Krok 2 – 2012 (General Medicine)

Routine examination of a child with a history of bronchial asthma reveals AP of 140/90 mm Hg. The most likely cause of the hypertension is:

Head of a department and a trade-union group have appealed to the head of a hospital about dismissal of the senior nurse who has 17 year record of service. The facts of charge were confirmed and recognized by the nurse herself. This nurse lives with a daughter (who is divorced and unemployed) and a 9-month-old grandson. Make an administrative decision:

Purulent mediastinitis is diagnosed at a 63-year-old patient. What diseases from the stated below CANNOT cause the purulent mediastinitis?

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

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 neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd day of life, then it became more acute. The adynamia, vomiting and hepatomegaly were observed. Indirect bilirubin level was 275µmol/L, direct bilirubin level – 5µmol/L, Hb- 150 g/l. Mother’s blood group – 0(I), Rh⁺, child’s blood group – A(II), Rh⁺. What is the most probable diagnosis?

An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?

A neonate is 5 days old. What vaccination dose of BCG vaccine (in mg) is necessary for vaccination of this child?

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^oC , along with right upper quadrant tenderness. The most likely diagnosis is:

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^oC , 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 45-year-old woman, mother of four children, comes to the emergency room complaining of a sudden onset of the epigastric and right upper quadrant pain, radiating to the back, accompanied by vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data shows leukocytosis, normal serum levels of amylase, lipase, and bilirubin. The most likely diagnosis is:

During an operation for presumed appendicitis the appendix was found to be normal; however, the terminal ileum is evidently thickened and feels rubbery, its serosa is covered with grayish-white exudate, and several loops of apparently normal small intestine are adherent to it. The most likely diagnosis is:

A girl is 12-year-old. Yesterday she was overcooled. Now she is complaining on pain in suprapubic area, frequent painful urination by small portions, temperature is 37.8^oC . Pasternatsky symptom is negative. Urine analysis: protein – 0.033 g/L, WBC- 20-25 in f/vis, RBC- 1-2 in f/vis. What diagnosis is the most probable?

A woman, primagravida, consults a gynecologist on 05.03.2012. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2012. When should she be given maternity leave?

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 patient’s condition has significantly improved. What is the most likely etiological factor?

A 3-year-old child has been admitted to a hospital because of ostealgia and body temperature rise up to 39^oC . Objectively: the patient is in grave condition, unable to stand for ostealgia, there is apparent intoxication, lymph nodesare enlarged up to 1.5 cm. Liver can be palpated 3 cm below the costal margin, spleen – 2 cm below the costal margin. In blood: RBCs – 3.0×10¹²/l, Hb- 87 g/l, colour index – 0.9, thrombocytes – 190×10⁹/l, WBCs – 3.2×10⁹/l, eosinophils – 1, stab neutrophils – 1, segmented neutrophils – 0, lymphocytes – 87, monocytes – 2, ESR – 36 mm/h. What examination should be conducted in order to specify the di-agnosis?

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 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?

An emergency team has delivered to a hospital an unconscious patient found lying in the street in winter. Objectively: the patient is pale, with superficial respiration; bradycardia with heartrate 54/min, t^o– 35^oC . AP- 100/60 mm Hg. Palpation of chest and abdomen revealed no peritoneal symptoms. There is a smell of alcohol from the patient’s mouth. What is the most likely diagnosis?

A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP-200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?

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 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, t^o– 39^oC , Ps- 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?

A 29-year-old female patient complains of dyspnea, heaviness and chest pain on the right, body temperature rise up to 37^oC . 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?

A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an in-patient hospital. He was diagnosed with progressing vegetative insufficiency. This disease relates to the following group of ionizing radiation effects:

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

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

A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37.6^oC . Sonography revealed that bi-le bladder was 5.5х2.7 cm large, its wall – 0.4 cm, choledochus – 0.8 cm in diameter. Anterior liver segment contains a roundi-sh hypoechoic formation up to 5 cm in diameter and another two up to 1.5 cm each, walls of these formations are up to 0.3 cm thick. What is the most likely diagnosis?

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^oC , 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 -S₁ syndrome. What is the most likely diagnosis?

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?

A  56-year-old  scientist  experiences constricting retrosternal pain several ti-mes 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 V₄₋₅. 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 consumi-ng 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 secundipara has regular birth activity. Three years ago she had cesarean section for the reason of acute intrauterine hypoxia. During parodynia she complains of extended pain in the area of postsurgical scar. Objectively: fetus pulse is rhythmic – 140 bpm. Vaginal examination shows 5 cm cervical dilatation. Fetal bladder is intact. What is the tactics of choice?

