerylonephritis Acute renal colic * Hemolytic Jaundice due to Hepatitis disease of newborn conjugation disorder [АВО incompatibility], Physiological jaundice Hemolytic disease of newborn [Rh incompatibility] 112. 113. 114. 115. were observed. 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 groupA[II], Rh+. Make the diagnosis. The 3 months old infant who is suffering from acute segmental pneumonia reveals dyspnea [respiration rate – 80 per minute], paradoxical breathing, tachicardia, total cyanosis. Respiration / pulse ratio is 1:2. The heart dullness under normal size. Such signs characterise: The 7 months old 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. 3 – year – old child has had fever, cough, coryza, conjunctivitis for 4 days. It took sulfadimethoxine. Today it has fever up to 39 C and maculopapular rash appears on its face. The rash is on normal background of the skin. What is your diagnosis? 2 – year – old girl has been ill for 3 days. Today she has low – grade fever, severe catarrhal signs, unabudant maculopapular rash on her buttocks and enlarged icteric type *Respiratory Respiratory failure failure of III degree of I degree Respiratory failure Myocarditis of I degree Congenital heart malformation *Ampiox+amicaci Macropen + n Penicillin Penicillin + Ampiox Gentamycin + Macropen Ampiox + polymixin * Measles Allergic rash Rubella Scarlet fever Pseudotuberculosis * Rubella Scarlet fever Measles Adenoviral infection Pseudotuberculosis 116. 117. 118. 119. occipital lymph nodes. What is your diagnosis? 3-year – old boy fell ill abruptly: fever up to 39 C, weakness, vomitng.Haemorrhagic rash of various size appear on his lower limbs in 5 hours.Meningococcemia with infective – toxic shock of 1 degree was diagnosed. What medications should be administered? 5 year old boy fell ill abruptly: fever up to 39,8 C, recurrent vomiting, severe headache. Convulsions occur in 3 hours. Physician found out positive meningeal sign. Pleocytosis of 2500 cells chiefly polymorphonuclear cells, elevated protein concentration and normal glucosa concentration was found in cerebrospinal fluid examination. What is your diagnosis? 7 –year – old girl has mild form of varicella. Headache, weakness, vertigo,tremor of her limbs, ataxia, then mental confusion occur on the 5th day of illness. Meningeal signs are negative. Cerebrospinal fluid examination is normal. How can you explain these sings? 7 year old girl fell ill abruptly: fever, headache, severe sore throat, vomiting. Minute bright red rash appear in her * Chloramphenicol Penicillin and succinate and prednisone prednisone Penicillin and immunoglobulin Chloramphenicol succinate and interferon Ampicillin and immunoglobulin * Purulent meningitis Serous meningitis Tuberculous meningitis Subarachnoidal hemorrhage Encephalitis *Encephalitis Meningitis Meningoencephalit Myelitis is Neurotoxic syndrome * Scarlet fever Measles Rubella Pseudotuberculosis Enteroviral infection 120. 121. 122. 123. 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? 8 year – old boy fell ill acutely: fever, weakness, headache, abdominal pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tenderness and hardened. What is your diagnosis? The 3 months old infant who is suffering from acute segmental pneumonia reveals dyspnea [respiration rate – 80 per minute], paradoxical breathing, tachicardia, total cyanosis. Respiration / pulse ratio is 1:2. The heart dullness under normal size. Such signs characterise: The 7 months old 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 14 year old patient. He complains of chest pain, temperature 38,5, * Dysentery Samonollosis Cholera Staphylococcal gastroenteritis Escherichiosis *Respiratory Respiratory failure failure of III degree of I degree Respiratory failure Myocarditis of I degree Congenital heart malformation *Ampiox+amicaci Macropen + n Penicillin Penicillin + Ampiox Gentamycin + Macropen Ampiox + polymixin *Rheumatic pancarditis Rheumatic pericarditis Rheumatic myocarditis Rheumatic endocarditis Septic endocarditis breathlessness. He had acute tonsillitis2 weeks ago. He is in a bad state. The skin is pale. Heart borders are widened, the tones are weakened. Above all heart area you can hear pericardium friction sound. Electrocardiogramm: the descent of voltage QRS, the inversion T. The liver is 3 sm enlarged. ESR – 4mm/h, ASL – 0 – 1260, C-reaction protein +++. Your diagnosis: 124. The child has complains of the «night» and «hungry» abdominal pains. At fibroscopy in area a bulbus ofa duodenum the ulcerrative defect a dia of 4 mms is found, the floor is obtected with a fibrin, [H.p +]. Administer the optimum schemes of treatment: 125. The child was born from 5th pregnancy and 1st delivery. Mother’s blood group A[II] Rh-, newborn’s -A[II] Rh+. The level of indirect bilirubin in umbilical blood was 58 mcmol/l, hemoglobin - 140 g/l, RBC-3,8 T/l. The level of indirect bilirubin in 2 hours was 82 mcmol/l. The hemolytic disease of newborn [ictericanemic type, Rh-incompatibility] was diagnosed. Choose the therapeutic tactics. 