Krok2 – 2013 Base(Therapy)

A 47 y.o. woman complains of having paroxysmal headaches for the last 5 years. The pain is one-sided, intense, localised in frontal region of head, accompanied by nausea and stomach discomfort, begins one of a sudden. Onset is usually preceded by vision reduction. Anamnesis gives evidence of periodical AP rise, but at the moment the woman doesnt take any medicines. Inbetween the onsets of headache her state is satisfactory. Objectively: high-calorie diet (body weight index – 29), AP- 170/95 mm Hg. Neurologic state has no pecularities. What is the most probable diagnosis?

A 7 y.o. boy suddenly felt pain in his right knee, it became edematic. The day before he took part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness. Objectively: body temperature is 37.5°C. The knee is painful, hot to the touch, edematic with local tissue tension over it. Blood count: Hb- 123 g/L, leukocytes – 5.6×10⁹/L, thrombocytes – 354×10⁹/L, prothrombin time – 12 seconds (normally 10-15 seconds), partly activated thromboplastin time – 72 seconds (normally 35-45 seconds). Hemorrhage time is normal, VIII:C factor is 5% of norm. What is the most probable diagnosis?

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

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

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

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

A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1.5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?

The physician must undertake measures for primary prophylaxis of iron deficiency anemia. Which of the following categories of patient are subject to such primary prophylactic measures?

A patient with unstable angina pectoris was given the following complex treatment: anticoagulants, nitrates, /alpha-adrenoblockers. However on the third day of treatment the pain still romains. Which in vestigation shoud be carried out to establish diagnosis?

The 28 y.o. woman applied to doctor because of limited loss of the hair. In the anamnesis – she had frequent headache indisposition, arthromyalgia, fever, irregular casual sexual life, drug user. RW is negative. What examination must be done first?

A 35 y.o. woman was admitted to thoracic surgery department with fever up to 40⁰C, onset of pain in the side caused by deep breathing, cough with considerable quantity of purulent sputum and blood with bad smell. What is the most likely diagnosis?

A 67 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale, damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP- 100/70 mm Hg. On ECG: heart rate- 200 bmp, ventricular complexes are widened, deformed, location of segments ST and of wave T is discordant. The wave P is not changed, superimposes QRST, natural conformity between P and QRS is not present. What kind of arrhythmia is present?

Male 30 y.o., noted growing fingers and facial scull, changed face. Complains of poor eyesight, weakness, skin darkening, loss of body weight. X-ray shows broadening of sella turcica, thinning of tuberculin sphenoidale, signs of increased intracranial pressure. What diagnosis can you make?

A patient complains of a tormental (agonizing) cough with expectoration of up to 600 ml/daily purulent chocolatecolor sputum with a decay smell. Onset of illness was abrupt, t0- 39⁰C, fever of irregular type. There is the area of darkening with a cavity in a center on X-ray film, with irregular contours and level of liquid. What disease is the question?

A 24 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is grey-pale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg. Blood level of residual N_2- 6.6 mmol/L, creatinine- 406 mmol/L. Days diuresis- 2300 ml, nocturia. Specific density of urine is 1009, albumin- 0.9 g/L, WBC- 0-2 in f/vis. RBC.- single in f/vis., hyaline casts single in specimen. Your diagnosis?

A 33 y.o. male patient was admitted to a hospital. A patient is pale, at an attempt to stand up he complains of strong dizziness. There was vomiting like coffee-grounds approximately hour ago. BP- 90/60 mm Hg., pulse- 120 b/min. In anamnesis, a patient has suffered from ulcer of the stomach, painless form during 4 years. An ulcer was exposed at gastrofiberoscopy. Your diagnosis:

A 48-year-old patient complains of heaviness in the right hypochondrium, itching of the skin.He had been treated in infectious diseases hospital repeatedly due to icterus and itch. On physical exam: meteorism, ascitis, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be diagnosed in this case?

A 25-year-old man has facial edema, moderate back pains. His temperature is 37.5⁰C, BP 180/100 mm Hg, 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 acute tonsillitis that started 2 weeks ago. What is the most probable diagnosis?

In the development of the inflammation processes glucocorticoids reduce the level of certain most important active enzyme. It results also in the reducing of the synthesis of prostaglandins and leucotrienes which have a key role in the development of inflammation processes. What is the exact name of this enzyme?

A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the first three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep.The most likelly cause is?

A 19-year-old man has suffered from moderate mental retardation since childhood. The patient is illiterate, can take care of himself, do simple household work and other kinds of easy work under supervision. What does his rehabilitation [tertiary prevention] require?

A 38 y.o. patient was urgently admitted to the hospital with complaints of sudden weakness, dizziness, loss of consciousness, body weight loss, nausea, vomiting, severe pain in epigastric area, diarrhea, skin hyperpigmentation. What is the most probable diagnosis?

An unconscious patient presents with moist skin, shallow breathing. There are signs of previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and reflexes are increased. Cramps of muscles of the extremities are seen. What is the most likely disorder?

A 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. Dermal integuments and scleras are icteric. There is hemorrhagic rash on the skin. Urine is bloody. The patient was fishing two weeks ago. What is the most likely diagnosis?

A 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain radiating to the back, accompanied by nausea, vomiting, 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 38.9°C, along with right upper quadrant tenderness. The most likely diagnosis is:

A 42-year-old woman suffers from bronchial asthma, has an acute attack of bronchial asthma. What medication from the listed below is contraindicated to render a first aid?

4 days ago a 32-year-old patient caught a cold: he presented with sore throat, fatigue. The next morning he felt worse, developed dry cough, body temperature rose up to 38.2°C, there appeared muco-purulent expectoration. Percussion revealed vesicular resonance over lungs, vesicular breathing weakened below the angle of the right scapula, fine sonorous and sibilant wheezes. What is the most likely diagnosis?

A 62-year-old patient complaining of enlargement of cervical, supraclavicular and axillary lymph nodes, subfebrile temperature for the last 3 months has been admitted to a hospital. In blood: WBCs – 64×10⁹/l, lymphocytes – 72%. What method of study should be used to specify the diagnosis?

A 38 y.o. woman complains of a purulent discharge from the left nostril. The body temperature is 37.5⁰C. The patient has been ill for a week and associates her illness with common cold. There are a pain and tenderness on palpation of her left cheek. The mucous membrane in the left nasal cavity is red and turgescent. The purulent exudate is seen in the middle meatus in maxillary. What is the most probable diagnosis?

A 40-year-old female patient has been hospitalized for attacks of asphyxia, cough with phlegm. She has a 4-year history of the disease. The first attack of asphyxia occurred during her stay in the countryside. Further attacks occurred while cleaning the room. After 3 days of inpatient treatment the patients condition has significantly improved. What is the most likely etiological factor?

The complications of acute cholecystitis which require surgical intervention are as follows EXCEPT:

A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis?

A schizophrenic patient considers himself to be “an outstanding scientist, a brilliant composer and an unrivalled artist”. He complains that “family and friends are always jealous of him and want to poison him”. Determine the psychopathological syndrome:

A 42-year-old patient complains of back pain, darkened urine, general weakness, dizziness that occurred after treating a cold with aspirin and ampicillin. Objectively: the patient is pale, with subicteric sclerae. HR – 98 bpm. Liver – +2 cm, spleen – +3 cm. In blood: RBCs – 2.6×10¹²/l, Hb – 60 g/l, CI – 0.9, WBCs – 9.4×10⁹/l, basophils – 0.5%, eosinophils – 3%, stab neutrophils – 6% segmented neutrophils – 58%, lymphocytes – 25%, monocytes – 7%, ESR – 38 mm/hour, reticulocytes – 24%. Total bilirubin – 38 millimole/l. What complication occurred in the patient?