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 anti-gen. 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?

At the radiological unit of a hospital gamma-devices of radiotherapy of “Agat”type and other closed sources of ionizing radiation are used for treatment of malignant neoplasms. What measures are to be taken to protect personnel during working with radioactive sources of such type?

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 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is to be prescribed to provide first aid?

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: heart’s 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 27-year-old woman presents at the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She hasn’t get pregnant. On examination: genital development is without pathology, uterine tubes are passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is the infertility cause?

To study physical development of children and adolescents, anthropometric studies are widely used. Choose a physiometric method of study from the below given.

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 60-year-old female patient had been admitted to a hospital for acute transmural infarction. An hour later the patient’s 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 di-astolic shock on the pulmonary artery. The patient presented with medium moi-st rales in the lower parts of lungs on the right and on the left. Body temperature – 36.4^oC . What drug should be given in the first place?

A 65-year-old patient complains of gradual worsening of the left eye vision during 10 months. On physical examinati-on: acuty of vision of the left eye is 0.01, not correctable. The eye is quiet, pupil of the eye is grayish, reflex from the eye-ground is absent. Intraocular pressure is 18 mm/Hg. What is the most probable preliminary diagnosis?

A patient is on the sick leave for 4 months continuously from the date of injury. The treatment is going to last for 1-2 months. Who has the right to extend the duration of medical certificate for this patient?

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- 200 g/L, RBC- 6.1×10¹²/L, bilirubin in blood – 58 mk mol/L due to unconjugated bili-rubin, Ht- 0.57. What is the child’s jaundi-ce explanation?

On the 4^th day after recovering from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient’s condition is moderately severe. Respiratory rate – 28-30/min, Ps- 96 bpm, AP- 110/70 mm Hg. Respiration above the left lung is vesicular, weak above the right lung. There are moist rales of different types above the lower lobe and amphoric breath near the angle of scapula. What is the most likely diagnosis?

A 25-year-old 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 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 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 absenr. What testing must be administered in the first place?

A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to 39^oC , headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?

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.

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 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 complai-ns of dizziness and heart pain irradiati-ng to the left nipple. Pain is not associ-ated 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 norma, 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^oC , 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 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient monitoring 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 weakened. In blood: 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 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 pathologi-es 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 1.5-year-old child fell ill acutely with high temperature 38^oC , 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?

Development of chronic venous insufficiency of lower extremities depends on the functional condition of so-called musculovenous pump. This term refers to the following group of muscles:

A 7-year-old child was brought to a doctor for a check. The child has a 4-year history of bronchial asthma, asthma attacks occur mainly in spring and summer. Allergy tests revealed hypersensitivity to poplar seed tufts, field herbs. What recommendation should be given?

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 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?

In morgue there are dead bodies with the following causes of death: electrotrauma; rupture of the spleen with acute anemia. There is one unknown person; one ethyl alcohol poisoned person and one drowned man. What dead body should the blood group be determined for?

A 36-year-old patient complains of skin rash that appeared a week ago and doesn’t 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 palpati-on and covered with keratinous squamae. What is the provisional diagnosis?

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 43-year-old female patiet complains of eruption on her right leg skin, pain, weakness, body temperature rise up to 38^oC . 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 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 to 40^oC and lasted up to 7 hours, then 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 the 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. Occipital muscles are evidently rigid, there are Kernig’s and Brudzinski’s signs. t^o– 39.5^oC , Ps-120/min., AP- 130/80 mm Hg. What is the reason for the leading syndrome of this disease?

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 54-year-old female patient has been admitted to a hospital 12 days after the beginning of acute pancreatitis. Objectively: the patient is in grave condition. The body temperature is hectic. Ps – 112 bpm. The abdomen is swollen. Epigastrium palpation reveals a very painful infiltration falling in the localization of pancreas. Abdominal cavity contains fluid. There is an edema of the left lumbar region. In blood: WBCs – 18×10⁹/l. What is the required tactics of the patient’s treatment?

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 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 hi-story 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 milli-mole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?

A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She has been observing these symptoms for about a month. Objectively: no pathology of internal organs was revealed. What laboratory analysis should be carried out in the first place?

A 36-year-old female patient complai-ns 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?