126. Mother with infant visited the pediatrician for expertise advice. Her baby was born *De-nol – Trichopolum – Claritromicin. De-nol Maalox-ranitidin Vicalinum-ranitidin Trichopolum *Replacement blood transfusion ( conservative therapy Conservative therapy Blood transfusion ( Symptomatic conservative therapy therapy Antibiotics *8 10 12 20 6 127. 128. 129. 130. 131. 132. with body mass 3,2 kg and of length 50 cm. He is 1 year old now. How many teeth the baby should has? Mother visited the pediatric for expertise advice. Her son was born with body's mass 3 kgs and length 48 cm. He's 1 year old now. What is the required normal mass ? 6 months infant was born with body's mass 3 kg and length 50 cm. He is given natural feeding. How many times per day the infant should be fed? Infant is 6.5 months now and is given natural feeding since birth. Body mass was 3.5 kg, with length 52 cm at birth. Now many times per day the supplement [up feeding] should be given? A 2 months old healthy infant with good appetite, is given artificial feeding since 1–st month. When is it advised to start the corrective feeding [fruit juice]? Infant was born with body mass 3 kg and of length 50 cm. Now he is 3 years old. His brother is 7 years, suffers from rheumatic fever. Mother requested the doctor for a cardiac check up for the 3 years old son. Where is the left relative heart border located? A 7-year-old girl suffers from bronchial *10,5 kg 9,0 kg 11,0 kg 12,0 kg 15,0 kg *5 7 6 8 4 *2 3 1 0 4 *4,0 months 1,5 months 2,0 months 3,0 months 1,0 months *1 cm left from the 1 cm right from the Along the left left left medioclavicular medioclavicular medioclavicular line line line 1 cm left from he 1 cm right from the left parasternal line left parasternal line *Both types of Fine budding rales Sebelent dry rales Coarse bubling Crepitation rales 133. 134. 135. 136. 137. 138. asthma. In spring, usually she has a bronchial attack. What was the conclusion after auscultation of the lungs? Boy, 7 year old, had an attack of asphyxia and distant whistling rale after playing with a dog. In the anamnesis: atopic dermatitis caused by eating eggs, chicken, beef. What group of allergins is the reason of the development of bronchial astma attacks? A 14 year old boy has rheumatism. During 2 years he has transfered 3 rheumatic attacks. What course of rheumatism does the patient have? The patient with aquired heart failure has diastolic pressure 0 mm Hg. What heart failure does the child have? Child [12 years old] has the ulcer disease of stomach. What is the etiology of this disease? A nine year old child is in hospital with acute glomerulonephritis. Clinical and laboratory show the acute condition. What food is not limited during the acute period of glomerulonephritis? An 18 month child, taken to hospital on the 4-th day of the disease. The disease began acutely with temperature 39, weakness, cough, breathlessness. He is rales *Epidermal Dust Pollen rales Itch mite Chemical *Prolonged Acute Subacute Latent PersistentReccurent *Aortal stenosis Helicobacter pylory *Carbohydrates Mitral stenosis *Intestinal bacillus Salt Aortal insufficiency Salmonella Liquid Mitral insufficiency Rheumatism Lambliosis Proteins Influenza Fats *Segmentary pneumonia Grippe Bronchitis Bronchiolitis Interstitial pneumonia 139. 140. 141. 142. pale has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right under scapula area. X-ray picture: unhomogenius segment infiltration 8-10 in the right, the increase of vascular picture, unstructural rools. Your diagnosis: 9 year old patient. She has fitlike abdominal pains after fried food. No fever. She has the pain in point Cera. The liver is not enlarged. Portion B [duodenal probe] 5 ml. Your diagnosis: A growth of the right side of the scrotum was found at the examination of a 3month-old child. This formation has elastic consistency, its size decreases in sleep and increases when the child is crying. What investigation will be helpful for make a correct diagnosis? A rounded shadow with well defined outlines was found at the costo-vertebral angle on the chest X-ray roentgenogram of the otherwise healthy 9-year-old girl . Make a preliminary diagnosis. A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby has a large cefalohematoma. The results of blood count are: Hb 120g\l, Er *Biliary tracts dyskinesia, hypotonic type. * palpation of the thickened cord, crossing the pubical tubercule [ sign of the silk glove]; Hepatocirrhosis Acute colitis Chronic duodenum Ulcer disease diaphanoscоpy palpation of the external inguinal ring punction of the scrotum examination of the formation in Trendelenburg’s position * Ganglionevroma Sympatoblastoma Ganglioneuroblast Sympatogonioma. oma. Sarcoma of the vertebra . *erythrocytes hemolisis intravascular hemolisis disturbance of the condensing of bile conjugative function of the hepar mechanical obstruction of the bile fall. 143. 144. 145. 146. 147. 