A hospital has admitted a 52-year-old patient with disseminated pulmonary tuberculosis, complaints of acute pain in the right half of chest, that developed after going upstairs to the 3^rd floor; cough, dyspnea at rest, marked cyanosis. What kind of complication should suspected first of all?

A 38-year-old male patient has been taking alcohol for 3 years. 3 days after a regular drinking period he felt anxiety and fear. It appeared to him that he was surrounded by spiders and worms, pursued by some “condemnatory voices”. His behaviour became aggressive. The patient demonstrated correct self-awareness but impairment of temporal and spatial orientation. What is the most likely diagnosis?

A painter working at a motorcar plant has been diagnosed with moderately severe intoxication with amide compounds of benzene. The in-patient treatment resulted in a considerable health improvement. What expert decision should be made in this case?

A 16-year-old patient who has a history of intense bleedings from minor cuts and sores needs to have the roots of teeth extracted. Examination reveals an increase in volume of the right knee joint, limitation of its mobility. There are no other changes. Blood analysis shows an inclination to anaemia (Hb- 120 g/l). Before the dental intervention it is required to prevent the bleeding by means of:

A 44-year-old patient complains about difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2×3 cm large that was changing its position during the examination. What conclusion can be made?

A 7-year-old boy had complained of headache, nausea, fatigue for 3 weeks. His condition gradually deteriorated, headache and general weakness progressed. The boy had bronchitis at the age of 3. His father has a history of pulmonary tuberculosis. Objectively: body temperature 37.5°C, conscious, lies supine, with the hip and knee flexed to 90 degrees, nuchal rigidity +6 cm, partial ptosis of the right eyelid, the dilated right pupil. General hyperalgesia is present. Liquor: transparent, pressure – 400 mm of water column, protein – 1.5%, cytosis – 610/3 with predominant lymphocytes, sugar – 1.22 mmol/l, chlorides – 500 mmol/l. What is the most likely diagnosis?

A 35-year-old patient complains about pain and morning stiffness of hand joints and temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years. Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What examination should be administered?

A 69-year-old female patient complains of temperature rise up to 38.3°C, haematuria. ESR – 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?

A 47-year-old patient complains of insomnia, heaviness over his entire body, constantly depressed mood. He considers himself good-for-nothing, inadequate. Believes that he is a burden to his family, wants to die. The patient is depressed, inactive, has a hypomimic face with sorrowful expression. He speaks quietly and monotonely,gives short answers. What is the most likely diagnosis?

A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joints pain. On examination: excited, to- 39°C, Ps- 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

A 64 y.o. patient has developed of squeering substernal pain which had appeared 2 hours ago and irradiated to the left shoulder, marked weakness. On examination: pale skin, cold sweat. Pulse- 108 bpm, AP- 70/50 mm Hg, heart sound are deaf, vesicular breathing, soft abdomen, painless, varicouse vein on the left shin, ECG: synus rhythm, heart rate is 100 bmp, ST-segment is sharply elevated in II, III aVF leads. What is the most likely disorder?

A 64-year-old patient complains of severe pain in the right side of chest, dyspnea, dry cough which appeared suddenly on exertion. Objectively: the right side of the chest lags behind in the act of breathing. Percussion reveals tympanic sound. Auscultation reveals pronouncedly diminished breath sounds on the right. Ps- 100/min, weak, arrhythmic. AP- 100/50 mm Hg. Cardiac sounds are decreased. What disease can be suspected in this patient?

A 29-year-old female patient complains of dyspnea, heaviness and chest pain on the right, body temperature rise up to 37.2°C. The disease is associated with a chest trauma received 4 days ago. Objectively: skin is pale and moist. Ps- 90 bpm, regular. Palpation reveals a dull sound on the right, auscultation reveals significantly weakened vesicular breathing. In blood: RBCs – 2.8×10¹²/l, colour index – 0.9, Hb- 100 g/l, WBCs – 8.0×10⁹/l, ESR – 17 mm/h. What results of diagnostic puncture of the pleural cavity can be expected?

A 54-year-old drowned man was rescued from the water and delivered to the shore. Objectively: the man is unconscious, pale, breathing cannot be auscultated, pulse is thready. Resuscitation measures allowed to save the patient. What complications may develop in the near future?

An 18-year-old patient since childhood suffers from bleeding disorder after minor injuries. His younger brother also has bleeding disorders with occasional haemarthrosis. Which laboratory test will be informative for diagnosis verification?

A 28-year-old patient complains of periodic compressing heart pain. His brother died at the age of 34 from a cardiac disease with similar symptoms. Objectively: the patients skin is pale. Heart borders display no significant deviations. Heart sounds are loud, there is a systolic murmur above all the points with a peak above the aorta. Echocardioscopy reveals thickening of the interventricular septum in the basal parts, reduction of left ventricular cavity. What drug should be administered in order to prevent the disease progression?

A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar part of the spine on physical excertion, in cervical and thoracal part (especially when coughing), pain in the hip and knee joints on the right. On examination: the body is fixed in the forward inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis, longitudinal ligament ossification. What is the most likely diagnosis?

A worker, aged 38, working in the slate production during 15 years, complains of expiratory exertional dyspnea, dry cough. On examination: deafening of the percutory sounds in interscapular region, rough breath sounds, dry disseminated rales. On fingers skin – greyish warts. Factory’s sectorial doctor suspects asbestosis. Which method is the most informative for diagnosis verification?

A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: BP- 130/80 mm Hg, heart rate=pulse rate 72 bpm, heart boarders are dilated to the left side, aortic systolic murmur. ECG- signs of the left venticle hypertrophy. What method of examination is the most informative in this case?

A 58-year-old woman complains of osteoarthrosis of knee-joint. For 2 weeks she had been receiving an in-patient medical treatment. She was discharged from the hospital in satisfactory condition with complaints of minor pain after prolonged static work. Local hyperemia and exudative effects in the area of joints are absent. What further tactics is the most expedient?

A 42-year-old patient applied to hospital with complaints of pain behind the sternum with irradiation to the left scapula. The pain appears during significant physical work, this lasts for 5-10 minutes and is over on rest. The patient is sick for 3 weeks. What is the preliminary diagnosis?

Medical examination of a 19-year-old worker revealed generalized lymphadenopathy mainly affecting the posterior cervical, axillary and ulnar lymph nodes. There are multiple injection marks on the elbow bend skin. The man denies taking drugs, the presence of injection marks ascribes to influenza treatment. Blood count: RBCs- 3.2×10¹²/l, Hb- 100 g/l, WBCs- 3.1×10⁹/l, moderate lymphopenia. What study is required in the first place?

A 24-year-old patient felt sick in 16 hours after dried fish intake. There was nausea, vomiting, weakness, flabbiness, double vision. On physical exam, there was decrease of a muscle tone, anisocoria, flaccid swallowing and tendon reflex. What is the most probable diagnosis?

A 72-year-old patient after operation due to holecystectomia was prescribed gentamicin (80 mg every 8 hours) and cephalothin (2 g every 6 hours) due to fever. In 10 days there was an increase of creatinine up to 310mumol/L. BP – 130/80 mm Hg, daily quantity of the urine is 1200 mL. Urine tests are without pathology. Ultrasound: the size of kidneys is normal. What is the most probable reason for renal failure?

