Krok 2 – 2005 (General Medicine)

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?

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?

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:

Define the basic registration document at the profound study of a case rate with temporary lost labor ability at the industrial enterprise:

A patient, aged 25, complains of pain in the I finger on the right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain gets worse. Acute pain appears on touching with the probe in ligament projection. What decease is the most likely?

A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density- 1,04 g/cm³, acidity 21⁰C, reductase probe – weak positive. What way the product is to be used in? What would you advise?

Patient  with  thyrotoxicosis  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 – 20⁰ , relative humidity 45%, air movement velocity 0.3 m/s, light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the conditions.

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

A 9 y.o. girl has an average height and harmonic growth development. She was ill with acute respiratory infection for five times. Define the group of her health.

The child is 11 m.o. He suffers from nervous-arthritic diathesis. The increased synthesis of what acid is pathogenic at nervous-arthritic diathesis?

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 52 y.o. man has recurrent transient ischemic attacks. Auscultation of the carotid arteries detects murmur. What diagnostic method is necessary to apply first?

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 Р is not changed, superimposes QRST, natural conformity between Р and QRS is not present. What kind of arrhythmia is present?

Ambulance was called to a 48 y.o. man. From the words of relatives he has had three episodes of lost consciousness and attacks during the day. On examination: the following fit is observed: patient is unconscious, fell on the floor, tonic and then clonic convuesions of trunk and extremities happened. The attack lasted for 4 minute, ended by involuntary urination. What type of attack was observed?

A 2 y.o. girl has been ill for 3 days. Today she has low–grade fever, severe catarrhal symptoms, non-abundant maculopapular rash on her buttocks and enlarged occipital glands. What is your diagnosis?

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 N₂– 6.6 mmol/L, creatinine- 406 mmol/L. Day’s 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 gastrofi-beroscopy. Your diagnosis:

A 40 y.o. patient of rheumatic heart disease complains of anorexia, weakness and loss of weigth, breathless and swelling of feet. On examination: t⁰– 39⁰C, pulse is 100/min. As ucultation: diastolic murmur in the mitral area. Petechical lesion a round clavicle; spleen was palpable, tooth extraction one month ago.

A patient with nosocomial pneumonia has signs of collapse. Which of the following pneumonia complication is the most likely to be accompanied with collapse?

A 27 y.o. man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеli-cobacter Pylori. What can be diagnosed in this case?

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

A 32 y.o. patient complains of severe weakness, tremor of extremities. On physical examination, there is loss of body weight, wet and warm skin. The thyroid gland is enlarged up to the 3^rd degree, painless, elastic. Ps- 108 bpm. BP- 160/55 mm Hg. The rest is in norm. What can be diagnosed?

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 likely cause is?

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?

7 y.o. boy with chronic sinusitis and rercurent pulmonary infections has chest X-ray demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?

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 2.9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks’ gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the most likely diagnosis?

Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level increasing up to 14 mmol/L. What is most appropriate for treatment of hyperbilirubinemia in this infant?

At term of a gestation of 40 weeks height of standing of a uterine fundus is less then assumed for the given term. The woman has given birth to the child in weight of 2500 g, a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor were fast. The cause of such state of the child were:

A 42 y.o. man died in a road accident after the haemorrhage on the site, due to acute hemorrhagic anaemia. What minimum percentage volume of the total blood loss would result in death at acute haemorrhage?

 What preparations are used for prevention of fungal infection?

What develops most often after accidental intake of Hydrochloric acid?

A woman, aged 40, primigravida, with infertility in the medical history, on the 42-43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I position, anterior positi-on. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are

30 y.o. woman, had mild trauma of 5^th finger of the left hand 15 days ago. She has treated her self at home. She presents to the hospital due to deterioration of the condition and temperature rise. Objectively: hyperemia and swelling on the ventral surface of finger. Restricted movements of the finger. X-ray of the left hand: an early stage of оsteomyolitis of the fifth finger could not be excluded. The diagnosis: panaris of 5^th finger of the left hand. What form of panaris has occurred in the patient?

A 36 y.o. patient is diagnosed with right sided pneumothorax. What method of  treatment is indicated to the patient?

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

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

A 17 y.o. patient complains of acute pain in the knee joint and t⁰– 38⁰C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain in the joints. Which diagnose is the most correct?

A 38 y.o. woman was hospitalized to the surgical unit with vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic fluid is obtained. What disease should be suspected?