3,5T\l, total serum bilirubin 123mmol\l, direct -11mmol\l, indirect - 112mmol\l. What are causes of hyperbilirubinemya in this case? A 4-month-old girl with blond hair and blue eyes has “mousy” odor of sweat and urine, delayed psychomotoric development. Mostly typical laboratory data for this disorder is A newborn girl has congenital lymphedema of the hands and feet, short neck with loose skin, antimongoloid slant of palpebral fissures, epicanthal folds. In epithelial cells of buccal scrape Xchromatin [Barr body] is absent. Diagnosis is A 52-year-old patient with previously functional Class П 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? An ECG of postinfartional [a year ago] patient shows pathological QS waves in leads VI-V3, I, aVL. Determine the location of old myocardial infarction. A 52-year-old patient has hypervolaemic type of essential hypertension. Which of *Positive urine High level of High level of High concentration Low level of ferric chloride test oxyproline in urine glycosaminoglyca of chlorides in thyroid gland nes in urine sweat hormones in blood *ShereshevskyTurner syndrome Klinefelter syndrome Down syndrome Edwards syndrome Patau syndrome * IHD. Unstable angina Cardialgia due to spine problem IHD. Functional Class П angina. Myocarditis Myocardial dystrophy * Septal and anterior * Hypothiazid Anterolateral Anterior Inferior Postrolateral Dibazol Clophelin Kapoten Nifedipin 148. 149. 150. 151. the following is necessary to prescribe either as monotherapy, or in a complex with other antihypertensive remedies? A 62-year-old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Pulse – 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure [CHF]? A patient, aged 49, complains of fever of 37,5 0С, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the aortic area; opening snap, presystolic murmur are auscultated. What is the most useful investigation for valvular disorder assessment? Physical examination of a person with chronic bronchitis reveals expansion of intercostal spaces, hyperresonant percussion note, decreased whispered voice sounds. Chest x-ray shows hyperinflated lungs, low and flattened diaphragm. Which of the signs is helpful in diagnosing lung emphysema? A patient with nosocomial pneumonia presents signs of collapse. Which of the following pneumonia complications is * CHF-2 B CHF- 1 CHF- 2 А CHF-0 CHF-3 * Phonocardiography Ballistocardiogram Chest x-ray Echocardiography+ DopplerEchocardiography ECG * All of them Low diaphragm Hyperresonant percussion note Hyperinflated lungs Expansion of intercostal spaces * Septic shock Exudative pleuritis Bronchial obstruction Toxic hepatitis Emphysema 152. 153. 154. 155. most likely to be accompanied with collapse? A 38-year-old patient has been treated in a hospital. A fever of 39 C, chest pain which is worsened by breathing, cough, brownish sputum appeared on the 7th 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 patient, aged 48, complains of heaviness in the right hypochondrium, itching of the skin. Repeatedly he had been treated in infectious diseases hospital due to icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall veins, protruded navel, spleen enlargement. Diagnosis is: A 27-year-old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is: A man, aged 25, presents with facial edema, moderate back pains, body temperature of 37,5 С, BP 180/100 mmHg, hematuria [ up to 100 in v/f], proteinuria [2,0 g/L], hyaline casts - 10 in v/f., specific gravity -1020. The onset of the disease is probably connected with * Cephalosporins of the Ш generation Penicillin Erythromycin Tetracycline Streptomycin * Liver cirrhosis Cancer of the liver Cancer of the head Gallstones of pancreas Viral hepatitis B * Gastritis of type B Gastritis of A type Reflux - gastritis Menetrier's gastritis Rigid antral gastritis * Acute Acute glomerulonephritis pyelonephritis Cancer of the kidney Urolithiasis Chronic glomerulonephritis 156. 157. 158. 159. acute tonsillitis 2 weeks ago. The most likely diagnosis is: A patient had stomach resection a year ago. He complains of general weakness, giddiness. Blood count: Er 2,6 g/L, Hb 80 g/L, C.ind 0.7, L – 3.7 g/L, reticulocytes 1\%, segm 56\%, lymp 34\%, mon. 6\%, ESR 17 mm/hour. Erythrocytes are hypochromic; there are anisocytosis & poikilo-cytosis. Fe of serum 5 mkmol/L. Diagnosis is: A patient of 62 years with DM-2. Diabetes is being compensated by diet and Maninilum. Pаtient has to undergo an operation for inguinal hernia. What should be tactics of hypoglycemic therapy? A 33-year-old lady has been suffering from DM for 5 years. The last 3 years she has taken 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 patient of 32 complains of severe weakness, tremor of extremities. Objective examination: body weight loss, wet & warm skin. The thyroid gland is enlarged * Iron-deficiency anemia B12-deficiency anemia Сhronic myeloleukosis Aplastic anemia Chronic lymphoid leukosis * Prescribe the Give Glurenorm in To continue with Prescribe the drugs Prescribe guanyl drugs of an insulin place of Maninilum. the current therapy of insulin of long guanidines of short activity activity * DM 1st type, severe form, decompensation, insulin resistant DM 2nd type, severe form, decompensation DM 1st type, severe form, subcompensation, Somoji phenomenon DM 2nd type, moderate form, Zabrodi phenomenon DM 1st type, severe form, decompensation, allergic response on insulin * Diffuse toxic goiter of the 3rd degree, thyrotoxicosis of Diffuse euthyroid goiter of the 3rd degree. Chronic autoimmune thyroiditis, hypertrophic type Chronic fibrous thyroiditis Toxiferous adenoma of the thyroid gland up to the 3rd degree, painless, elastic. Pulse: 108. BP- 160\55 mmHg. Everything else is normal. The diagnosis is: 160. In the development of the inflammation processes glucocorticoids reduce the level of a certain most important active enzyme. It results also in the reducing of the synthesis of prostaglandins and leukotrienes which has a key-role in the development of the inflammation processes. Give the exact term of this enzyme. 