A 40 y.o. patient was admitted to the gasteroenterology with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: skin is jaundice, traces of scratches, liver is +5 cm, splin is 6×8 cm. In blood: alkaline phosphatase – 2.0 mmol/(hourL), general bilirubin – 60 mkmol/L, cholesterol – 8.0 mmol/L. What is the leading syndrome in the patient?

A 55-year-old male had been treated at the surgical department for acute lower-extremity thrombophlebitis. On the 7^th day of treatment he suddenly developed pain in the left part of chest, dyspnea and cough. Body temperature was 36.1°C, respiratory rate – 36/min. The patient was also found to have diminished breath sounds without wheezing. Ps- 140/min, thready. AP- 70/50 mm Hg. The ECG shows Q_III-S_1 syndrome. What is the most likely diagnosis?

A 26-year-old patient undergoes a course of treatment due to chronic glomerulonephritis. The treatment was successful, normalization of all the characteristics was recorded. What sanitorium and health resort treatment could be recommended?

After a wasp-bite there was an itching of skin, hoarse voice, barking cough, anxiety. On physical exam: there is edema of lips, eyelids, cyanosis. What medicine is to be taken first?

A 16-year-old adolescent was vaccinated with DTP. In eight days there was stiffness and pain in the joints, subfebrile temperature, urticarial skin eruption, enlargement of inguinal, cervical lymph nodes and spleen. What kind of allergic reaction is observed?

2 weeks after recovering from angina a 29-year-old patient noticed face edemata, weakness, decreased work performance. There was gradual progress of dyspnea, edemata of the lower extremities, lumbar spine. Objectively: pale skin, weakening of the heart sounds, anasarca. AP- 160/100 mm Hg. In urine: the relative density – 1021, protein – 5 g/l, erythrocytes – 20-30 in the field of vision, hyaline cylinders – 4-6 in the field of vision. What is the most likely diagnosis?

A 56-year-old scientist experiences constricting retrosternal pain several times a day while walking for 100-150 m. The pain lasts for up to 10 minutes and can be relieved by nitroglycerine. Objectively: the patient is overweight, heart borders exhibit no abnormalities, heart sounds are rhythmic, Ps- 78 bpm, AP- 130/80 mm Hg. ECG contains low amplitude of T wave in V_4-5. What disease might be suspected?

In autumn a 25-year-old patient developed stomach ache arising 1.5-2 hours after having meals and at night. He complains of pyrosis and constipation. The pain is getting worse after consuming spicy, salty and sour food, it can be relieved by means of soda and hot-water bag. The patient has been suffering from this disease for a year. Objectively: furred moist tongue. Abdomen palpation reveals epigastrial pain on the right, resistance of abdominal muscles in the same region. What is the most likely diagnosis?

A 51 y.o. woman complains of dull pain in the right subcostal area and epigastric area, nausea, appetite decline during 6 months. There is a history of gastric peptic ulcer. On examination: weight loss, pulse is 70 bpm, AP is 120/70 mm Hg. Diffuse tenderness and resistance of muscles on palpation.There is a hard lymphatic node 1x1cm in size over the left clavicle. What method of investigation will be the most useful?

On the 20th of June a townsman was brought to clinic. The disease broke out acutely, starting with fever, rise in temperature to 38-39⁰C. There also was weakness, acute headache, nausea, vomiting, pain all over the body, sleep disorder. On physical examination: hyperemia of skin of face, neck, thorax. Meningeal signs are positive. 12 days ago the patient returned from the Siberia, from the forest. What is the most probable diagnosis?

A 37-year-old patient has sudden acute pain in the right epigastric area after having fatty food. What method of radiological investigation is to be used on the first stage of examining the patient?

A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- 35×10⁹/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?

A 38-year-old patient is under observation having polyneuritic syndrome with considerable loss of weight, fever, rise in BP. Blood test:: considerable inflammatory changes. What examination is the most expedient to make the diagnosis?

A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR- 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?

A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1.014. Daily loss of protein with urine is 1.5 g. What drug should be chosen for treatment of arterial hypertension?

A 26 y.o. male patient with postoperative hypothyroidism take thyroxine 100 mg 2 times a day. He has developed tachycardia, sweating, irritability, sleep disorder. Determine further treatment tactics

A 28-year-old man was discharged from the hospital after having an out-of -hospital pneumonia. He has no complaints. On physical exam: his temperature is -36.6⁰C, RR-18/min, Ps – 78 bpm, BP- 120/80 mm Hg. During ausculation there is harsh respiration to the right of the lower part of the lung. Roentgenologically: infiltrative changes are absent, intensification of the pulmonary picture to the right in the lower lobe. How long should the doctor keep the patient under observation?

A 20-year-old adolescent lives in the nidus of tuberculous infection. The tuberculine Mantoux test with 2 TU was determined as hyperergic. What signs determine the hyperergic test of this adolescent?

A survey radiograph of a miner (24 years of service record, the dust concentration in the workplace is at the rate of 260-280 mg/m³ with 15% of free silica) shows lung changes that are typical for pneumoconiosis. What type of pneumoconiosis is it?

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

A 35-year-old man was operated on peptic ulcer of the stomach. Mass deficit of the body is 10 kg. The level of glucose after operation in the undiluted cellular blood on an empty stomach is 6,7 mmol. During repeated examination – 11.1 mmol (after meal), level of HbA1c – 10%. Could you please make an interpretation of the given data?

A 52 y.o. woman complains of weakness, painful itching after washing and bathing, sensation of heaviness in the head. On examination: hyperemia of skin of face, neck, extremities. BP- 180/100 mm Hg. Spleen is 4 cm below the rib arch edge. What is the most probable diagnosis?

A 37-year-old patient was brought to resuscitation unit. General condition of the patient is very severe. Sopor. The skin is grey, moist. Turgor is decreased. Pulse is rapid, intense. BP – 160/110 mm Hg, muscle tonus is increased. Hyperreflexia. There is an ammonia odor in the air. What is the presumptive diagnosis?

A 57-year-old man complains of shortness of breath, swelling on shanks, irregularity in cardiac work, pain in the left chest half with irradiation to the left scapula.Treatment is uineffective. On physical exam: hearts sounds are diminished, soft systolic murmur on the apex. Ps – 100/min, arrhythmical, BP – 115/75 mm Hg. The liver is +2 cm, painful. Roentgenoscopy: enlargement of heart shadow to all sides, pulsation is weak. Electrocardiogram (ECG): leftventricled extrasystolia, decreased voltage. What method of investigation is necessary to do to determine the diagnosis?

A 55 y.o. patient complains of distended abdomen and rumbling, increased flatulance, liguid foamy feces with sour smell following the dairy products consumption. What is the correct name of this syndrome?

A 54-year-old patient has an over 20-year history of femoral osteomyelitis. Over the last month she has developed progressing edemata of the lower extremities. Urine test reveals: proteinuria at the rate of 6.6 g/l; in blood: dysproteinemia in form of hypoalbuminemia, increase in alpha_2- and gamma-globulin rate, ESR – 50 mm/h. What is the most likely diagnosis?

In an inhabited locality there is an increase of diphtheria during the last 3 years with separate outbursts in families. What measure can effectively influence the epidemic process of diphtheria and reduce the morbidity rate to single cases?