The girl is 12 y.o. Yesterday she was overcooled. Now she complains on pain in suprapubic area, frequent painful urination by small portions, temperature is 37.8⁰C. Pasternatsky symptom is negati-ve. Urinalysis: protein- 0.033 g/L, WBC– 20-25 in f/vis, RBC– 1-2 in f/vis. What diagnosis is most probable?

The girl of 11 y.o. She is ill for 1 month. She has “butterflytype rash on face (spots and papules), pain and swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC: Нb– 80 g/L, RBC– 2.9×10¹²/L, WBC– 15×10⁹/L, ESR- 40 mm/hour. Uri-nalysis: protein– 0.33 g/L. What is the most probable diagnosis?

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

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

A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When should she be given maternity leave?

An infant aged 1 year on the third day of common cold at night developed inspiratory stridor, hoarse voice and barking cough. Physical examination revealed suprasternal and intercostal chest retractions. There is a bluish skin discoloration moistly seen over the upper lip. The respiratory rate is 52 per min and pulse- 122 bpm. The body temperature is 37.5⁰C. What disease does the infant have?

A newborn aged 3 days with hyper-bilirubinemia (428 mkmol/L) developed following disorders. From beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primi-tive reflexes loss are noted. Now physical examination reveals convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?

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

3 weeks ago the patient was ill with tonsillitis. Clinical examination reveals edema, arterial hypertension, hematuria, proteinuria (1.8 g/per day), granular and erythrocital casts. What is the preliminary diagnosis?

47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is hyperpigmentated. There is multiple xanthelasma palpebrae. The liver is +6 cm enlarged, hard with acute edge. The blood analysis revealed total bilirubin 160 mkmol/L, direct – 110 mkmol/L, AST (asparate aminotransferase)- 2.1 mmol/L per hour, ALT– 1.8 mmol/L, alkaline phosphotase- 4.6 mmol/L per hour, cholesterol– 9.2 mmol/L, antimi-tochondrial antibodies M2 in a high titer. What is the probable diagnosis?

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

The 67 y.o. patient had 5 recurrent fractures of the lower extremities without considerable cause within 5 years. O-shaped deformity of the legs in the knee joints has appeared. The skull, pelvis and lower extremities X-Ray shows the thickening of flat bones. In the long bones there is a hyperostosis along the bone axis.The blood test has not revealed any inflammation activity. Serum calcium is normal. What disease do you consider in this case?

The woman who has delivered twins has early postnatal hypotonic uterine bleeding reached 1.5% of her bodyweight. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP– 75/50 mm Hg. What is the further treatment?

A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the lower abdomen. She has had the last menstruation 3.5 months ago. The pulse is 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36.6⁰C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?

18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has suddenly appeared unconscious at home. The patient had no menses within last 3 months. On examination: pale skin, the pulse- 110 bpm, BP- 80/60 mm Hg. The Schyotkin’s sign is positive. Hb- 76 g/L. The vaginal examination: the uterus is a little bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct size. The posterior fornix of the vagina is tendern and overhangs inside. What is the most probable diagnosis?

A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical hospital with complains of pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?

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

A 33 y.o. patient was admitted to the reception room of the Central District Hospital. He complains of a severely painful swelling localized on posterior neck, fever up to 38.4⁰C and general weakness. In anamnesis: diabetes mellitus within 5 years. On physical examination on the posterior neck surface there is an infiltrate elevated above surrounding skin. The tissues affected by swelling are tense and blue reddish discoloration in central area. There are also several purulent necrotic pustules which are connected with each other and form a large skin necrosis. A thinned necrotic skin of this swelling has holes looking like sieve, pus discharges through out. What disease should a doctor consider first of all?

A 19 y.o. man was admitted to the reception department in 20 minutes after being wounded with the knife to the left chest. The patient is confused. The heart rate is 96 bpm and BP- 80/60 mm Hg. There are the dilated neck veins, sharply diminished apical beat and evident heart enlargement What kind of penetrative chest wound complications has developed in patient?

A 35 y.o. patient complains of a difficult swallowing, pain behind the breastbone. He can eat only liquid food. While swallowing sometimes he has attacks of cough and dyspnea. Above mentioned complaints are progressing. It is known that the patient has had a chemical burn of esophagus one month ago. What complication does the patient have?

An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?

A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?

A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation. He was discharged in the condition of clinical remission. What recommendations should the doctor give to prevent exacerbations?

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

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, joint’s pain. On examination: excited, t⁰– 39⁰ , 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?