161. А patient is suffering of a chronic heart insufficiency [degree II; phase A]. The patient has been given a proper therapeutic treatment along with furosemide. Later the patient developed a lumbosacral nerve root syndrom. To reduce the acute pains the doctor prescribed a certain agents, which lowered the effect of furosemide. Give the name of this medicine. 162. Which of the following is used for tuberculin diagnosis in the masses the average degree * Phospholipase A2 Arachidonic acid Lipoxygenasе Cyclooxygenase – 1 Cyclooxygenase – 2 * Indomethacin Digoxin Furosemide Panangin Riboxinum PPD-L standard dilution of 2 TU in 0,1 ml 163. Vaccination of BCG should be conducted 5 days on: 164. In a male aged 25 focal shadowings of Focal small and medium intensity with unequal ATK tuberculin 3 months Disseminated PPD-L diluted in 5 TU in 0,1 ml 10 days Miliary Dry pure tuberculin Tuberculin in the form of ungutum 12 months Fibro-cavernous 5 years Tuberculoma 165. 166. 167. 168. 169. contours in the 1st and 2nd segments of the right lung were revealed during prophylactic photoroentgenography investigation. Which clinical form can be suspected in this patient? Neonate of 5 days. What vaccination dose of BCG vaccine [in мg] is necessary for vaccination of this child? A 39-year-old woman applied to a doctor with the complaints of monomorphous eruption on the skin of the trunk and mouth mucosa. Pemphigus vulgaris has been diagnosed on the base of the clinical picture. What cytological test verifies the diagnosis? A 32-year-old man 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’s sign].What investigation should be carried out first of all? A triad of symptoms [“stearing spot”, “terminal film”, “blood dew”] have been revealed in a patient. What disease should yoe think about? A woman 26 years old has abused alcohol for 7 years. She has psychological 0.05 мg *Cytodiagnosis after Tzanck 0.025 мg Test for LE-cells 0.075 мg 0.1 мg 0.2 мg Detection of eosinophiles in the contents of the bullae Detection of Detection of Lanhgerhans’ giant Meisner’s cells corpuscles *Wasserman test, IFT T. pallidum Detection of the Consultation of Immobilization Test nasal mucouse for neuropathist [TPI] Micobacterium Leprae Hansen CBC *Psoriasis Lichen ruber planus Vasculitis Seborrhea Ritter’s disease * Treatment of Medical abortion alcoholism and full Decrease of alcohol use Participation in the Gyneacological A-ANON group observation dependence on alcohol, but no withdrawal syndrome. Drinks almost every day approximately 50 – 100 gr. of wine. Is at her 4-th week of pregnancy. Primary prevention of fetal alcohol syndrome requires: 170. Patient N., 27 years old 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: 171. Patient K, male, 19 years old, has suffered moderate mental retardation since childhood. Is illiterate, can take care of himself, do simple household work and other kinds of easy work under supervision. His rehabilitation [tertiary prevention] requires: 172. Patient F., male, 16 years old was behind other children in development since early childhood and still has moderate mental retardation. He is short, has dismorphic body, his face is round, flattened, his eyes abstinance from alcohol during all the period of pregnancy * Supportive treatment with neuroleptics of prolonged action Long-term hospitalization Psychiatric observation Participation in a self-help group Psychoanalytic treatment * All the above mentioned Supervision of a social worker Physical work Supervision of under supervision relations [ if any] None of the above mentioned * Chromosome abnormality Gene abnormality Maternal alcohol abuse during pregnancy Pathological delivery Infection in mother during pregnancy are narrow and slanted, and there are epicantial folds in the corners of his eyes. There is only one transversal flexor line on his palms. What is the probable etiology of this state? 