A 14-year-old victim was drawn out of the water in winter after 15 minutes of being in the water. The victim shows no vital signs. What measures are to be taken?

An electro-gas welding operator working at a machine workshop performs welding and cutting of metal, which is accompanied by intense UV-radiation. His welding station is equipped with effective mechanical ventilation. What occupational disease is most likely to develop in an electro-gas welding operator?

A woman complains of high temperature to 38⁰C, mild pain in the throat during 3 days. On examination: angle lymphatic nodes of the jaw are 3 cm enlarged, palatinel tonsils are enlarged and coated with grey plaque which spreads to the uvula and frontal palatinel arches. What is the most probable diagnosis?

A 48-year-old male patient complains of constant pain in the upper abdomen, mostly on the left, that is getting worse after taking meals; diarrhea, weight loss. The patient is an alcohol abuser. 2 years ago he had acute pancreatitis. Blood amylase is 4 g/hcdotl. Coprogram shows steatorrhea, creatorrhea. Blood glucose is 6.0 mmol/l. What treatment is indicated for this patient?

A 60-year-old female patient had been admitted to a hospital for acute transmural infarction. An hour later the patients contition got worse. She developed progressing dyspnea, dry cough. Respiratory rate – 30/min, heart rate – 130/min, AP- 90/60 mm Hg. Heart sounds were muffled, there was also diastolic shock on the pulmonary artery. The patient presented with medium moist rales in the lower parts of lungs on the right and on the left. Body temperature – 36.4°C. What drug should be given in the first place?

A 62-year-old male has been hospitalized in the intensive care unit with a continuous attack of retrosternal pain that cannot be relieved by nitroglycerin. Objectively: AP- 80/60 mm Hg, heart rate – 106/min, breathing rate – 22/min. Heart sounds are muffled, a gallop rhythm is present. How would you explain the AP drop?

A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39.5⁰C. He had a respiratory disease 1.5 week ago. On examination: temperature- 38.5⁰C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur. What indicator is connected with possible etiology of the process?

A 30 y.o. male patient complains of itching of the skin which intensifies in the evening. He has been ill for 1.5 months. On examination: there is rash with paired papules covered with bloody crusts on the abdomen, hips, buttocks, folds between the fingers, flexor surfaces of the hand. There are traces of line scratches. What additional investigations are necessary to make diagnosis?

A 50-year-old locksmith has a long-term record of work under the effect of mercury vapors with concentration exceeding MPC by 5-10 times. Clinical examination revealed the lability of vasomotors of skin, pulse and arterial pressure; total hyperhydrosis; asymmetric innervation of facial and lingual muscles, positive subcortical reflexes, intention tremor. Against the background of increased emotional excitability the patient presents with lack of self-confidence, shyness. A dentist found him to have parodontosis, chronic stomatitis. What disease can be suspected?

4 hours after having meals a patient with signs of malnutrition and steatorrhea experiences stomach pain, especially above navel and to the left of it. Diarrheas take turns with constipation lasting up to 3-5 days. Palpation reveals moderate painfulness in the choledochopancreatic region. The amylase rate in blood is stable. X-ray reveals some calcifications located above navel. What is the most likely diagnosis?

A 58 y.o. male patient is examined by a physician and suffers from general weakness, fatigue, mild pain in the left subcostal area, sometimes frequent painful urination. Moderate splenomegaly has been revealed. Blood test: neutrophilic leukocytosis with the progress to myelocyte; basophil- 2%; eosinophil- 5%. There is a urate crystales in urine, erythrocyte- 2-3 in the field of vision. What is the preliminary diagnosis?

A 56-year-old patient with diffuse toxic goiter has ciliary arrhythmia with pulse rate of 110 bpm, arterial hypertension, AP- 165/90 mm Hg. What preparation should be administered along with mercazolil?

A 54-year-old patient complains of weakness, weight loss despite the unchanged appetite, frequent urination, skin itch for six months. Some time ago the patient underwent treatment for furunculosis. She hasn’t been examined recently. Objectively: malnutrition, dry skin with signs of scratching. Small lymph nodes can be palpated in the axillary regions. Changes in the internal organs are absent. What testing must be administered in the first place?

A 43 y.o. woman complains of severe pain in the right abdominal side irradiating in the right supraclavicular area, fever, dryness and bitterness in the mouth. There were multiple vomitings without relief. Patient relates the onset of pain to the taking of fat and fried food. Physical examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is painful during palpation and somewhat tense in right hypochondrium. What is the most likely diagnosis?

Several hours before, a 28-year-old patient suddenly developed acute headache and repeated vomiting, then lost consciousness. Objectively: focal neurological symptoms were not found. Pronounced meningeal symptoms were revealed. AP – 120/80 mm Hg. According to clinical and liquorological findings the patient was diagnosed with subarachnoid haemorrhage. After administration of dehydrants the patient’s condition somewhat improved. What is the main component of further emergency care?

A 24-year-old man on the 5^th day of acute respiratory disease with high grade temperature started having strong headaches, systemic dizziness, sensation of double vision, paresis of mimic muscles to the right, tickling by swallowing. Diagnosis: Acute viral encephalitis. Determine the basic direction of the emergent therapy

On the 5^th day of a respiratory disease accompanied by fever a 24-year-old man developed progressing headaches, systemic dizziness, double vision, facial muscles paresis on the right, choking from swallowing. He was diagnosed with acute viral encephalitis. Identify the main tendency of the emergency treatment:

A 30-year-old patient was delivered to the admission ward of the infectious disease department. The disease had started acutely on the background of normal temperature with the appearance of frequent, liquid, profuse stool without pathological impurities. Diarrhea was not accompanied by abdominal pain. 12 hours later there appeared recurrent profuse vomiting. The patient rapidly developed dehydration. What is the most likely diagnosis?

A 65 y.o. woman complains of complicated mouth opening following foot trauma 10 days ago. Next day she ate with difficulties, there were muscles tension of back, the back of the head and abdomen. On the third day there was tension of all muscle groups, generalized convulsions every 10-15 min. What is the most probable diagnosis?

Gastric juice analysis of a 42-year-old male patient revealed absence of free hydrochloric acid at all stages. Endoscopy revealed pallor, thinning of gastric mucosa, smoothed folds. Microscopically the atrophy of glands with intestinal metaplasia was found. What disease is this situation typical for?

A 45-year-old female patient complains of frequent liquid stools with a lot of mucus, pus and blood; pain across the abdomen, loss of 7 kg within 6 months. She has a 1-year history of non-specific ulcerative colitis. What group of drugs should be preferred for this patient?

A 54-year-old male patient complains of aching pain in the lumbar region, that is getting worse after standing in an upright position, physical exercise, supercooling. The patient also reports of experiencing weakness in the afternoon. Pain in the lumbar region, said about 10 years old. Objectively: pale skin, to- 37.2°C, AP- 180/100 mm Hg, minor costovertebral angle tenderness (Pasternatsky symptom). In blood: RBCs – 3.5×10¹²/l, WBCs – 6.5×10⁹/l, ESR – 22 mm/h. In urine: the relative density – 1010, leukocytes – 12-15 in the field of vision, erythrocytes – 2-3 in the field of vision. Urine bacterial count – 100000 in 1 ml. What is the most likely diagnosis?