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

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

The district pediatrician is charged with the analysis of infant mortality. What is taken for the unit of observation in infant mortality investigation?

Chief district pediatrician has to carry out analysis of infant mortality rate. What should he take as a unit of the observation?

A 43 y.o. patient complains of mass and, pain in the right breast, elevation of temperature to 37.2⁰C during 3 last months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?

A 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?

Deputy of chief medical officer carried out a study of morbidity rate for population which had been served at the polyclinics for the last 5 years. What statistical values can help in calculations of diseases level dissamination?

A 37 y.o. woman is suffering from squeezing substernal pain on physical exertion. On examination: AP- 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 child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t⁰– 38.2⁰ , facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?

There were registered 500 cases of urolithiasis per 10000 inhabitants. What kind of statictical indices is presented?

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

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

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

A 14 y.o. girl complains of profuse bloody genital discharges during 10 days after suppresion of menses for 1,5 months. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology on the internal genitalia. In blood: Нb– 70 g/L, RBC- 2.3×10¹²/L, Ht– 20. What is the most probable diagnosis?

A 14 y.o. patient suddenly fell ill when high fever, acute pain in the right shin. In two weeks X-ray showed translucent spaces (destructive focuses) with unevel countours in the middle third of tibia diaphysis. Along the bone edge there was a narrow line of shadow (periostitis) 1-2 mm from the surface. What is the most likely diagnosis?

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/(hour*L), general bilirubin – 60 mkmol/L, cholesterol – 8.0 mmol/L. What is the leading syndrome in the patient?

A 43 y.o. patient had cholecystectomy 6 years ago due to chronic calculous cholecystitis. Lately he has suffered from pain in the right subcostal area and recurrent jaundice. During last 2 weeks jaundice hasn’t gone. Stenoutic papillitis 0.5 cm in length has been revealed. What is the best way of treatment?

A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrome during first days of the disease. What is the role of angiotesin II in the pathogenesis?

On physiologic-sanitary examination of railway department work it was revealed that loaders work is of III degree of difficulty. They unload vagons with sand, manually break coagulated mass by shovel and shift it. What criteria was used to evaluate work of loaders?

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?

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

Examination of placenta, which has just been born, reveals defect 2×3 cm in size. There is no bleeding. What tactics is the most reasonable?

A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?

A district pediarician has carried out infant mortality rate analysis in his area. What data has been used?

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.

Body temperature of a 12 y.o. girl increased up to 39−40⁰C in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II degree. Nikolsky syndrome is positive. What is the most probable diagnosis?

A 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, positions near the medial part of Poupart’s ligament. The lump is situated inwards from the spermatic cord. What is the most probable preliminary diagnosis?

A 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. АP- 180/100 mm Hg. Spleen is 4 cm below the rib arch edge. What is the most probable diagnosis?

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

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

A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?

A local doctor has to prepare a report about the health condition of the population of his region. What medical indexes of population health condition should he use?

A boy, aged 9, is examined: height-127 cm (-0.36), weight – 28.2 kg (+0.96), chest circumference- 64.9 cm (+0.66), lung vital capacity – 1520 ml (-0.16). What is the integrated assessment of the child’s physical development?

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

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 36 y.o. patient was admitted to the hospital with sharp pain in substernal area following occasional swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and localized between scapulas. In a day temperature elevated, condition became worse, dysphagia intensified. What complication has developed?

A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the second day there developed jaundice. On the 3^rd day appeared changes of neurologic status: nystagmus, Graefe’s sign. Urea is yellow, feces- golden-yellow. Mother’s blood group is (II)Rh−, child-(II)Rh+. On the third day child’s Hb is 200 g/L, RBC- 6.1×10¹²/L, bilirubin in blood – 58 mk mol/L due to unconjugated bilirubin, Ht- 0.57. What is the child’s jaundice explanation?

A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?

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 19 y.o. patient was admitted to the hospital with acute destructive appendicitis. He sufferes from hemophilia B-type. What antihemophilic medicine should be inclended in pre-and post-operative treatment plan?

A 24 y.o. male patient was transferred to the chest surgery department from general surgical department with acute post-traumatic empyema of pleura. On the X-ray: wide level horizontal of fluid on the right. What method of treatment should be prescribed?

A 28 y.o. homeless male was admitted to the hospital because of initial diagnosis “influenza”. Roseolo-petechiae rash has appeared on the trunk and internal surfaces of the limbs on the fifth day. Temperature is 41⁰C, euphoria, face and sclera’s hyperemia, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?