173. Patient A., male, 27 years old came to consult a psychiatrist with the following complaints: after a bad car accident, the victim of which he was and in which his wife was killed, he suffered depression, anxiety, flash-backs of the event, sleep disorders and nightmares about the accident. He also had emotional numbness and fatigue. The cause of the disorder was: 174. A female patient 28 years old, became depressed, her mood is melancholic; this state is associated with hypobulia, hypokinesia, slow speed of thinking. Her attitude towards her past present and future is pessimistic. The pathogenetic mechanism of this state is supposed to involve dysfunction in the: 175. A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand. This state lasted for a few seconds. After that the patent was rather confused, for some moments he couldn’t understand what was happening. * Severe stress Adjustment disorder Environmental factors Patient’s Endogenic factors personality features * Hypothalamus Frontal lobes Pituitary Hippocampus Corpus callosum * Petit mal, epilepsy Grand mal, epilepsy Jacksonian fit, epilepsy Disphoria, epilepsy Twilight state, epilepsy He totally forgot the state he was in and the events around him, occurring while he was in that state. Name the disorder: 176. The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stays in strange postures. It is possible to set [form] her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder: 177. Patient T., female, 35 years old, suffers from epileptic fits since she was 15 years old. She has seizures during which she loses consciousness, falls down and has tonic and clonic convulsions. The fits occur once a week. What are the main principles of treetment in epilepsy? 178. What auscultative data are watched in bronchoectatic disease? * Catatonic stupor, Depressive stupor, shizophrenia bipolar disorder Apathetic stupor, shizophrenia Psychogenic stupor, Dissociative stupor, stress disorder dissociative psychosis * All the above mentioned Individual approach Gradual beginning Continuous longterm treatment None of the above mentioned * The clinical picture depends on full or empty bronchiectasia and on caliber of bronchus. 179. What from enumerated syndromes is main * Syndrome of in acute diffuse bronchitis ? muco-ciliary insufficiency. Bronchial breathing. Amphoric breathing. Dry whistling rales. Moist fine bubbling rales [nonconsonating]. Syndrome of bronchial obstruction. Syndrome of respiratory insufficiency. Syndrome of pulmonary tissues insufficiency. Syndrome of pulmonary tissues augmented 180. The primary bronchopneumonia more often arises as … * Complication of acute bronchitis. Complication of pneumorrhagia. Crepitation. 181. What auscultative data of the lungs does in * Bronchial lobar pneumonia exist at stage of breathing. hepatization ? 182. What is the basic of crepitation ? * The separation of alveoli during inspiration on walls of which the fibrin has put. 183. Sputum “full mouth” [is more often in * Bronchoectatic morning time] is characteristic for: disease. 184. What is auscultated in syndrome of * Pathological infiltration of pulmonary tissue ? bronchial breathing. 185. When can pulmonary bleeding arise ? 186. What auscultative phenomenon arises at beginning of acute bronchitis ? 187. Symptoms of the effected pallidar system do not include? 188. What of the mentioned symptoms isn't characteristic of poliomyelitis? 189. Name the symptom of stretching of the ishiatic nerve? * Bronchoectatic disease. * Harsh. *Hemibalism *Disturbance of sensitiveness *Lasseg's Complication of stagnation of blood in the lungs. Moist consonating rales. aerisation. Complication of Complication of infarct of the lungs. pneumoconiosis. Moist nonconsonating rales. Increased vesicular breathing. Friction of the inflamed pleural layers during respiration. Empyema of pleura. Amphoric breathing. Bronchopneumonia . Vesiculo-bronchial breathing. Micrografy Torpid distal paralysis Vasserman's Existence of Existence of a Stenosis of a clear bronchiectasis filled cavern containing space of bronchus. by pus. liquid and air. Pulmonary Focal pneumonia. tuberculosis. Intensified vesicular Decreased breathing. vesicular breathing, dry rales. Diffuse catarrhal Bronchiolitis. bronchitis. Moist fine bubbling Crepitation. rales. Plastic hypertension Bradikinesia Hypotension Lessage's Hyporeflexia Brudzinsky's Acute bronchitis. Harsh. Lobar pneumonia in a stage of red hepatization. Moist medium bubbling rales. Hipomimia Hypotrophy Kernig's 190. Name the nuclei of the cranial nerves which are affected Weber's alternating syndrome? 191. Neuralgia of the trigeminal nerve is characterized by? *Oculomotor Accessory Glossopharyngeal Vagus Loss of sensitivity Trophical on the face disturbances of cornea and loss of corneal reflex Hypoglossal Positives effect from sponging by 5\% solution of cocaine on the posterior surface of the mucosa of the middle turbinate bone Affection of mimic muscles of half of the face Leaden intoxication *Transient pain on Permanent pain in the face and trigger the area of areas innervation 192. Central paresis of the mimic muscles is characterized by: * Affection of mimic muscles of the lower half of the face? 193. The patient H., aged 36,works as a * An acute nightman during 12 years.He applied with intoxication complaints of the headache, loss of appetite, syncopal conditions, metallic taste in the mouth, sometimes stomachache, dispeptical frustration, diarrhea and constipation. Objective: fragility of nails, hyperkeratosis of palms. Diagnosis? 194. A diagnosis of chronic arsenious * Haemolytic intoxication was defined in a patient Y., a anemia nightman. What form of anemia is characteristic in this disease? 