A 67-year-old male complains of dyspnea on exertion, attacks of retrosternal pain, dizziness. He has no history of rheumatism. Objectively: pale skin, acrocyanosis. There are rales in the lower parts of lungs. There is systolic thrill in the II intercostal space on the right, coarse systolic murmur conducted to the vessels of neck. AP- 130/90 mm Hg, heart rate – 90/min, regular rhythm. The liver extends 5 cm under the edge of costal arch, shin edemata are present. Specify the assumed valvular defect:

A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Ps- 76 bpm. AP- 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?

A 51-year-old female patient complains of frequent defecation and liquid blood-streaked stools with mucus admixtures, diffuse pain in the inferolateral abdomen, 6 kg weight loss over the previous month. Objectively: body temperature – 37.4°C, malnutrition, skin is pale and dry. Abdomen is soft, sigmoid is painful and spasmodic, makes a rumbling sound. Liver is dense, painful, extends 3 cm below the costal margin. What is the most likely diagnosis?

A 18 y.o. female student complains of dyspnea during the intensive exertion. The condition became worse half a year ago. On examination: pulse rate is 88 bpm, accelerated, AP- 180/20 mm Hg, pale skin, heart borders are dilated to the left and up. There is systolic-diastolic murmur in the 2hd intercostal space, S_2 at pulmonary artery is accentuated. ECG has revealed both ventricles hypertrophy. Thoracic X-ray has revealed pulsation and protrusion of the left ventricle, lung trunk. What doctors tactics should be?

A 49-year-old male patient complains of dyspnea of combined nature, cough, shin edemata, abdomen enlargement due to ascites. He has a 20-year history of chronic bronchitis. For the last 3 years he has been disabled (group II) because of cardiac changes. Objectively: mixed cyanosis, edemata. Ps – 92/min, rhythmic, AP – 120/70 mm Hg, respiration rate – 24/min. There is accentuation of the second sound above the pulmonary artery. Auscultation reveals the box resonance above the lungs. There are also dry rales over the entire surface of lungs. What is the mechanism of heart changes development in this patient?

A 24-year-old man on the second day of the disease with a sudden onset complains of a strong headache in temples and in the area of orbits, dull pain in the body, dry painful cough. His temperature is 39⁰C. Adynamic. Mucous membrane of oropharynx is “flaming”, rales are not ausculated. What is the most probable diagnosis?

A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient observation for the increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are muffled. Blood test results: WBCs – 9.8×10⁹/l, ESR – 22 mm/h. Blood glucose – 9.8 millimole/l. What disease is the most likely cause of this crisis?

A 43-year-old female patient complains of unstable defecation with frequent constipations, abdominal swelling, headache, sleep disturbance. Body weight is unchanged. What disease are these clinical presentations typical for?

A 43-year-old man who often contacts with ethyl gasoline was admitted to a hospital with complaints of general weakness, dizziness, memory impairment, sleepiness at daytime and insomnia at night, sensation of a hair in the mouth, colicky pains in the right subcostal region. What is the most likely diagnosis?

A 35-year-old patient has been in the intensive care unit for acute renal failure due to crush for 4 days. Objectively: the patient is inadequate. Breathing rate – 32/min. Over the last 3 hours individual moist rales can be auscultated in lungs. ECG shows high T waves, right ventricular extrasystoles. CVP – 159 mm Hg. In blood: the residual nitrogen – 62 millimole/l, K+- 7.1 millimole/l, Cl– 78 millimole/l, Na+- 120 millimole/l, Ht – 0.32, Hb – 100 g/l, blood creatinine – 0.9 millimole/l. The most appropriate method of treatment would be:

A 45-year-old man was brought to clinic with complaints of the pain that started suddenly in the left chest part and epigastric area, shortness of breath, nausea, one-time vomiting. The acute pain started after weight-lifting. On physical exam: shallow breathing, RR – 38/min, left chest part is behind during respiration, by percussion – tympanitic sound, respiration is not ausculated. Ps – 110 bpm, of weak filling. BP – 100/60 mm Hg, insignificant displacement of heart to the right, sounds are dull. What examination is the most expedient to do first?

A 35 y.o. woman is suspected of aplastic anemia. The bone marrow punction has been administered with the diagnostic purpose. What changes in the marrow punctatum are suggested?

A 47-year-old woman underwent a thyroid gland resection on account of nodular euthyroid goiter. What preparations are most likely to prevent the disease recurrence?

A 55 y.o. male patient complains of weakness during 2 months, pain in the right side of the thorax, cough, blood-streaked sputum. On X-ray: intensive triangle shadow in the area of lower lobe that is connected to mediastinum. What is the most likely disorder in the lungs?

A 60 y.o. patient experiences acute air insufficiency following of the venoectomy due to subcutaneous vein thrombophlebitis 3 days ago. Skin became cianotic, with grey shade. Marked psychomotor excitement, tachypnea, substernal pain. What postoperative complication has occurred?

A 19-year-old woman complains of pain in the abdomen and joints, asks for more analgetics and somnifacient injections. The patient was examined. Gynecological and urological pathologies are absent. There are signs of previous punctures along superficial veins of the extremities. The patient does not explain the origin of punctures. Tendon reflexes of upper and lower extremities are the same, quick. Photoreaction of the pupil of the eye is weak. The tongue is grey coated. During communication the patient in affectively not even-tempered. There is diarrhea without pathologic inclusions. What tactics is necessary to improve the condition of this patient?

A patient has an over a year-old history of fast progressive rheumatoid arthritis. X-raying confirms presence of marginal erosions. What basic drug would be the most appropriate in this case?

A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S_1 at apex, there is diastolic murmur with presystolic intensification, opening snap, S_2 accent at pulmonary artery. What rind of heart disorder is observed?

A 23-year-old patient complains of a dull ache, sensation of heaviness and distention in the epigastrium immediately after meals, foul-smelling eructation; dry mouth, empty stomach nausea, diarrhea. Objectively: the skin is pale, the patient is of thin build. Abdomen is soft on palpation, there is epigastric pain. The liver does not extend beyond the costal arch. In blood: Hb – 110 g/l, RBCs – 3.4×10¹²/l, WBC count is normal. ESR – 16 mm/h. What is the most informative study that will allow make a diagnosis?

A 49-year-old patient complains of deglutition problems, especially with solid food, hiccups, voice hoarseness, nausea, regurgitation, significant weight loss (15 kg within 2.5 months). Objectively: body weight is reduced. Skin is pale and dry. In lungs: vesicular breathing, heart sounds are loud enough, heart activity is rhythmic. The abdomen is soft, painless on palpation. Liver is not enlarged. What study is required to make a diagnosis?

A 60-year-old patient has been admitted to a hospital with complaints of dyspnea, tightness in the right subcostal area, abdomen enlargement. These presentations have been progressing for a year. Heart auscultation reveals presystolic gallop rhythm. Objectively: swelling of the neck veins, ascites, palpable liver and spleen. What disease requires differential diagnostics?

A 40-year-old patient, the forester, complains of severe headache, body temperature rise up to 39.5°C, trembling limbs. From the patients history we know that he had seriously cut his hand during the dissection of a killed fox. Objectively: depressed mood. The patient asks not to turn on the light or open the door. Any noise causes apparent motor excitation. When he saw a carafe of water, he developed convulsive throat spasms. What tactics should an emergency doctor choose?

A 28-year-old woman has a 12-year history of chronic glomerulonephritis with latent course. Over the past six months she has developed general weakness, loss of appetite, low work performance, nausea. The patient complains of headache, pain in the joints. On examination: anemia, blood urea – 34.5 millimole/l, blood creatinine – 0.766 millimole/l, hyperkalemia. What complication has developed?