A 6-year-old child complains of frequent liquid stool and vomiting. On the 2^nd day of desease the child presented with inertness, temperature rise up to 38.2^oC , Ps- 150 bpm, scaphoid abdomen, palpatory painful sigmoid colon, defecation 10 times a day with liquid, scarce stool with mucus and streaks of green. What is a provisional diagnosis?

A 68-year-old patient consulted a doctor about a tumour in her left mammary gland. Objectively: in the upper internal quadrant of the left mammary gland there is a neoplasm up to 2.5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?

A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from these presentations for about half a year. Prostate volume is 45 cm³ (there are hypoechogenic nodes in both lobes, capsule invasion). The rate of prostate-specific antigen is 60 ng/l. Prostate biopsy revealed an adenocarcinoma. Which of the supplemental examination methods will allow to determine the stage of neoplastic process in this patient?

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 impaired far vision. Previously his eyes often turned red and hurt. Objectively: the eyes are not irritated, the cornea is transparent, anterior chambers are median deep, their moisture is transparent. The iris of the right eye has not changed in colour, its pattern is unchanged. The pupil is of irregular shape, scalloped. Biomicroscopy of the crystalline lens reveals the areas of opacity and vacuoles. Make a diagnosis:

A 26-year-old patient complains of experiencing pain in the right hand for 4 days. The pain arose at the site of corns on the palmar surface at the base of the II and III fingers. Some time later the dorsum of hand became edematic. I and III fingers are half-bent in the interphalangeal joints, the hand looks like “rake”. What is the most likely diagnosis?

A 40-year-old female patient complain of headache, dizziness, muscle weakness, sometimes – 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. Conn’s 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 30-year-old 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 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?

A woman while working in vegetable garden developed severe pain in the loin. Lasague’s 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 36-year-old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?

A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: t^o– 37.3^oC , 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?

Educational rooms are illuminated with various lighting fittings. What type of lighting fittings is the most appropriate in respect of hygienic norms?

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 – 11×10⁹/l, stab neutrophils – 6%, segmented neutrophils – 70%, lymphocytes – 8%, ESR – 42 mm/h. What is the ethiological factor of pneumonia?

A 53-year-old woman complained of cardiac pain and rhythm intermissions. She had experienced these presentations since childhood. The patient’s father had a history of cardiac arrhythmias. Objectively: the patient was in grave condition, Ps- 220 bpm, AP- 80/60 mm Hg. ECG: heart rate – 215/min, widening 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?

A 42-year-old patient with acute haemorrhage and class III blood loss underwent blood transfusion and got 1.8 l of preserved blood and erythromass of the same group and Rh. After the transfusion the patient complained of unpleasant retrosternal sensations, his arterial pressure dropped to 100/60 mm Hg, there appeared convulsions. Blood serum calcium was at the rate of 1.7 milli-mole/liter. What is the mechanism of this complication development?

A 27-year-old patient with a knife stomach wound has been delivered to a hospital 4 hours after injury. Objectively: the patient is in grave condition. Ps- 120 bpm, weak. AP- 70/40 mm Hg. Laparotomy revealed a lot of liquid blood in the abdominal cavity. The patient has been found to have bleeding from the mesenteric vessels of the small intestine. Damage to hollow organs has not been revealed. What is the best way to restore the blood loss?

A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?

The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of popultaion. What statistic method should be chosen?

On the  tenth  day  after  discharge from the maternity house a 2-year-old patient consulted a doctor about body temperature rise up to 39^oC , pain in the right breast. Objectively: the mammary gland is enlarged, there is a hyperemized area in the upper external quadrant, in the same place there is an ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful. What is the most likely diagnosis?

During the dynamic observation over a parturient woman in the second stage of labor it was registered that the fetal heart rate fell down to 90-100/min and didn’t come to normal after contractions. Vaginal examination revealed the complete cervical dilatation, the fetal head filling the entire posterior surface of the pubic symphysis and sacral hollow; the sagittal suture lied in the anteroposterior diameter of the pelvic outlet, the posterior fontanelle was in front under the pubic arch. What plan for further labour management should be recommended?

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?

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-year-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 stopped 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?

An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate – 40/min, jugular pulse is present. Ps- 185 bpm, of poor volume. AP- 75/40 mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed. At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:

A 1-month-old child became restless and presented with an increase in head sweating. It’s known from the history that the child has been fed with cow’s milk since birth (September 5). Examination revealed craniotabes. A doctor administered a course of UV radiation. Decide, if the child needs ergocalciferol:

Two hours ago a 38-year-old patient got pain in his right shin. He was diagnosed with popliteal artery embolism, acute arterial insufficiency of grade I. What is the most appropriate therapeutic tactics?