A patient complains of intense pressing pain in the pharynx, mainly to the  right, impossibility to swallow even liquid food. The illness started 5 days ago. The patient’s condition is grave. Body temperature – 38.9⁰C, speech is difficult, voice is constrained, difficulties in opening the mouth. Submaxillary glands to the right are painful, enlarged. What is the most probable diagnosis?

In a 65 y.o. female patient a tumor 13х8 сm in size in the umbilical area and above is palpated, mild tenderness on palpation, unmovable, pulsates. On ausculation: systolic murmur. What is the most probable diagnosis?

A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?

A 18 y.o. woman consulted a gynecologist with complaints of the pain in the lower part of the abdomen, fever up to 37.5⁰C, considerable mucopurulent discharges from the genital tract, colic during urinating. After mirror and vagina examination the results are the following: the urethra is infiltrated, cervix of the uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened, free. Bacterioscopy test showed diplococcus. What diagnosis is the most probable?

A 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 child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0.45. What is the most probable 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 2 m.o. child was delivered at term with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of child.

A 2 m.o. breast-fed child suffers from cheek skin hyperemia, sporadic papulous elements on the skin of the chest and back following the apple juice introduction. The child is restless. What is the initial pediatritian’s tactics?

A 43 y.o. woman complains of severe pain in the right abdominal side irradi-ating 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?

On the 5^th day of the respiratory disease a 24 y.o. man has developed progressive headaches systemic dizziness, feeling of seeing double, paresis of mi-mic muscles on the right, choking while swallowing. Acute viral encephalitis has been diagnosed. What is the main direction of urgent therapy?

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?

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 2^nd intercostal space, S₂ 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 doctor’s tactics should be?

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 girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?

A 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?

In a forest summer camp children have variable procedures to harden their organisms. What procedure has the most hardening power?

There is a dynamic growth of number of congenital abnormalities such as central paralysis, newborns blindness, idiocy among the population that lives near to pesticides production enterprise. Compounds of which pollutant can cause the development of this pathology?

A 7 y.o. child had elevation of temperature tol 40⁰C in anamnesis. For the last 3 months he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal column. What is the most probable diagnosis?

A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick li-ps, opened mouth, hyperthelorismus) has systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the sternum left edge. The pulse on the left brachi-al artery is weakened. BP on the right arm is 110/60 mm Hg, on the left – 100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most probable?

At’s planned to construct multifield a new hospital in one of the central city districts. What building type is the most appropriate in this case?

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 occured?

A 1,5 y.o. child fell ill acutely with high temperature 38⁰C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occured in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis?

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

A 24 y.o. woman presents with prolonged fever, nocturnal sweating. She’s lost weight for 7 kg during the last 3 months. She had irregular intercourses. On examination: enlargement of all lymphaden groups, hepatolienal syndrom. In blood: WBC- 2.2×10⁹/L. What is the most likely diagnosis?

A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S₁ at apex, there is diastolic murmur with presystolic intensification, opening snap, S₂ accent at pulmonary artery. What rind of heart di-sorder is observed?

A 31 y.o. woman has suffered from systemic sclerodermia for 14 years. She was treated in hospitals many times. She complains of periodical dull pain in the cardiac area, palpitation, dyspnea, headache, eyelids swelling, weight loss, pain and limbs deformities. Which organ’s disorder worsens the prognosis?

A 70 y.o. male patient with mild headaches complains of speech di-sorder, 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, central type of hemiparesis and hemihyperesthisia on the same side. What is the most probable diagnosis?

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

A 35 y.o. male patient suffers from chronic glomerulohephritis and has been on hemodialysis for the last 3 years. He has developed irregularities in the heart activity, hypotension, progressive weakness, dyspnea. On ECG: bradycardia, 1st degree atrioventicular block, high sharpened T-waves. Before he had severely disturbed the drinking and diet regimen. What is the most likely cause of these changes?

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?

A 18 y.o. woman complains of weakness, dizziness, loss of appetite, menorrhagia. There are petechiae on the skin of the upper extremities. Blood test: Hb– 105 g/L; RBC- 3.2×10¹²/L; coloured index– 0.95; thromb.– 20×10⁹/L. The sedi-mantation 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 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of 50 sec duration. There is a appearing of the fetus head. Perineum is of 4 cm height, has turned pale. What should be done in this case?

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 40 h.o. child age has hyperosthesia, CNS depression, dyspepsia. Sepsis is suspected. What should the differential diagnosis be made with?