A 70 y.o. male patient with mild headaches complains of speech disorder, weakness in right limbs. There was a history of miocardial infarction and arrhythmia. On nu eroligical examination there are elements of motor aphasia, central paresis of VII and XII cranial nerves pairs on the right side, cental type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

After treating a field with pesticides a machine operator presents with great weakness, headache, nausea, vomiting, diarrhea, visual impairment, watery eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle fibrillation of tongue and eyelids are oberved. Pupils are narrowed, there is tachycardia, lung auscultation reveals moist small and medium bubbling rales. In blood: changed level of cholinesterase activity. What is the most likely diagnosis?

A 40-year-old man is ill with autoimmune hepatitis. Blood test: A/G ratio 0.8, bilirubin – 42 mumol/L, transaminase : ALT- 2.3 mmol g/L, AST – 1.8 mmol g/L. What is the most effective means in treatment from the given below?

A farmer hurt his right foot during working in a field and came to the emergency station. He doesn’t remember when he got last vaccination and he has never served in the army. Examination of his right foot revealed a contaminated wound up to 5-6 cm long with uneven edges. The further treatment tactics will be:

A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to 38°C. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood: WBCs – 9.5×10⁹/l, ESR – 40 mm/h, CRP – 1.5 millimole/l, fibrinogen – 4.8 g/l, uric acid – 0.28 millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely diagnosis?

A 20 daily y.o. female patient is suffering from chronic bronchitis. Recently there has been production about 0.5 L of purulent sputum with maximum discharge in the morning. Fingers are like “drum sticks”, there are “watching glass” nails. What is the most probable diagnosis?

Topographic percussion of lungs in a patient who got a serious job-related barotrauma revealed that the lower lungs borders were located one rib below normal, there was a significant increase in both lungs height and Kronigs isthmus. What disease should be suspected in the first place?

An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are many-coloured petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/l; RBC- 3.2×10¹²/L; C.I.- 0.95; thromb.- 20×10⁹/L. The sedimentation time according to Lee White is 5; hemorrhagia duration according to Duke is 8, “pinch and tourniquet” test is positive. What is the most probable diagnosis?

A 28 y.o. male patient was admitted to the hospital because of high temperature 39⁰C, headache, generalized fatigue, constipation, sleep disorder for 9 days. There are sporadic roseolas on the abdomen, pulse- 78 bpm, liver is enlarged for 2 cm. What is the most probable diagnosis?

A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3^rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis – 13.1×10⁹/l, ESR- 28 mm/h. What is the most likely diagnosis?

A 20 y.o. patient with bronchial asthma experiences dyspnea attacks 3-4 times a week. Nocturnal attacks are 1 time a week. FEV1- 50% of necessary figures, during the day its variations is 25%. What is the severity of bronchial asthma condition?

A 40 y.o. man complains of headache in occipital area. On physical examination: the skin is pale; face and hand edema, BP- 170/130 mm Hg. On Ech°CG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3.5 g/day. What is the probable diagnosis?

After a serious nervous stress a 35-year-old patient has developed on the dorsal surface of hands redness and swelling that were later replaced by small inflammatory nodules, vesicles and following erosion with a significant serous discharge. The process is accompanied by severe itching. What is the most likely diagnosis?

A 36-year-old patient complains of skin rash that appeared a week ago and doesnt cause any subjective problems. Objectively: palm and sole skin is covered with multiple lenticular disseminated papules not raised above the skin level. The papules are reddish, dense on palpation and covered with keratinous squamae. What is the provisional diagnosis?

In the morning a patient had nausea, abdominal discomfort, single vomiting, dry mouth. In the evening, the patient presented with the increasing general weakness, double vision, difficult swallowing of solid food. Objectively: ptosis, mydriasis, anisocoria, absence of gag and pharyngeal reflex, dry mucous membranes. The previous evening the patient had dinner with canned food and alcohol. What is the presumptive diagnosis?

A 30-year-old patient complains of paroxysmal abdominal pain, frequent liquid stools up to 10 times a day. Throughout the first 3 days he had a fever, since the 2^nd day of disease there were scant liquid stools mixed with mucus. On palpation: tenderness of all colon segments. Sigmoid colon was found spastic. What is your provisional diagnosis?

A 38-year-old woman experiences episodic increases in arterial pressure up to 240/120 mm Hg, which is accompanied by nausea, vomiting, tachycardia, increased sweating, hyperglycemia. The attack is usually followed by the excessive urination. Renal sonography reveals an additional formation adjacent to the upper pole of the right kidney and possibly belonging to the adrenal gland. What laboratory test will allow to clarify the diagnosis?

A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of legs and feet skin. Ps – 80/min, AP – 210/100 mm Hg. In blood: eosinophilia at the rate of 15%. What disease can be suspected in this case?

A 46-year-old patient complains of sudden palpitation, which is accompanied by pulsation in the neck and head, fear, nausea. The palpitation lasts for 15-20 minutes and is over after straining when holding her breath. What kind of cardiac disorder may be suspected?

A 5-grade pupil complains about extensive skin rash accompanied by intensive itch, especially at night. Objectively: there are small red papules set mostly in pairs in the region of interdigital folds on both hands, on the flexor surface of radicarpal articulations, abdomen and buttock skin as well as internal surface of thighs. In the centre of some papules vesicles or serohaemorrhagic crusts can be seen. There are multiple excoriations. What is the most likely diagnosis?

A welder at work got the first-degree burns of the middle third of his right shin. 5 days later the skin around the burn became edematic and itchy. Objectively: on a background of a well-defined erythema there is polymorphic rash in form of papules, vesicles, pustules, erosions with serous discharge. What is the most likely diagnosis?

A 58-year-old patient has a 3-year history diabetes mellitus type II. He has been keeping to a diet and regularly taking glyburide. He has been delivered to a hospital on an emergency basis for acute abdomen. Objectively: the patient is of supernutrition type. The skin is dry. In the lungs vesicular breathing can be auscultated. Heart sounds are regular, 90/min. AP- 130/70 mm Hg. The symptom of “wooden belly” is visible. Blood sugar – 9.8 millimole/l. The patients has indication for laparotomy. What is the most appropriate way of further treatment of diabetes?

A 56 y.o. man, who has taken alcoholic drinks regularly for 20 years, complains of intensive girdle pain in the abdomen. Profuse nonformed stool 2-3- times a day has appeared for the last 2 years, loss of weight for 8 kg for 2 years. On examination: abdomen is soft, painless. Blood amylase – 12g/L. Feces examination-neutral fat 15 g per day, starch grains. What is the most reasonable treatment at this stage?

A 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38°C. The disease is acute. Objectively: there is an edema on the right leg skin in the region of foot, a well-defined bright red spot in form of flame tips which feels hot. There are isolated vesicles in focus. What is your provisional diagnosis?

A 45-year-old patient complains of some painless nodular elements tending to peripheral growth and fusion. He has a 2-year history of this disease. Aggravation takes place mainly in spring. In anamnesis: the patients father had similar skin lesions. Objectively: pathological elements looke like guttate and nummular nodules, plaques covered with white scales. What is your provisional diagnosis?