A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On examination the skin is intensely red, elastic, with preserved turgor. Puerile respiration is present. Respiration rate – 40/min, cardiac sounds are rhythmic, sonorous. HR- 138/min. The abdomen is soft. The liver extends 2 cm below the costal margin. Diuresis is sufficient. Stool is in form of meconium. What is the most likely diagnosis?

A 47-year-old female patient complains of leg heaviness, fatigue when  standing and walking. This feeling disappears when she takes a horizontal position. Objectively: dilatation of the superficial veins of the left shin and thigh with pigmentation and trophic skin disorders. What functional test should the examination be started with?

A 28-year-old patient complains of discomfort, acute pain in the lower third of the left labia majora. The disease began suddenly after menstruation. Objectively: body temperature is 38^oC . The left labia majora has a formation to 3 cm diameter, with hyperemic surface, extremely painful to the touch, with symptoms of fluctuation. What is the most likely diagnosis?

A 40 week pregnant secundipara is 28 years old. Contractions are very active. Retraction ring is at the level of navel, the uterus is hypertonic, in form of hourglass. On auscultation the fetal heart sounds are dull, heart rate is 100/min. AP of the parturient woman is 130/80 mm Hg. What is the most likely diagnosis?

A neonatologist examining a full-term mature baby revealed the shortening and external rotation of the newborn’s lower extremity. Clinical examination revealed positive Ortolani sign, symptom of non-vanishing pulse, additional skin folds on the internal surface of thigh. What is the most likely 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 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38^oC , he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?

An emergency situation at a chemical plant caused acute occupational intoxication. A doctor who revealed the case of “acute occupational disease (intoxication)”must notify the following authority:

A 42-year-old builder consulted a doctor about a foot injury with a nail that he got in the morning of the same day. The wound was washed with water. Three years ago he was vaccinated against tetanus. Examination established satisfactory condition of the patient. The left foot was slightly edematic, there was a stab wound on the sole. In order to prevent tetanus it is primarily required to:

A 6-year-old child has duodenal ulcer. What antibacterial drug should be co-administered together with metronidazole and De-Nol in order to eradicate Heli-cobacter pylori infection?

Against the background of angina a patient has developed pain in tubular bones. Examination revealed generalized enlargement of lymph nodes, hepatolienal syndrome, sternalgia. In blood: RBCs – 3.6×10¹²/l, Hb- 87 g/l, thrombocytes – 45×10⁹/l, WBCs – 13×10⁹/l, blasts – 87%, stab neutrophils – 1%, segmented neutrophils – 7%, lymphocytes – 5%, ESR -55 mm/h. What is the most likely diagnosis?

A 51-year-old patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2.5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?

A 25-year-old female patient complains about having amenorrhea for 3 years. She associate it with difficult labour complicated by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective examination reveals no pathological changes of uterus and its appendages. What is the disease pathogenesis?

Hygienic expertise of a sample taken from the batch of grain revealed 2% of grains infected with microscopic Fusarium fungi. On the ground of laboratory analyses this batch of grain should be:

Among the inhabitants of a workmen’s settlement located near an industrial plant the cases of nervous and endocrine system diseases as well as renal diseases became more frequent. Blood analyses revealed a decrease in sulfhydryl groups. These pathologies might have been caused by the following substance released into the environment:

It is required to analyze the level of daylight illumination in a ward of therapeutics unit. What device should be applied to estimate the level of daylight illumination?

During the medical examination at school the schoolchildren had to undergo plantography. After the analysis of footprints platypodia was found in 30% of pupils. What is the percentage of the flatfoot isthmus?

A factory’s sectorial doctor selects a group of persons who often fall ill for thorough monitoring. At the same time he takes into consideration the number of etiologically related cases with temporary disability in each of the employees over the last year. An employee falls into this group if the number of sickness cases is:

Half an hour ago a 67-year-old patient with a hernia picked up a heavy object, which caused acute pain in the region of hernia protrusion, the hernia couldn’t be reduced. Objectively: the hernia in the right inguinal region is roundish, tight, moderately painful; during palpation it was reduced back to the cavity, the pain was gone. Specify the further medical tactics:

Production areas of a greenhouse complex have the following microclimate parameters: air temperature – 42^oC , humidity – 98%, air velocity- 0.05 mps, temperature of enclosing surfaces – 15^oC . Characterize the microclimate of production areas:

A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?