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 it’s 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 EchoCG: concentric hypertrophy of the left ventricle. Ultrasound examination of the kidneys reveals thinned cortical layer. Urine analysis shows proteinuria of 3.5 g/day. What is the probable diagnosis?

A 28 y.o. primagravida, pregnancy is 15-16 weeks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2.5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?

A primapara with pelvis size 25-28-31-20 cm has active labor activity. Waters poured out, clear. Fetus weight is 4500 g, the head is engaged to the small pelvis inlet. Vasten’s sign as positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?

A 41 y.o. man complains of acute pain in the right side of the thorax and sudden increase of dyspnea following the lifting of heavy object. The patient’s condition is serious: lips and mucous are cyanotic, breathing rate is 28 per min, pulse- 122 bpm., AP- 80/40 mm Hg. There is tympanitis on percussion and weakened breathing on auscultaion on the right. S₂ is accentuated over pulmonary artery. What is the urgent measure on the prehospital stage?

A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight loss for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of this disease?

A 74 y.o. female patient complains of pain, distended abdomen, nausea. She suffers from heart ichemia, post-infarction and diffusive cardiosclerosis. On examination: grave condition, distended abdomen, abdominal wall fails to take active part in breathing. On laparoscopy: some cloudy effusion, one of the bowel loops is dark-blue. What is the most probable diagnosis?

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 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is mufflet, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation, fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The small fontanelle is at the symphis. What is the further tactics of the labor?

A 31 y.o. patient has had mental disorder for a long time. He suffers from insomnia for a long time. He has developed fears, suicidal thoughts, tried to hang himself. His mood is depressed, he refuses from treatment. What measures are the most expedient for the prevention of suicide?

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 Botkin’s 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 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 ⁰C. 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 mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory viral disease before the labor. Labor in time, with prolonged period without waters. A child had erythematous eruption on the 2 day, then there were seropurulent vesicles about 1cm. Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is flabby. The temperature is subfebrile. What is the most probable diagnosis?

A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratory disorders: sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy’s type in the child?

During intramuscular DTP vaccination in clinic, a 3 m.o. child developed signs of laryngospasm, paleness of skin, cyanosis of lips, “cock cry”, stop of respiration, tension of the whole body with overturned backward head. Allergological history of the child is not complicated. What is the most probable diagnosis?

A 60 y.o. man complains of significant pain in the right eye, photophobia, lacrimation, reduced vision of this eye, headache of the right part of the head.  Pain occurred 2 days ago. On examination: Vis OD- 0.03, congested injection of the eye ball, significant cornea edema, front chamber is deep, pupil is narrow, athrophic iris, there is optic nerve excavation on the eye fundus, intraocular pressure- 38 mm Hg. Vis OS-0.8 unadjustable. The eye is calm, healthy. Intraoccular pressure- 22 mm Hg. What is the most probable diagnosis?

A 41 y.o. woman has suffered from nonspecific ulcerative colitis during 5 years. On rectoromanoscopy: marked inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous. In blood: WBC- 9.8×10⁹/L, RBC- 3.0×10¹²/L, sedimentation rate-52 mm/hour. What medication provides pathogenetic treatment of this patient?

A 49 y.o. female patient presents with acute attacks of headache associated with pulsation in temples, increasing AP to 280/140 mm Hg. Pheochromocytoma is suspected. What is the mechanism of hypertensive crisis in this patient?

To replace the blood loss replacement 1000 ml of the same group of Rhesus-compatible donated blood was transfused to the patient. The blood was conserved by sodium citrate. At the end of hemotransfusion there appeared excitement, pale skin, tachycardia, muscles cramps in the patient. What complication should be suspected?

A 20 y.o. patient suddenly felt ill 12 hours ago. There was pain in epigastric area, nausea, sporadic vomiting. He had taken alcohol before. In few hours the pain localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC- 12.2×10⁹/L. What is the most probable diagnosis?

A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toes. All types of sensitivity are preserved. No blisters. What degree of frostbite is observed?

A 24 y.o. 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 98 y.o. male patient complains of pain in the left lower limb which intensifies on walking, feeling of cold and numbness in both feet. He has been ill for 6 years. On examination: pale dry skin, hyperkeratosis. Hairy covering is poorly developed on the left shin. “Furrow symptom “is positive on the left. Pulse on foot arteries and popliteal artery isn’t palpated, on the femoral artery it’s weak. On the right limb the artery pulsation is reserved. What is the most probable diagnosis?