195. The man, aged 42, applied to the * Silicosis Affection of masticatory group of muscles Chronic arsenious intoxication from pesticides Prolapse of papillary reflex Trophic disorders An acute Carbone bisulfide poisoning by OPS intoxication Aplastic anemia Iron deficiency anemia Silicatosis Hyper sideric anemia Bronchiectatic Normochromic anemia Chronic bronchitis Tuberculosis of 196. 197. 198. 199. therapeutist with complaints of pricking pains in scapulas area, dyspnea on physical exertion, cough with discharge of small amount of sputum. During 10 years he works in coal mining. On percussionbox-note sound in the lower parts, on auscultation- a harsh breathing. There were no changes in the heart. Possible diagnosis? A sick man M., aged 52, a street cleaner. He was ill with pneumoconiosis during 2 years. It’s nessesary to recommened for the treatment of this disease: The woman, aged 42, 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 man,aged 37,working on the collective farm on sowing,was admitted to the infectious hospital with the clinical symptoms: miosis,labored breathing,sweating.What kind of poisoning is it and what is the first aid? A 4-year old child attends the lungs disease * Alkaline inhalations *Unithiol Broncholitics Oil inhalations Sulfonilamides Antibiotics Pentoxil Magnesium sulphate Sodium hydrate of carbon Seduxen *Poisoning by POC. Treatment: atropine Poisoning by lead. Poisoning by the Poisoning by Seduxen Treatment: tetacine methylic alcohol. vapours of mercury. Calcii Treatment: ethylic Treatment:unithiol alcohol Lymphoprolipherati Hypoplastic Duodenal ulcer Atrophic gastritis *Worm invasion 200. 201. 202. 203. kindergarten. Complaints of the bad appetite, fatigue. Objective examination: skin and mucous membrane are pale, child is asthenic. In the hemogram: hypochromatic anemia 1st., leucomoide reaction, of the eosinophile type. What pathology must be excluded at first? A woman of 36 years is on the 12-th week of the first pregnancy. We know from the history that she was treated for infertility. She was in the guests and contacted with child who developed rubella in 2 days after meeting. Woman doesn’t know if she has ever been infected with rubella. What is the adequate tactics? Patient L., 50-year old, has been admitted to the clinics with atrophic gastritis. In the blood test: erythrocytes 3.8 T/L, Hb 68 g/l, c.i. 1, macroanisocytosis, poikilocytosis. There is a megaloblastic type of haemopoesis. A number of leukocytes, reticulocytes and thrombocytes is lowed. Which pathology is suspected?i A 32-year old woman developed the Laiel’s syndrome after taking the biceptol. What immunotrope remedies are indicated in this situation? The disease began acutely. The frequent watery stool developed 6 hours ago. The ve process anemia *Monitory of the Interruption of the specific Ig G Ig M pregnancy with the ELISA Immune globulin injection Cyclovin administration Interferon administration *B-12-deficiency anemia Irondeficiency anemia Hemolytic anemia Post-hemoragic anemia Thalassaemia *Steroid Non-specific Specific immune immunodepressants immune modulators modulators *Cholera Toxic food-borne infection Salmonellosis Interferons Non-steroid immunedepressants Typhoid fever Dysentery body’s 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? 204. The patient 25-years-old was admitted on *Botulism the 1st day of the disease with complaints of double vision in the eyes, difficult respiration. 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? 205. The patient Н., of 28 years old, was *Typhoid fever. admitted to the clinic with complaints of the temperature increase up to 39,0(С, headache, weakness, constipation on the 9th day of the disease. On examination: single roseolas are on skin of the abdomen. The pulse rate is 78 per minute. The liver is enlarged by 2 cm. What is the probable diagnosis? 206. The patient was admitted to the hospital *Leptospirosis on the 7th day of the disease with complaints of high temperature, headache, pain in the muscles, especially in calf muscles. The dermal integuments and Yersiniosis Leptospirosis Salmonellosis, gastrointestinal form Lambliasis Leptospirosis. Brucellosis. Sepsis. Malaria. Yersiniosis Salmonellosis Brucellosis Trichinellosis scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient went fishing two weeks ago. What is the diagnosis? 207. The patient has been in the hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice was intensified on the 14th day of the disease. The liver diminished in sizes. Due to what complication of viral hepatitis, has the patient’s condition worsened? 208. The patient, 18-years-old was admitted to the hospital with complaints of headache, weakness, high temperature, pain in the throat. Objectively: enlargement of all groups of lymphatic nodules was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In the blood - leukocytosis, atypical lymphocytes - 15\%. What is the probable diagnosis? 209. The patient 28-years-old was hospitalized with preliminary diagnosis "influenza". Roseolous-petechial rash appeared on the 5th days of disease on the trunk. The temperature is 41(С. Hyperemia of the face, reddening of scleras, tremor of the tongue, tachycardia, splenomegaly are *Hepatic encephlopathy Meningitis Relapse of viral hepatitis Cholangitis Infectious-toxic shock *Infectious mononucleosis. Acute lymphoid leukosis. Diphtheria. Angina. Adenoviral infection. *Epidemic typhus Measles Alcohol delirium Leptospirosis Typhoid fever marked. What is the most probable diagnosis ? 