Sanitary-veterinary examination of a cow carcass revealed measle contaminati-on (2-3 measles per 10 cm²). What tactics should be chosen in respect of this meat consumption?

A 28-year-old female patient complains of having haemorrhage from the genital tracts for 1 month. 6 months ago she had natural delivery and gave birth to a girl weighing 3100 g. Objectively: the uterus is enlarged to 9-10 weeks, mobile, painless, of heterogenous consistency. Examination reveals vaginal cyanosis, anaemia and body temperature rise up to 37.8^oC . There is a significant increase in hCG concentration in the urine. What is your provisional diagnosis?

The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be the most informative for the analysis of this data?

A 43-year-old male patient undergoing treatment for peptic ulcer complains of weakness, dizziness, coffee-ground vomiting, melena. After administration of haemostatics the patient’s condition has not improved, fresh blood has shown up in the vomit, skin bruises of different sizes have appeared. In blood: thrombocytes – 50×10 ⁹/l, Lee-White clotting time – 35 minutes, APTT – 80 seconds. In this case it is most rational to administer the following preparation:

A girl of 3 months presents with rhinitis, dyspnea, dry cough. These manifestations has been observed for two days. Objectively: the child has pale skin, acrocyanosis, shallow respiration at the rate of 80/min. Percussion reveals handbox resonance over the whole surface of lungs, there are a lot of fine rales. What is the most likely diagnosis?

A 30-year-old patient has been admitted to the intensive care unit for multiple bee stings. The skin is covered with cold sweat. The pulse is felt just on the carotid arteries, 110 bpm, respiration is 24/min, rhythmic, weakened. Which drug should be given in the first place?

A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia, constipations. The patient’s face is masklike, solid edema of hands is present. The heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude protein – 85/l, γ-globulines – 25%. What is the most likely diagnosis?

A 45-year-old man has been exhibiting high activity for the last 2 weeks, he became talkative, euphoric, had little sleep, claimed being able “to save the humanity”and solve the problem of cancer and AIDS, gave money the starangers. What is the most likely diagnosis?

After  the  pneumatic  dilatation  of oesophageal stricture a patient developed acute retrosternal pain getting worse when throwing the head back and swallowing. Objectively: dilatation of the neck veins, dropped beat pulse, signs of purulent intoxication, oliguria, emphysema of the upper portion of chest. What disease can be suspected?

A 32-year-old patient consulted a doctor about being enable to get pregnant for 5-6 years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal examination and USI the patient was diagnosed with endometrioid cyst of the right ovary. What is the optimal treatment method?

The objective of a statistical study was to find out the extent of seeking medical care by the population. For this purpose 300 residents of the area were interviewed. Information was collected by means of a special questionnaire. What method of collecting information was used by researchers?

An 8-month-old baby has had problems with nasal breathing and muco-purulent discharge from the nose for a week. Examination reveals a rhinedema, muco-purulent discharges from the middle nasal meatus as well as on the back of pharynx. What disease are these symptoms most typical for?

A city’s population is 400000 inhabitants in 2005 there were registered 5600 deaths, including 3300 cases caused by cardiovascular diseases, 730 – by tumours. Which of the following indicators allows to characterize the share of the circulatory system diseases as the cause of death in the city?

It is planned to organize a rural outpatient clinic. The patients will be able to visit the doctors of the following specialities:

A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?

In a rural health district a child died in the first month of life. In order to analyze this situation it was necessary to complete expert evaluation of medical records. Which medical document was analyzed in the first place?

The head of prenatal care department intends to complete expert evaluation of compliance with medical and technological standards of pregnancy follow-up. What documents must be verified for this purpose?

Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:

A 35-year-old patient complains of heartburn, sour eructation, burning, compressing retrosternal pain and pain along the esophagus rising during forward bending of body. The patient hasn’t been examined, takes Almagel on his own initiative, claims to feel better after its taking. Make a provisional diagnosis:

All the joints on the left elbow of a newborn are extended, the whole arm hangs vertically along the trunk with the forearm pronated. Active movements in the elbow joint are absent but present in the shoulder joint. The hand is flattened, atrophied, cold to the touch, hangs passively. Grasp reflex and hand-mouth reflex on the affected side are missing. Haemogram values are normal. What is the most likely diagnosis?

Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel is 2×2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in respect of its volume and composition. Muscle tonus is within norm. What is the most likely diagnosis?