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 2 y.o. boy was admitted to the hospital with weight loss, unstable discharges, anorexia, following the semolina’s introduction (since 5 months). The child is adymanic, flabby, pale dry skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the upper part of the abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a lot of neutral fat. What is the cause of the disease?

On medical observation a doctor identified girl (162 cm tall and 59 kg weight) who complained loss of ability to see surrounding objects clearly in the evening. On examination: dry skin, hyperkeratosis. Her daily ration includes the following vi-tamines: vitamine А– 0.5 mg, vit. ₁– 2.0 mg, vit. ₂– 2.5 mg, vit. ₆– 2 mg, vit.С– 70 mg. What is the hypovitaminosis type?

A woman in labor, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for  inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?

A 30 y.o. patient had deep burn covering 30% of body 30 days ago. Now he presents with continued fever, loss of appetite, night sweats. Burned surface weakly granulates. What is the stage of burn disease?

A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?

A female, aged 20, after smoking notices a peculiar inebriation with the feeling of burst of energy, elation, irreality and changing of surroundings: the world gets full of bright colours, the objects change their dimensions, people’s 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?

A 29 y.o. patient was admitted to the hospital with acute girdle pain in epi-gastric area, vomiting in 1 hour after the meal. On examination: pale, acrocyanosis. Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom. What is the maximal term to make a diagnosis?

A 33 y.o. patient was admitted to the hospital with stopped recurrent peptic ulcer bleeding. On examination he is exhausted, pale. Нb– 77 g/L, Нt– 0.25. Due to anemia there were two attempts of blood transfution of identical blood group ( )Rh+. Both attempts were stopped because of anaphylactic reaction. What blood transfution environment is desirable in this case?

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

A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2.5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3.3 g/L, leucocytes cover the field of vision. What is doctor’s tactics in this case?

A 35 y.o. female patient was admitted to the surgical department with symptoms of ulcerative gastric hemorrhage. It’s been the third hemorrhage for the last 2 years. After conservative treatment vomiting with blood stopped, hemoglobin elevated from 60 till 108 g/L. General condition became better. But profuse vomiti-ng with blood reoccured in 2-3- hours. Hemoglobin decreased to 93.1 g/L then to 58.1 g/L. What is the tactics of treatment?

A victim of a road accident, aged 44, is operated on account of intraperitoneal haemorrhage. In which case can the patient’s blood from the abdominal cavity be used for autotransfusion?

A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39⁰ . Sudden onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?

A patient, aged 25, suffering from stomach ulcer. Had a course of treatment  in the gastroenterological unit. 2 weeks later developed constant pain, increasing and resistant to medication. The abdomen is painful in epigastric area, moderate defense in pyloroduodenal area. Which complication development aggravated the patient’s state?

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).

A patient aged 18 with a cranial injury was in comatose state during several hours. In post-comatose period gets tired quickly, non-productive in dialog – in the beginning answers 2-3 questions, then gets tired and can not understand the point of the question. Which psychotropic should be given to the patient to prevent psychoorganic syndrome?

A 25 y.o. patient was admitted with chest trauma. Clinical and X-ray examination have revealed tense pneumothorax on the left. What emergency treatment should be undertaken?

A 38 y.o. patient complains of pain in lumbar part of spinal column with irradiation to the back surface of the left leg following the lifting of a heavy object. Pain is increasing on change of the body position and in vertical position. positive stretching symptoms were revealed on examination. What is an initial diagnosis?

A child is being discharged from the surgical department after conservative treatment of invagination. What recommendations should doctor give to mother to prevent this disease recurrence?

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?

During dynamic investigation of a patient the increase of central venous pressure is combined with the decrease of arterial pressure. What process is proved by such combination?

A male patient complains of heartburn which gets stronger while bending the body, substernal pain during swallowing. There is a hiatus hernia on X-ray. What disorder should be expected at gastroscopy?

A 2.5 m.o. child presents with muscle hypotonia, sweating, alopecia of the back of the head. The child is prescribed massage, curative gymnastics and vitamin D. What is the dosage and frequency of vitamin D administration?

A 43 y.o. male complains of stomach pain, which relieves with defecation, and is accompanied by abdominal winds, rumbling, the feeling of incomplete evacuation or urgent need for bowel movement, constipation or diarrhea in alternation. These symptoms have lasted for over 3 months. No changes in laboratory tests. What is the most likely diagnosis?

After delivery and revision of placenta there was found the defect of placental lobe. General condition of woman is normal, uterine is firm, there is moderate bloody discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is the following necessary action?

A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?