A 47-year-old patient came to see a doctor on the 7^th day of disease. The disease developed very fast: after the chill body temperature rose up to 40°C and lasted up to 7 hours, then it dropped abruptly, which caused profuse sweat. There were three such attacks occuring once in two days. Two days ago the patient arrived from Africa. Objectively: pale skin, subicteric sclera, significantly enlarged liver and spleen. What is the cause of fever attacks in this disease?

On the 2^nd day of illness a 27-year-old patient complains of unbearable headache, repeated vomiting. Objectively: the patient is in a grave condition. He is conscious but adynamic. Lies in a forced position with his head thrown back. There is no skin rash. Nuchal muscles are evidently rigid, there are Kernigs and Brudzinskis signs. to- 39.5°C, Ps- 120/min, AP- 130/80 mm Hg. The leading syndrome of this disease is caused by:

A 43 y.o. woman complains of shooting heart pain, dyspnea, irregularities in the heart activity, progressive fatigue during 3 weeks. She had acute respiratory disease a month ago. On examination: AP- 120/80 mm Hg, heart rate 98 bpm, heart boarders +1.5 cm left side, sounds are muffled, soft systolic murmur at apex and Botkins area; sporadic extrasystoles. Liver isn’t palpated, there are no edema. Blood test: WBC- 6.7×10⁹/L, sedimentation rate- 21 mm/hour. What is the most probable diagnosis?

A 37-year-old woman is sick with bronchial asthma for 15 years. Recenlty asthmatic attacks occur 4-5 times per week, night attacks -2-3 times per month. To stop attacks, the patient takes salbutamol. On physical exam: condition is relatively satisfactory. RR – 20/min, Ps is 76 bpm, BP – 120/80 mm Hg. Respiration in lungs is vesicular. Cardiac sounds are muted, rhythm is normal. What medication should be prescribed to prevent attacks of bronchial asthma on the first stage?

A 52 y.o. male patient has become ill gradually. There is pain in the left side of the thorax during 2 weeks, elevation of temperature till 38-39°C. On examination: left chest side falls behind in breathing movement no voice tremor over the left lung. Dullness that is more intensive in lower parts of this lung. Right heart border is deviated outside. Sharply weakened breathing over the left lung, no rales. Heart sounds are mufflet, tachycardia. What is the most probable diagnosis?

A 50-year-old patient was hospitalized in severe condition with complaints of chills, high grade temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP – 80/40 mm Hg. What first aid is necessary for the patient?

A 42-year-old female patient suffers from micronodular cryptogenic cirrhosis. Over the last week her condition has deteriorated: she developed convulsions, mental confusion, progressing jaundice. What study may give reasons for such aggravation?

A patient has chronic heart failure of the II stage. He takes furosemide regularly three times a week. He had developed bronchopneumonia and had been administered combined pharmacotherapy. On the fifth day of therapy the patient complained of hearing impairment. What drug coadministered with furosemide might have caused the hearing loss?

A 37-year-old woman complains of generalized fatigue, irritability, dysphagia, chalk hunger. On physical exam: t- 36.5⁰C, respirations – 20/min, Ps – 96 bpm, BP – 110/70 mm Hg. Satisfactory nourishment. The skin and visible mucous membranes are pale. Blood test: Hb -70g/L, erythrocytes – 3.4×10¹²/L, CI – 0.7, reticulocytes – 2%, leucocytes – 4.7×10⁹/L, eosinophilis. – 2%, band neutrophils – 3%, segmented neutrophils – 64%, lymphocytes – 26%, monocytes – 5%, ESR – 15 mm/min. Serum ferrum – 7.3 mumol/L, total protein – 70g/L. Deficit of what factor caused the development of the disease?

A 28-year-old patient has been hospitalized for the pain in the epigastric region. He has a 10-year history of duodenal ulcer (DU). Recently, the pain character has changed: it became permanent, persistent, irradiating to the back. There are general weakness, dizziness, fatigue. The patient has put off weight. Objectively: HR- 68/min, AP- 120/80 mm Hg. What is most likely cause of deterioration?

A 57-year-old male patient complains of dyspnea on exertion, heaviness in the right hypochondrium and shin edemata towards evening. Objectively: temperature – 38.1°C, HR- 20/min, HR=Ps=92/min, AP- 140/90 mm Hg. There is apparent kyphoscoliosis. In the lungs single dry rales can be auscultated. Heart sounds are muffled, rhythmic. ECG: Rv1+Sv5=15 mm. X-ray picture shows the bulging of pulmonary artery cone, right ventricle enlargement. What is the most likely cause of this condition?

A 24-year-old emotionally-labile woman presents with irritation, depressed mood, palpitation, shooting pain in the heart area, generalized fatigue following the divorce. On examination: palm hyperhydrosis, pulse rate- 72-78 bpm, labile, heart without changes. ECG is normal. What is the most probable pathology in this case?

A 30-year-old woman with a long history of chronic pyelonephritis complains about considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP- 200/120 mm Hg. In blood: creatinine – 0.62 millimole/l, hypoproteinemia, albumines – 32 g/l, potassium – 6.8 millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?

A patient had macrofocal myocardial infarction. He is overweight for 36%, AP is 150/90 mm Hg, blood sugar- 5,9 mmol/L, general cholesterol- 4.9 mmol/L, uric acid- 0.211 mmol/L. Which risk factor should be urgently eradicated during the secondary prevention?

A 36-year-old female patient complains of bruises on the body, gingival haemorrhage, general weakness. A month ago she had a severe domestic poisoning with some pesticide (the patient can not remember the name). She has a 7-year record of working in contact with petroleum products, particularly benzene. In blood: RBCs – 3.2×10¹²/l, WBCs – 2.7×10⁹/l, thrombocytes – 70×10⁹/l. What is the most likely pathology?

While staying in a stuffy room a 19-year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are cold. AP- 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological signs. What is the most likely diagnosis?

A patient complains of frequent, bulky, frothy stools with greenish mucus, cramping pain in the umbilical region, abdominal murmur, body temperature at the rate of 39°C. The patient associates the disease with consumption of soft-boiled eggs. What is the most likely pathogen?

A 40-year-old female patient complains of headache, dizziness, muscle weakness, occasional cramps in the extremities. She has been taking antihypertensive medications for 10 years. AP- 180/100 mm Hg. Blood potassium – 1.8 millimole/l, sodium – 4.8 millimole/l. In urine: alkaline reaction, the relative density – 1012, protein and sugar are not found, WBCs – 3-4 in the field of vision, RBCs – 1-2 in the field of vision. Conns syndrome is suspected. Which drug should be chosen for the treatment of arterial hypertension?

An 18-year-old patient presents no problems. Percussion reveals that heart borders are displaced to the right and left by 1 cm, there is a coarse systolic murmur with its epicenter within the 4^th intercostal space on the left. What is the most informative examination to confirm the clinical diagnosis?

A 56-year-old patient complains of having persistent chest pain on the right for the last 2 months. The pain is not associated with respiration. He also complains of cough with blood-streaked sputum, weakness, decreased performance, fatigue. Chest radiograph shows a globular shade of 4×6 cm connected to the root of the lung in the lower part of the right lung. What is the most likely diagnosis?

A 18-year-old patient had subtotal strumectomy due to malignant capillary cystadenoma of the thyroid gland. In 2 months there was a suspicion of metastasis presence in the lungs. What rontgenological method is to be used first?