A 35-year-old victim of a road accident has got an injury of the right side of his chest. Objectively: respiration rate – 28-30/min, respiration is shallow, restricted respiratory excursion and acrocyanosis are present. Ps-110 bpm, AP- 90/60 mm Hg. Respiratory sounds over the right lung cannot be auscultated. Chest radiograph shows fractures of the VI-VII ribs on the right, the right pleural cavity contains both air and fluid, with the fluid at about the level of the V rib, the shadow of the mediastinum is displaced to the left. What first aid should be provided to the victim?

A 20-year-old patient complains of pain in the left lumbar region, arterial pressure rise up to 160/110 mm Hg. USI revealed that the structure and size of the right kidney were within age norms, there were signs of 3 degree hydronephrotic transformation of the left kidney. Doppler examination revealed an additional artery running to the lower pole of the kidney. Excretory urogram shows a narrowing in the region of ureteropelvic junction. Specify the therapeutic tactics:

A hospital admitted a patient with coarse breathing (obstructed inspiration), skin cyanosis, tachycardia and arterial hypertension. He has a history of bronchial asthma. An hour ago he was having salbutamol inhalation and forgot to remove a cap that was aspired while taking a deep breath. What measures should the doctor take?

A patient undergoing treatment for the left-sided destructive pneumonia presents with deterioration of his general condition, progressing dyspnea, cyanosis. Objectively: the left side of chest is not involved in respiration, breathing sounds cannot be auscultated. Radiograph shows a shadow reaching the 5 rib with a horizontal fluid level and a radiolucency above it, the mediastinum is displaced to the right. What is the medical tactics?

A 10 week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen, bloody discharges from the genital tracts. The problems turned up after ARVI. The woman was registered for antenatal care. Speculum examination revealed cyanosis of vaginal mucosa, clean cervix, open cervical canal discharging blood and blood clots; the lower pole of the gestational sac was visible. What tactics should be chosen?

A 29-year-old patient complains of absent menstruation for a year, milk discharge from the nipples when pressed, loss of lateral visual fields. X-ray shows an expansion of the sella turcica. What is the most likely cause of this condition?

On the second day after preventive vaccination a 2-year-old boy presented with abdominal pain without clear localization, body temperature rose up to 38^oC . On the third day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and around the joints. Knee joints were edematic and slightly painful. Examination of other organs and systems revealed no pathological changes. What is the most likely diagnosis?

A patient with uterine fibromyoma sized up to 8-9 weeks of pregnancy consulted a gynaecologist about acute pain in the lower abdomen. Examination revealed pronounced positive symptoms of peritoneal irritation, high leukocytosis. Vaginal examination revealed that the uterus was enlarged up to 9 weeks of pregnancy due to the fibromatous nodes, one of which was mobile and extremely painful. Appendages were not palpable. Discharges were mucous, coming in moderate amounts. What is the treatment tactics?

On the 6^th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput, neck and buttocks. General condition of the child is normal. What disease should be suspected?

A 3-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient’s condition is satisfactory, in the region of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray picture shows brachial bone destruction with sequestra. What complication arose in the postoperative period?

A 40-year-old female patient complains of having a bulge on the anterior surface of neck for 5 years. Objectively: Ps- 72 bpm, arterial pressure – 110/70 mm Hg, in the right lobe of thyroid gland palpation reveals a mobile 4×2 cm node, the left lobe is not palpable, the basal metabolic rate is 6%. What is the most likely diagnosis?

A 14-year-old patient with signs of internal haemorrhage has been taken to a hospital after a fight. He has had haemophilia A since childhood. He has been diagnosed with retroperitoneal hematoma. What should be administered in the first place?

A patient is 14 years old. Cytochemical study of punctate revealed 40% of blasts, there was negative reaction to peroxidase and with Sudan black, positive reaction to glycogen. Specify the form of acute leukemia:

A 58-year-old patient complains of a headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2^nd aortic sound is accentuated. AP- 240/120 mm Hg, HR-92/min. Auscultation reveals some fine moisr rales in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?

A 59-year-old male patient with essential hypertension of stage II is registered with the dispensary department of a polyclinic. The patient regularly takes ACE inhibitors and calcium antagonists. How often should a therapeutist examine this patient (except for exacerbation periods)?