210. The patient, 43-years-old 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 ? 211. In the patient of 21 years old the disease began with increase of temperature to 39,0(С, headache, chill, repeated vomiting. Rigidity of occipital muscles is determined. The analysis of liquor: cytosis - 1237 in 1ml, of them: 84 \% of neutrophils, 16 \% of lymphocytes. On bacterioscopy gram-negative cocci, are found in liquor. What is the most probable disease? 212. The theory of self regulation of epidemiological process by V.D. Belyakov includes all mentioned bellow except *Anthrax Carcinoma of skin Erysipelas Erysipeloid Eczema *Meningococcal Meningococcal infection: purulent infection: serous meningitis. meningitis Secondary purulent meningitis. Serous meningitis. Infectious mononucleosis. 213. The diagnosis of the AIDS epidemic * Localization of the parasite in the host organism and the ways of discharging of the parasite into the environment * The Geno- and phenotypic heterogeneity of the populations of a parasite and host Mutability of the biological properties of the parasite and the host populations The phase selfreorganisation of the parasite populations and a host The viroscopic The bacteriological The virological The regulation role of social and natural conditions in the phase reorganization of the epidemiological process The serological initially was made in the USA by means of 214. The contagious hypothesis by D. Frocastro and D. Samoylovich being considered as a causative agent of infectious diseases 215. A 70yr. Old alcoholic male with poor Vancomycin dental hygiene is to have his remaining teeth extracted for subsequent dentures.He has mitral valve stenosis with mild cardiac insuffiency and is being treated with сaptopril,digoxin and furosemide.The dentist decides that his medical history warrants prophylactic antibiotic therapy prior to the procedure and prescribes: 216. A 20 yr old woman with a 3-4 month *Ulcerative colitis Gastroenteritis history of bloody diarrhoea; stool examination negative for ova and parasites;stool cultures negative for clostridium,campylobacter and yersinia;normal small bowel series;oedema,hyperemia and ulceration of the rectum and sigmoid colon seen on sigmoidoscopic examination.Select the most likely Diagnosis: 217. A patient treated for springtime allergies *Erythromycin Ampicillin with terefenadine develops an upper respiratory tract problem.He receives an epidemiological method * The alive germs, which are transmitted from one person to another *Amoxycillin method The environmental factors method The miasma of cosmotelluric origin Tetracycline method The pathological discharges of an organism Co-trimoxazole method Invasion of the body by the evil spirits Imipenem Carcinoid syndrome Zollinger-Ellison syndrome Granulomatous colitis Cefactor Doxycycline Co-trimoxazole 218. 219. 220. 221. antibiotic and develops a cardiac arrhythmia.What was the likely antibiotic? A 75yr. Old man who had developed diabetes within the last six months was found to be jaundiced.He was asymptomatic except for weight loss of 10 pounds in 6 months.On physical examination he is found to have a nontender, globular, right upper quadrant mass that moves with respiration. A CT scan shows enlargement of the head of the pancreas,with no filling defects in the liver. Most likely diagnosis: A 16yr. Old 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: A 60yr. Old 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 160/100mmHg, and a slight enlarged prostate. Which of the following medications would be useful in treating both of these conditions: A 36yr. Old alcoholic patient has cirrhosis and pancreatic insufficiency due to recurrent pancreatitis. He complaints of *Carcinoma of the Infectious hepatitis Haemolytic head of the jaundice pancreas Malignant biliary stricture Metastatic disease of liver *Henoch Schonlein Haemolytic uraemic Thrombotic Heavy metal purpura syndrome thrombocytopenic poisoning purpura *Doxazosin Labetalol Phetolamine Propranolol Sub acute bacterial endocarditis Isoproterenol *Zinc Copper Selenium Chromium Manganese 222. 223. 224. 225. nightblindness, decreased ability to taste food, and dry skin with hyperpigmentation. These complaints suggest deficiency of: A 47 year old man presents to his physician with progressive abdominal swelling.On examination he is found to have ascites and a tender,enlarged liver.If the patient describes a chronic course associated with wasting and low grade fever,the diffrential diagnosis should include everything EXCEPT: A 60yr. Old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes: A 42yr. Old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalised for agitation and bizarre behaviour. Examination reveals asterixes on the hands, ankle clonus, and spider angiomas on the face and chest.Blood ammonia level is twice its baseline.Precipitating factors to look for include all of the following