A 58-year-old patient was diagnosed basal-cell skin cancer, 1st stage. Tumor is up to 1 cm in size and with up to 0.5 cm deep infiltration in tissues. Tumor is localized in the right nasolabial area. Choose the most optimal method of treatment

A 27-year-old patient complains of nasal haemorrhages, multiple bruises on the anterior surface of the trunk and extremities, sudden weakness. In blood: Hb- 74 g/l, reticulocytes – 16%, RBCs – 2.5×10¹²/l, platelets – 30×10⁹/l, ESR- 25 mm/h. What is the most effective measure for the treatment of thrombocytopenia?

2 days ago a patient presented with acute pain in the left half of chest, general weakness, fever and headache. Objectively: between the 4 and 5 rib on the left the skin is erythematous, there are multiple groups of vesicles 2-4 mm in diameter filled with transparent liquid. What disease are these symptoms typical for?

A woman while working in vegetable garden developed severe pain in the loin. Lasagues and Nery tension signs are obviously marked on the right. Lumbar lordosis is smoothed, movements are harshly restrained in lumbar part of the spine. Right ankle (Achilles) reflex is absent. What kind of disease can it be?

After lifting a load a patient felt undurable pain in the loin. He was diagnosed with acute lumbosacral radiculitis. Which of the following is contraindicated for this patient?

An unconscious 35-year-old patient has been delivered by an ambulance to the intensive care unit. Objectively: the patient is in semicoma. Moderate mydriasis is present. The reaction of pupils to light is reduced. The reaction to verbal instructions is missing. AP is 150/100 mm Hg, there is tachycardia. Blood contains methanol. What antidote should be administered?

A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, peoples faces get cartoon features, loss of time and space judgement. What is the most likely diagnosis?

A 75 y.o patient can not tell the month, date and season of the year. After long deliberations she manages to tell her name. She is in irritable and dissatisfied mood. She always carries a bundle with belongings with her, hides a parcel with bread, shoes in her underwear in her bosom as well as “invaluable books”. What is the most probable diagnosis?

While lifting a heavy load a 39-year-old patient suddenly felt a severe headache, pain in the interscapular region, and started vomiting. Objectively: the pulse is rhythmic, 60/min, AP- 180/100 mm Hg. The patient is agitated. He presents with photophobia, hyperacusis. There are positive Kernigs and Brudzinskis signs on both sides. In blood: WBCs – 10×10⁹/l. CSF is bloody, cytosis is 240/3. What is the most likely diagnosis?

A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: to- 37.3°C, respiration rate – 19/min, heart rate = Ps- 92/min; AP- 120/80 mm Hg. Vesicular respiration. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and can be still heard after cough. ECG showed no pathological changes. What is the most likely diagnosis?

A 45-year-old patient, a sailor, was hospitalized on the 2^nd day of the disease. A week ago he returned from India. Complains of body temperature of 41°C, severe headache, dyspnea, cough with frothy rusty sputum. Objectively: the patient is pale, mucous membranes are cyanotic, breathing rate is 24/min, tachycardia is present. In lungs: diminished breath sounds, moist rales over both lungs, crepitation. What is the most likely diagnosis?

HIV displays the highest tropism towards the following blood cells:

A 25-year-old patient complains of general weakness, dry cough, sweating, subfebrile temperature. Objectively: lung auscultation reveals vesicular resiration with no wheezing. Fluorogram shows focal shadows of high intensity in the 1-2 segments of the right lung. Mantoux test gave a reaction of 16 mm of induration. What clinical form of tuberculosis is most likely?

A 22-year-old patient is a clerk. His working day runs in a conditioned room. In summer he was taken by an acute disease with the following symptoms: fever, dyspnea, dry cough, pleural pain, myalgia, arthralgia. Objectively: moist rales on the right, pleural friction rub. X-ray picture showed infiltration of the inferior lobe. In blood: WBC – 11cdot109/l, stab neutrophils – 6%, segmented neutrophils – 70%, lymphocytes – 8%, ESR – 42 mm/h. What is the ethiological factor of pneumonia?

A 53-year-old female patient complains of cardiac pain and rhythm intermissions. She has experienced these presentations since childhood. The patients father had a history of cardiac arrhythmias. Objectively: the patient is in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG results: heart rate – 215/min, extension and deformation of QRS complex accompanied by atrioventricular dissociation; positive P wave. Some time later heart rate reduced down to 45/min, there was a complete dissociation of P wave and QRST complex. Which of the following will be the most effective treatment?

A 49-year-old patient complains of dyspnea, cough. There are no sputum discharges. He has repeatedly used salbutamol and intal but with no effect. Objectively: he is only able to sit while leaning on the table. Cyanosis of face, acrocyanosis are present. Breathing is shallow, laboured, in some parts it cannot be auscultated; there are diffuse rales, expiration is significantly prolonged. Heart sounds are muffled, tachycardia is present. Ps – 112/min, AP- 110/70 mm Hg. Liver is located near the costal arch. There are no peripheral edemata. What is your provisional diagnosis?

Thrombosis of the coronary artery caused myocardial infarction. What mechanisms of injury will be the dominating ones in this disease?

A female patient consulted a dermatologist about the rash on the trunk and extremities. Objectively: interdigital folds, flexor surfaces of wrists and navel region are affected with pairs of nodulo-cystic eruptions and crusts. The rash is accompanied by skin itch that is getting stronger at night. What external treatment should be administered?

A 54 y.o. male patient suffers from dyspnea during mild physical exertion, cough with sputum which is excreted with difficulty. On examination: diffuse cyanosis. Is Barrel-chest. Weakened vesicular breathing with prolonged expiration and dry whistling rales. AP is 140/80 mm Hg, pulse is 92 bpm, rhythmic. Spirography: vital capacity (VC)/predicted vital capacity- 65%, FEV1/FVC– 50%. Determine the type of respiratory insufficiency (RI)

An ambulance had been called to a 48-year-old man. According to his relatives, the patient had had three attacks of unconsciousness accompanied by convulsions within 24 hours. On examination the doctor witnessed the following attack: the patient lost consciousness and fell to the floor, developed tonic, then clonic convulsions of trunk and extremities. The attack lasted 1 minute and ended with involuntary urination. Specify the kind of attack:

A patient is 60 years old, retired, worked as deputy director of a research institute. Behavioural changes appeared 2 years ago after the death of her husband: she stopped looking after herself and leaving the house; then she refused to clean the apartment and cook. Mental status: temporal disorientation. The patient does not understand many of the questions, is confused; does not know how to cook soup or fasten a button. Her speech is characterized by stumbling and logoclonia. She does not recognize doctors, fellow patients. She cries a lot but can not explain the reason for tears. What is the mechanism of this pathology?

A 26-year-old patient has abused alcohol since the age of 16, needs a morning-after drink to cure hangover. He takes alcohol nearly every day, “a little at a time”. Twice a week he gets severely drunk. The patient works as a motor mechanic, over the last 2 years work conflicts have become more frequent. What medical and tactical actions should be taken in this case?

A 26-year-old patient with left lower lobe pneumonia experiences an acute chest pain on the left during coughing. Objectively: diffuse cyanosis, extension of the left side of chest. Percussion reveals high tympanitis. Auscultation reveals no respiratory murmurs above the left side of chest. There is a deviation of the right cardiac border towards the midclavicular line. What examination will be the most informative?

A male patient presents with swollen ankles, face, eyelids, elevated AP- 160/100 mm Hg, pulse- 54 bpm, daily loss of albumine with urine- 4g. What therapy is pathogenetic in this case?