A 37-year-old patient complains of pain in the lumbar spine that is getting stronger during walking; restricted mobility, edema of the right side of abdomen. He has a history of focal tuberculosis. X-ray picture shows the destruction of the adjacent surfaces of the 1-2 vertebral bodies of the lumbar spine, vertebral body height is decreased, intervertebral foramen is undetectable. Abdominal ultrasound reveals a 15×20 cm formation in the retroperitoneal space, there are echo signals of fluid presence. What is the most likely diagnosis?

The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents with anxiety, acrocyanosis, peripheral edemata, dyspnea. Auscultation of lungs reveals fine moist rales on both sides mainly in the lower parts. AP- 65/40 mm Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole). Liver is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of examination is most informative for assessing the child’s status dynamics?

Forensic medical expertise of corpse of a newborn revealed: body weight 3500 g, body length 50 cm, the umbilical cord was smooth, moist, glossy, without any signs of drying. Hydrostatic tests were positive. The test results are the evidence of:

A 60-year-old patient complains of nearly permanent sensation of heaviness and fullness in the epigastrium, that increases after eating, foul-smelling eructation, occasional vomiting with food consumed 1-2 days ago, weight loss. 12 years ago he was found to have an ulcer of pyloric channel. The patient has taken ranitidine for periodic hunger pain. The patient’s condition has been deteriorati-ng over the last 3 months. Objectively: splashing sound in the epigastrium is present. What kind of complication is it?

A hospital admitted an 11-year-old boy diagnosed with medium-severe asthma, exacerbation period. In order to arrest the attacks the boy was administered broncholytic nebulizer therapy. During the day the child’s condition stabilized. What is the most appropriate method for further monitoring of respiratory function in this patient?

A full-term newborn was born with body weight of 4000 g, body length of 57 cm. Reaction to the postnatal check was absent. There was diffuse cyanosis, heart rate of 80/min. What resuscitation measures should be taken?

A 52-year-old patient works as a secretary and has 30 year record of service. She complains of spasms in her right hand during working and inability to type and write. Up to 80% of her work involves hand load. The patient has been presenting with these symptoms for 2 years. Objectively: the right hand is tense, there is an increase in muscle tone, attempts to write cause spasms. Examination revealed no pathological changes of CNS. What is the most likely diagnosis?

A multigravida with Rh-isosensitization was found to have a decrease in anti-Rh titer from 1:32 to 1:8 at 33-34 weeks of gestation. Ultrasound revealed double contour of head, ebnlargement of fetal liver, placental thickness of 50 mm. The patient has indication for:

A 22-year-old vegetarian patient with signs of malnutrition consulted a doctor about smell and taste distortion, angular stomatitis. Objectively: marked blue sclerae. The patient was diagnosed with iron deficiency anemia. What is the dominating clinical syndrome?

A patient complains of retrosternal pain, difficult swallowing, over 10 kg weight loss within three months, general weakness. In blood: hypochromic anaemia, neutrophilic leukocytosis. In feces: weakly positive Gregersen’s reaction. On esophagram a filling defect with ill-defined serrated edges shows up along a large portion of the esophagus. What is the most likely diagnosis?

A 27-year-old patient complains of irritability, tearfulness, depression, and sometimes aggressiveness, headache, nausea, vomiting, swelling of the mammary glands. The mentioned problems arise 5-6 days before menstruation and gradually progress until menstruation, 3 days after it the problems disappear. What is the most likely diagnosis?

A 2-year-old child in a satisfactory condition periodically presents with moderate proteinuria, microhematuria. USI results: the left kidney is undetectable, the right one is enlarged, there are signs of double pyelocaliceal system. What study is required to specify the diagnosis?

An emergency doctor has diagnosed a 32-year-old woman with generalized convulsive status epilepticus. The deterioration in the patient’s condition is caused by a sudden gap in the epilepsy treatment. Specify the doctor’s further tactics:

A 75-year-old male patient complains of slight pain in the right iliac region. The abdominal pain arose 6 days ago and was accompanied by nausea. Surgical examination revealed moist tongue, Ps- 76 bpm. AP- 130/80 mm Hg. Abdomen was soft, slightly painful in the right iliac region on deep palpation, the symptoms of the peritoneum irritation were doubtful. In blood: RBCs – 4.0×10¹²/l, Hb- 135 g/l, WBCs – 9.5×10⁹/l, stab neutrophils – 5%, segmentonuclear – 52%, lymphocytes – 38%, monocytes – 5%, ESR – 20 mm/h. Specify the doctor’s further tactics:

A 56-year-old patient was undergoing a surgery for suture repair of perforated ulcer. During the operation the cardiomonitor registered ventricular fibrillation. The first-priority measure should be:

On the 10th day postpartum a puerperant woman complains of pain and heaviness in the left mammary gland. Body temperature is 38.8^oC , Ps- 94 bpm. The left mammary gland is edematic, the supero-external quadrant of skin is hyperemic. Fluctuation symptom is absent. The nipples discharge drops of milk when pressed. What is a doctor’s further tactics?