EXCEPT: A 45yr. Old man is admitted with his 3rd episode of upper gastrointestinal *Chronic Pancreatitis Tuberculosis Cirrhosis with hepatocellular carcinoma Hepatitis Alcoholic liver disease with cirrhosis *Coronary artery bypass grafting Intravenous strptokinase Excercise testing Oral aspirin Antihypertensive therapy *Insufficient protien ingestion Bleeding esophageal Excessive diuretic Non compliance therapy with lactulose therapy Spontaneous bacterial peritonitis *Supression of A fasting gastrin hypergastrinaemia level of 450pg/ml. Post operative notes detailling Liver metastasis on A history of CT scan diarrhoea haemorrhage. He had 2 prior ulcer operation. Zollinger-Ellison syndrome is suspected. All the following would support your suspicions EXCEPT: 226. A 60yr. Old woman, mother of 6 children, developed sudden onset of upper abdominal pain radiating to the back, associated with nausea, vomitting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temp.of 38.9C, along with right upper quadrant tenderness.Most likely Diagnosis: 227. A 30yr. Old man presents with a history of recurrent pneumonias and a chronic cough production of foul smelling, pirulentsputum, ocassionally glood tinged,which is worse in the morning and on lying down.on physical examination, the patient appears chronically ill with clubbing of fingers, wet inspiratory reils at the base of lungs posteriorly. Most likely diagnosis: 228. The 30-years old patient with the complications on a headache in a nucha ,poor dream with nightmares has addressed to policlinic. A BP was 150/95 Hg.An item. A boundary arterial by secretin given IV *Choledocholithias Benign biliary is stricture ulcers in the duodenum and jejunum Malibnant biliary stricture Carcinoma of the head of the pancreas Choledochal cyst *Bronchoectasis Chronic bronchitis Disseminated pulmonary tuberculosis Pulmonary neoplasm Chronic obstructive emphysema * In the second In a first In a fourth In a third In a fifth 229. 230. 231. 232. 233. 234. hypertension was diagnosed. In what dispensary group he mast be addresseed for supervision on an arterial hypertension? 3.In the young patient at the reference to policlinic there was diagnosed the 1 stage of hypertension. How many times during the year it is necessary to examine him? 11 Patient K.,52 years old, has sustained an acute myocardial infarction 2.01.2001. State of health is satisfactory.After what time according to the instruction he can be send on sanatorium treatment to specialized sanatorium? 16 The family doctor diagnosed in a patient an acute bleeding of an intestine. What is professional tactics of the doctor in this situation? In the structure of death rate in Ukraine the major place is taken by the diseases of? 68 The doctor of the city cardiological center solves the problem of the patient after the discharge from a hospital to the balneal department of sanatorium:who cannot be routed? Woman age 40,ill on rheumatic disease with composite mitral disease with prevalence of the stenosis of left venous * Twice. Once. 3 times. 4 times. 5 times. * 1.07.2001. 1.03.2001. 1.04.2001. 1.05.2001. 1.06.2001. *The urgent hospitalisation in sergical departmewnt. *Diseases of cirkulatory sistem. To inject The urgent A day time hospital. A hospital at home. intravenously the hospitalization in aminocapronic acid. therapeutic department. Oncological Disease of Disease of Disease of urinary disease. digesstive sysstem. respiratory system. and endocrine systems. *200/110-240/120 140/90-160/100 90/60-120/80 160/90-180/90 180/110-90/60 *Mitral comissurotomia. Conduction of current bicilinoprophilaxis. Assiging of anticoagulants. Assiging of venous vasodilatators . foramen.Complainse on the palpitation,fatigability progressing dyspnea,attacks of a dyspnea and hemoptysis.Now she can not execute even the mild activities.What tactics is the most expedient? 235. The man,42 years old, has died in a road accident after the hemorrhage on the place ,due to acute hemorrhagic anemia. What minimum percent of all volume of blood could result in death at acute hemorrhage? 236. In the woman of 42 years ,who suffers from bronchial asthma ,the acute attack of a bronchial asthma has developed. What medication from listed below is contraindicated at granting the first aid to this woman? 237. Patient K., laboratory-assistantradiograph; the amount of Gammaradiation per day is 0,65 R. Two years later with 60 Co while examining irritability, head aches, poor appetite have developed. Blood count is normal. While examining 6 years later after cessation of any contact with ionizing radiation she complained of severe head - aches, dizziness, cardiac pains, undue fatigability, weakness; instability of periphery blood indices [especially white] *25-30\%. 6-9\%. 10-14\%. 15-20\%. 35-50\%. * Euphylinum Izardin. Corazolum. Morphinum hydrochloride.. Strophanthin hydrochloride . * Chronic radiation Chronic radiation disease of the disease of the third second degree of degree of severity. severity Acute radiation sickness of moderate degree Acute radiation sickness of light degree Acute radiation sickness of severe degree are being registered. Make up the diagnosis.