A 30-year-old female patient complains of milk discharge from the mammary glands, 5-month absence of menstruation. She had one physiological labour four years ago. Objectively: mammary glands are normally developed. Bimanual examination reveals that the uterus is decreased in size, the ovaries are of normal size. MRI-scan shows no cerebral pathologies. Concentration of thyroid-stimulating hormone is normal.The serum prolactin level is increased. What is the most likely diagnosis?

During self-examination a 22-year-old patient revealed a mammary tumour. Palpation revealed a firm, painless, freely mobile formation up to 2 cm, peripheral lymph nodes were not changed. USI results: in the superior external quadrant of the right mammary gland there was a big formation of increased echogenicity, sized 18×17 mm. The patient was provisionally diagnosed with fibroadenoma. What is a doctor’s further tactics?

A 42-year-old female lives in the basement, is unemployed, undernourished. She complains of having general weakness, hair loss, brittle nails for six months, likes to eat chalk. Objectively: the patient is emaciated, pale, has dry skin. Peripheral lymph nodes are not enlarged. Liver is +1.5 cm. In blood: RBCs – 1.8×10¹²/l, Hb- 62 g/l, colour index – 0.78, reticulocytes – 0.5^o/_oo, ESR- 18 mm/h. Leukogram exhibits no pathology. What is a provisional diagnosis?

A 78-year-old patient complains of severe pain in the lower abdomen, perineum and rectum; intense urge to urinate and inability to urinate without assistance. Abdomen palpation reveals a moderately painful globular formation above the pubis, there is percussion dullness over the formation. What is the most likely diagnosis?

A 3-year-old child with ARVI had been administered biseptol, paracetamol, nazoferon. On the third day of treatment the baby’s condition deteriorated: he developed sore throat, stomatitis, conjunctivitis, hypersalivation, painful dark red spots on the neck, face, chest and legs, then the spots were replaced with vesicles. Examination revealed lesions of mucous membranes around the mouth and anus. What is your provisional diagnosis?

Preventive examination of a 50-year-old woman revealed a dense tumour of the right mammary gland up to 5 cm in diameter without distinct outlines. The skin over the tumour looked like lemon peel. Palpation revealed a lymph node in the axillary region. What is the most likely diagnosis?

A 20-year-old patient complains of breath shortness, continuous dull heart pain, irritability. Objectively: general condition is satisfactory, the pulse is labile, AP- 130/60 mm Hg. ECG shows repolarization disorder. The patient has been diagnosed with cardiac-type neurocirculatory dystonia. The patient should receive treatment under the following conditions:

A 38-year-old male works within the range of ionizing radiation. At a routine medical examination he presents no problems. In blood: RBCs – 4.5×10¹²/l, Hb-80 g/l, WBCs – 2.8×10⁹/l, thrombocytes – 30×10⁹/l. Decide if this person can work with sources of ionizing radiation:

A patient who undergoes treatment at a tuberculosis clinic has complained of having progressing headache for the last 3 weeks. Neurological examination reveals rigidity of occipital muscles, no focal symptoms. What is your provisional diagnosis?

A patient with chronic suppurative otitis has developed severe headache, vomiting, body temperature rise. The meningeal symptoms are present. There are no focal neurological symptoms. The further tactics of a doctor should be:

A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the symptoms of chronic tonsillitis, mitral insufficiency, carious teeth. What is the optimal method of secondary prophylaxis?

Routine examination of a 16-year-old boy revealed the presence of three heart sounds on auscultation. The third sound is low and occurs in early diastole, there is no additional murmur. In history: pneumonia six months ago. The patient presents no problems. Examination revealed hyposthenia, underdevelopment of muscles. Laboratory and instrumental studies revealed no peculiarities. What is the origin of the additional heart sound?

A patient’s condition is getting worse towards evening: she becomes excited, complains of “internal anxiety”, “a weight on her heart”, foreboding of evil – “something evil will happen to me or my family”. The patient is sad, melancholic, has poor appetite and sleep disorders. Specify the kind of mental disorder: